title: Endoscopic prediction of tumor invasion depth in early gastric cancer.
abstract: BACKGROUND
  Although conventional endoscopy is a good diagnostic tool to evaluate tumor depth (T staging) in early gastric cancer (EGC), its accuracy has not been determined and no consensus has been reached regarding standard endoscopic criteria.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of endoscopic T staging and to identify the characteristic endoscopic features for mucosal (T1m) and submucosal (T1sm) tumors.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  A consecutive 2105 patients with EGC who underwent either surgical (n=1624) or endoscopic (n=481) resection.
  
  
  METHODS
  Endoscopic staging was performed by consensus of 2 endoscopists based on the characteristic endoscopic criteria of T1m (smooth surface protrusion or depression, slight marginal elevation, and the smooth tapering of converging folds) and T1sm (irregular surface, marked marginal elevation, and clubbing/abrupt cutting/fusion of converging folds). The endoscopic staging was compared with the pathologic staging of the resected specimen.
  
  
  RESULTS
  The overall accuracy of endoscopic staging was 78.0% (1642/2105). The sensitivity, specificity, and positive and negative predictive values of T1m endoscopic staging were 85.5%, 73.9%, 82.0%, and 78.5%, whereas those for T1sm were 72.6%, 81.9%, 71.9%, and 82.4%, respectively.
  
  
  CONCLUSIONS
  Retrospective study. Endoscopic predictions for T1sm tumors were correct in only 72% of cases.
  
  
  CONCLUSIONS
  Conventional endoscopy was found to provide reliable accuracy for T staging in EGC and may be an effective method for assessing penetration depth. A detailed endoscopic evaluation regarding tumor base, margin, and converging folds may provide useful information to determine tumor depth and to select the optimal therapeutic strategy, particularly for endoscopic resection.
authors.affiliation: Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jeongmin
authors.initials: J
authors.lastname: Choi
authors.forename: Sang Gyun
authors.initials: SG
authors.lastname: Kim
authors.forename: Jong Pil
authors.initials: JP
authors.lastname: Im
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Hyun Chae
authors.initials: HC
authors.lastname: Jung
authors.forename: In Sung
authors.initials: IS
authors.lastname: Song
mesh_terms: D004210:Dissection / Q000379:methods; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery