title: Ulcerous change decreases the accuracy of endoscopic ultrasonography diagnosis for the invasive depth of early gastric cancer.
abstract: BACKGROUND
  With the development of endoscopic submucosal dissection, an expansion of the criteria for local treatment was suggested for lesions with ulcerous changes or undifferentiated-type adenocarcinoma.
  
  
  OBJECTIVE
  To determine the efficacy of endoscopic ultrasonography for such lesions, we retrospectively analyzed factors that influenced accurate diagnosis by endoscopic ultrasonography of the depth of tumor invasion.
  
  
  METHODS
  We investigated 267 gastric adenocarcinomas for which histopathological results were obtained by endoscopic mucosal resection or gastrectomy. The lesions were divided into four groups by histological type and the presence of ulcerous changes. Five clinicopathological factors were assessed for their possible associations with incorrect diagnosis.
  
  
  RESULTS
  The positive predictive value (PPV) for cancer limited within the mucosa (endoscopic ultrasonography, EUS-M) and cancer invaded into the submucosal layer (EUS-SM) were 88.0% (125 of 142 lesions) and 60.0% (30 of 50 lesions), respectively. The lesions diagnosed as EUS-M/SM borderline (37 lesions) included 19 lesions (51.4%) of M cancer and 17 lesions (45.9%) of SM cancer. In logistic analysis, ulcerous changes (p < 0.0001) and macroscopic classification (p = 0.0284) were factors that caused incorrect diagnosis by endoscopic ultrasonography. In the group having differentiated-type adenocarcinoma with ulcerous changes, the PPV of EUS-SM was 25% (3 of 12), and there was a significant difference (p < 0.05) between the EUS-SM of this group and that of the differentiated-type adenocarcinoma without ulcerous changes.
  
  
  CONCLUSIONS
  The accuracy of endoscopic ultrasonography tumor staging was not sufficient for the lesions with ulcerous changes in our study. Therefore, we should be careful to perform endoscopic submucosal dissection for lesions with ulcerous changes.
authors: Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
authors: K
authors: K
authors: Akashi
authors: H
authors: H
authors: Yanai
authors: J
authors: J
authors: Nishikawa
authors: M
authors: M
authors: Satake
authors: Y
authors: Y
authors: Fukagawa
authors: T
authors: T
authors: Okamoto
authors: I
authors: I
authors: Sakaida
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D019160:Endosonography; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D013276:Stomach Ulcer / Q000150:complications / Q000000981:diagnostic imaging*