Accuracy Estimation of Endoscopic Ultrasonography for Assessing the Depth of Invasion in Early Gastric Cancer

Hideki Ura, Ryuichi Denno, Koichi Hirata, Tetsuhiro Tsuruma, Hidekazu Kameshima, Takahiro Yasojima, Koji Yamaguchi

First Department of Surgery, Sapporo Medical University

The significance of local therapies for early gastric cancer was studied with regard to curability from the viewpoint of accuracy of endoscopic ultrasonographv (EUS) for preoperatively assessing the depth of cancer invasion. EUS was performed in 56 patients with early gastric cancer. The overall accuracy rate of EUS was 66.1%. Ten patients with mucosal cancer had been overdiagnosed as suffering invasion into the submucosa, and 9 with submucosal cancer had been underdiagnosed as having mucosal cancer. In the latter, 8 were found to have minute invasion into the submucosa (sm₁). Thus it seemed difficult to discriminate between mucosal cancer and sm₁. A large sample of submucosal cancers was classified into three groups by the degree of invasion into the submucosa, sm₁, sm₂ and sm₃, and the rates of lymph node metastasis were investigated. The sample number was 223 submucosal cancers which had been resected in our department since 1975. The metastatic rates in regional lymph nodes were 11.1%, 20.8% and 18.9% for sm₁∼sm₃ respectively. On the other hand, that of mucosal cancer was 0.5%. The rate in sm₁ was clearly higher than that in mucosal cancer. In order to carry out local therapies for early gastric cancer, reliable differential diagnosis of mucosal and submucosal cancers should be supported. Although promising, EUS still does not provide sufficient discrimination between mucosal cancer and sm₁. Therefore, the attending physician should avoid local therapies unless he or she can make a definite preoperative discrimination between the two.

Key words
gastric cancer, endoscopic ultrasonography of the stomach, endoscopic therapy of early gastric cancer, surgical local resection of early gastric cancer

Reprint requests
Hideki Ura First Department of Surgery, Sapporo Medical University
South 1, West 16, Chuo-ku, Sapporo, 060 JAPAN

Accepted
June 14, 1995

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