Clinicopathologic Factors Associated With Poor Diagnostic Accuracy of Endoscopic Ultrasonography in Early Gastric Cancer

Endoscopic ultrasonography demonstrated lower diagnostic accuracy in staging early gastric cancer lesions larger than 2 cm, lesions with ulceration, or lesions with non-flat morphology. Study authors wrote that, “the appropriate management plan for [early gastric cancer] is determined according to the depth of tumor invasion. Therefore, accurate T staging is critical for decision-making in [early gastric cancers].”

This retrospective study included 223 early gastric cancer lesions from 211 patients with early gastric cancer who had undergone endoscopic resection or gastrectomy in a single academic hospital between March 2016 and September 2019. The diameter of the tumors was 2.6 cm, and 82 (36.8%) tumors had ulceration. The diagnostic accuracy of endoscopic ultrasonography was determined by comparison of the T stage by endoscopic ultrasonography with the histopathology of the resected specimen. A subgroup analysis was also done based on the criteria for endoscopic resection.

The overall accuracy of T staging performed by endoscopic ultrasonography was 66.4%. The diagnostic accuracy was significantly higher in the cases of lesions ≤2 cm when compared to those 2 to 3 cm (odds ratio [OR], 3.59, 95% confidence interval [CI], 1.65 to 7.79; P = .001), or those >3 cm (OR, 5.47; 95% CI, 2.55 to 11.74; P < .001). EUS was also significantly less accurate for lesions with ulceration (OR, 2.62; 95% CI, 1.38 to 4.97; P = .006) or non-flat morphology (OR, 2.94; 95% CI, 1.11 to 7.74; P = 0.29).

In the cases of tumors with larger size, ulceration, and non-flat morphology, endoscopic ultrasonography tended to overestimate the T stage. There were 59 tumors overestimated to be either T1b or T2b that were more accurately T1a. For lesions corresponding to the absolute endoscopic resection criteria, the endoscopic ultrasonography accuracy was significantly higher than for those which corresponded to the expanded criteria (97.3% vs 71.9%; P = .002).

The authors concluded that early gastric lesions “corresponding to the expanded criteria were more likely to be overstaged by [endoscopic ultrasonography]. Therefore [early gastric cancer] with ulceration and a size larger than 2 cm should be carefully considered when performing local staging by [endoscopic ultrasonography before gastrectomy.”

Source:

Kim SJ, Lim CH, and Lee BI. Accuracy of endoscopic ultrasonography for determining the depth of invasion in early gastric cancer. Turk J Gastroenterol. Published online August 10, 2022. doi: 10.5152/tjg.2022.21847