THE OUTCOME OF PREOPERATIVE ENDOSCOPIC ULTRASONOGRAPHY IN EARLY GASTRIC CANCER

Tanzila Islam*, Mehtab Uddin Ahmed, Farhana Shimu and Debarati Bosak

ABSTRACT

Background: Endoscopic ultrasonography (EUS) is the most routinely utilized tool for early gastric cancer T staging (EGC). However, research on EUS for staging EGC found wildly disparate sensitivities and specificities. Objective: In this study our main goal is to evaluate the outcome of preoperative endoscopic ultrasonography in early gastric cancer. Method: This cross sectional study was carried out at tertiary medical hospital from January 2021 to January 2022. A total of 100 lesions underwent curative surgery or ESD in center, with 100 of them diagnosed with EGCs pathologically were included as a sample population. Conventional endoscopy (video endoscope Q260 or H260, Olympus Medical Systems, Tokyo, Japan) was used to examine all lesions before EUS. There were two types of EUS devices utilized: ultrasound was used for smaller or flat lesions, and ultrasound endoscope (was used for bigger or depressed lesions). Results: During the study, 46% patients belongs to 41-50 years age group and majority were male. The median tumor diameter was >2.0 cm (Range, 0.4–10.0) was accompanied in 55% lesions. In the final pathological diagnosis, the invasion depth was M for 70% lesions and SM for 30% lesions, and differentiated histology was diagnosed in 75% and undifferentiated histology in 25%. Within the mucosal cancer group, 80% were accurately diagnosed as EUS-M whereas among the submucosal cancer group, 20% were under-estimated as M cancer and 45% were over-estimated either as MP (n = 8) or 56% were SS. the accuracy was significantly lower for the lesions located at angle and body of the stomach, ulcer/scar (+), excavated type, lesions with white fur on surface, >2.0 cm in diameter, and submucosal invasion, as well as the undifferentiated types of lesions. In addition, The accuracy of EUS for the lesions within absolute indications and expended indications were 75 and 55%, respectively. For the lesions beyond the indications for endoscopic resection, the accuracy of EUS was 25%. Conclusion: malignancies were independently related with EUS misinterpretation of EGC depth, and 0-III type lesions were an independent risk factor for EUS over-diagnosis of invasion depth. As a result, EUS is not required usually for choosing the treatment strategy for EGC.

Keywords: Early gastric cancer (EGC), Endoscopic submucosal dissection (ESD), Endoscopic ultrasonography (EUS).