title: Clinicopathologic factors influence accurate endosonographic assessment for early gastric cancer.
abstract: OBJECTIVE
  EUS has become a valuable tool for the selection of patients who are suitable for EMR of early gastric cancer (EGC). The aim of this study was to evaluate the various clinicopathologic factors affecting the diagnostic accuracy of EUS in EGC.
  
  
  METHODS
  A retrospective, single-center study.
  
  
  METHODS
  A total of 206 patients suspected of EGC endoscopically who underwent EUS examination and curative treatment for EGC at Severance Hospital, Seoul, Korea, from October 2001 to May 2005 were included.
  
  
  METHODS
  We reviewed the medical records of 206 patients and compared preoperative EUS staging with final histopathologic staging of the resected specimen according to the clinicopathologic parameters.
  
  
  RESULTS
  The diagnostic accuracy of EUS for predicting tumor invasion depth was significantly affected by the histopathologic differentiation and the size of tumor. The differentiated cell types were associated with higher diagnostic accuracy in predicting the tumor invasion. Lesions located in the mid one third of the stomach larger than 3 cm had significantly higher probability of overstaging. Poorly differentiated histologic diagnosis had a significantly higher probability of understaging. There was no significant factor associated with the endosonographic prediction of lymph node metastasis.
  
  
  CONCLUSIONS
  EGC with undifferentiated histopathologic features or large tumor size is more frequently associated with an incorrect diagnosis in tumor invasion depth by EUS. EGC with a size larger than 3 cm and poorly differentiated histologic diagnosis should be cautiously considered in the decision on treatment modality by pretreatment EUS staging.
authors.affiliation: Department of Internal Medicine, Institute of Gastroentorology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jie-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Kee Sup
authors.initials: KS
authors.lastname: Song
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Youn
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.forename: Si Young
authors.initials: SY
authors.lastname: Song
authors.forename: Jae Bock
authors.initials: JB
authors.lastname: Chung
mesh_terms: D003951:Diagnostic Errors; D019160:Endosonography / Q000592:standards*; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D009361:Neoplasm Invasiveness / Q000175:diagnosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology