title: Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection.
abstract: BACKGROUND
  Endoscopic ultrasonography (EUS) has become a reliable method for predicting the invasion depth of early gastric cancer (EGC). This study evaluated the accuracy of EUS in identifying lesions meeting expanded-indication criteria for endoscopic submucosal dissection (ESD) and analyzed clinicopathologic factors influencing the diagnostic accuracy of EUS in assessing tumor invasion depth.
  
  
  METHODS
  This study investigated 542 EGCs of 515 patients who underwent EUS pretreatment. The pretreatment EUS-determined diagnosis was compared with the final histopathologic evaluation of resected specimens, and the impact of various clinicopathologic parameters on diagnostic accuracy was analyzed.
  
  
  RESULTS
  The diagnostic accuracy of EUS in identifying lesions meeting expanded-indication criteria for ESD was 87.8% (259/295) for differentiated adenocarcinoma (D-type) 30 mm in diameter or smaller, 43.5% (10/23) for D-type tumor larger than 30 mm in diameter, and 75% (42/56) for undifferentiated adenocarcinoma (UD-type) 20 mm in diameter or smaller. Using multivariate analysis, the diagnostic accuracy of EUS in predicting tumor invasion depth was determined to be decreased significantly by ulcerous change and large tumor size (diameter, ≥30 mm).
  
  
  CONCLUSIONS
  For patients with EGC, D-type lesions 30 mm in diameter or smaller and UD-type lesions 20 mm in diameter or smaller can be diagnosed with high accuracy by EUS, but larger D-type lesions (diameter, >30 mm) should be considered carefully in terms of EUS-based treatment decisions. Findings of ulceration and large tumors are associated with incorrect diagnosis of tumor invasion depth by EUS.
authors: Ariake Hospital of Japanese Foundation for Cancer Research,Tokyo, Japan.
authors: Kazuhisa
authors: K
authors: Okada
authors: Junko
authors: J
authors: Fujisaki
authors: Akiyoshi
authors: A
authors: Kasuga
authors: Masami
authors: M
authors: Omae
authors: Kazuhito
authors: K
authors: Yoshimoto
authors: Toshiaki
authors: T
authors: Hirasawa
authors: Akiyoshi
authors: A
authors: Ishiyama
authors: Yorimasa
authors: Y
authors: Yamamoto
authors: Tomohiro
authors: T
authors: Tsuchida
authors: Etsuo
authors: E
authors: Hoshino
authors: Masahiro
authors: M
authors: Igarashi
authors: Hiroshi
authors: H
authors: Takahashi
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002454:Cell Differentiation; D004210:Dissection / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013276:Stomach Ulcer / Q000209:etiology / Q000473:pathology; D047368:Tumor Burden