What types of early gastric cancer are indicated for endoscopic ultrasonography staging of invasion depth?
OBJECTIVE
To clarify the diagnostic efficacy and limitations of endoscopic ultrasonography (EUS) and the characteristics of early gastric cancers (EGCs) that are indications for EUS-based assessment of cancer invasion depth.


METHODS
We retrospectively investigated the cases of 153 EGC patients who underwent conventional endoscopy (CE) and EUS (20 MHz) before treatment.


RESULTS
We found that 13.7% were "inconclusive" cases with low-quality EUS images, including all nine of the cases with protruded (0-I)-type EGCs. There was no significant difference in the diagnostic accuracy between CE and EUS. Two significant independent risk factors for misdiagnosis by EUS were identified-ulcer scarring [UL(+); odds ratio (OR) = 4.49, P = 0.003] and non-indication criteria for endoscopic resection (ER) (OR = 3.02, P = 0.03). In the subgroup analysis, 23.1% of the differentiated-type cancers exhibiting SM massive invasion (SM2) invasion (submucosal invasion ≥ 500 μm) by CE were correctly diagnosed by EUS, and 23.1% of the undifferentiated-type EGCs meeting the expanded-indication criteria for ER were correctly diagnosed by EUS.


CONCLUSIONS
There is no need to perform EUS for UL(+) EGCs or 0-I-type EGCs, but EUS may enhance the pretreatment staging of differentiated-type EGCs with SM2 invasion without UL or undifferentiated-type EGCs revealed by CE as meeting the expanded-indication criteria for ER.
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Jiro
J
Watari
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Shigemitsu
S
Ueyama
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Toshihiko
T
Tomita
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Hisatomo
H
Ikehara
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Kazutoshi
K
Hori
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Ken
K
Hara
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Takahisa
T
Yamasaki
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Takuya
T
Okugawa
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Takashi
T
Kondo
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Tomoaki
T
Kono
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Katsuyuki
K
Tozawa
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Tadayuki
T
Oshima
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Hirokazu
H
Fukui
Jiro Watari, Shigemitsu Ueyama, Toshihiko Tomita, Hisatomo Ikehara, Ken Hara, Takahisa Yamasaki, Takuya Okugawa, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Hiroto
H
Miwa
Conventional endoscopy; Endoscopic submucosal dissection; Endoscopic ultrasonography; Gastric cancer; Invasion depth diagnosis