The Usefulness of Endoscopic Ultrasonoraphy for Discriminating Gastric Mucosal Cancer from Submucosal Invasion

Lee, Seung Hyung; Jang, Yong Seok; Jeon, Sang Hoon; Kim, Seong Yeol; Jang, Byoung Kuk; Chung, Woo Jin; Cho, Kwang Bum; Park, Kyung Sik; Hwang, Jae Seok

Abstract

BACKGROUND/AIMS
Endoscopic ultrasonography (EUS) has been used to discriminate gastric mucosal cancer (T1m) from submucosal invasion (T1sm). Thus the aims of this study are 1) to determine the accuracy of EUS for diagnosing tumor depth, 2) to compare the accuracy of EUS with the endoscopic impressions of variously experienced endoscopists and 3) to compare the accuracy of performing EUS by one doctor according to the experience.
METHODS
The EUS and pathologic reports of early gastric cancer patients were analyzed. The same endoscopic images were reviewed again by 3 endoscopists, who had one-, three- and five-years experience, respectively. The accuracies of EUS and conventional endoscopy were analyzed.
RESULTS
77 patients were included from November 2003 to October 2005. The kappa of the EUS for actual examiner and conventional endoscopy for reviewer 1, reviewer 2 and reviewer 3 were 0.421, 0.134, 0.359 and 0.307, respectively and accuracies were 68.8%, 45.5%, 67.5% and 62.3%, respectively. Of the 52 T1m patients, 23 (44.2%) were overstaged as T1sm with performing EUS. But of 25 T1sm patients, only 1 (4.0%) was understaged as T1m with performing EUS. The accuracy and kappa of the EUS for one doctor during the first-year experience were 60.6% and 0.316, respectively, and they were 75.0% and 0.508, respectively during the second-year experience.
CONCLUSIONS
EUS is useful for complementing the conventional endoscopic discrimination of gastric mucosal cancer from submucosal invasion. Yet physician should keep in mind the relatively common overstaging.