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. 2023 Mar 26;12(7):2505.
doi: 10.3390/jcm12072505.

Diagnostic Accuracy of Endoscopic Ultrasonography in Selecting Patients for Endoscopic Submucosal Dissection for Early Gastrointestinal Neoplasms

Pietro Gambitta  1 , Paola Fontana  1 , Ilaria Fanetti  1 , Giulia Veglia  1 , Maurizio Vertemati  2 , Antonio Armellino  3 , Paolo Aseni  2   4
Affiliations

Diagnostic Accuracy of Endoscopic Ultrasonography in Selecting Patients for Endoscopic Submucosal Dissection for Early Gastrointestinal Neoplasms

Pietro Gambitta et al. J Clin Med. .

Abstract

Tumor invasion depth and lymph node metastasis determine the prognosis of gastrointestinal (GI) neoplasms. GI neoplasms limited to mucosa (m1 or m2) and superficial submucosa (sm1) can be treated effectively with minimally invasive endoscopic therapy, while the deep invasion of the submucosa (sm2 or sm3) is associated with lymph node metastasis, and surgical resection is required. Correct staging is therefore crucial for preoperative evaluation and planning. Endoscopic ultrasonography (EUS) can be used to detect the depth of invasion due to its close proximity to the lesion. The diagnostic accuracy of EUS, when compared to conventional endoscopic staging, is debated as it can under- or overstage the lesion. We aim in this study to determine if EUS can accurately differentiate mucosal from submucosal GI neoplasms to select patients with early GI lesions for endoscopic submucosal dissection (ESD) or surgery. From March 2014 to February 2022, 293 patients with early superficial GI neoplasms were admitted to our endoscopic unit for EUS staging. To evaluate the accuracy of EUS, we compared the preoperative EUS findings with the definitive histopathologic findings on the resected specimen. Overall, 242 of 293 lesions were correctly staged by EUS (82.59%). In the evaluation of submucosal invasion or deeper, EUS understaged 38 of 293 (12.96%) and overstaged 13 of 293 (4.43%) lesions. EUS has excellent accuracy in staging superficial GI neoplasms; its use is highly recommended before ESD since it can also detect lymph node metastases around the lesions, thus changing the indication from ESD to surgery.

Keywords: ESD; endoscopic ultrasonography; gastrointestinal neoplasms; prognosis; staging; subepithelial lesion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diagnostic flowchart for patients with suspected superficial GI cancer to select those eligible for ESD or surgery. (LN—lymph node; CLS—colonoscopy).
Figure 2
Figure 2
EUS of early gastric cancer at the lesser curvature of the gastric. Antrum with infiltration of the muscularis mucosae (arrow). Staging uT1m2, N0.
Figure 3
Figure 3
EUS of early gastric cancer (arrow) limited to the lamina propria. Staging uT1m1. (LU—lumen; M—mucosa; SM—submucosa; MP—muscularis propria). B—balloon.
Figure 4
Figure 4
EUS image of early gastric cancer with shallow infiltration (arrow) of the submucosal tissue (staging sm1). (M—mucosa; SM—submucosa; MP—muscularis propria; TU—tumor).
See this image and copyright information in PMC

References

    1. Han Y., Sun S., Guo J., Ge N., Wang S., Liu X., Wang G., Hu J., Wang S. Is endoscopic ultrasonography useful for endoscopic submucosal dissection? Endosc. Ultrasound. 2016;5:284–290. doi: 10.4103/2303-9027.191606. - DOI - PMC - PubMed
    1. Coda S., Lee S.Y., Gotoda T. Endoscopic mucosal resection and endoscopic submucosal dissection as treatments for early gastrointestinal cancers in Western countries. Gut Liver. 2007;1:12–21. doi: 10.5009/gnl.2007.1.1.12. - DOI - PMC - PubMed
    1. Stein H.J., Feith M., Bruecher B.L., Naehrig J., Sarbia M., Siewert J.R. Early esophageal cancer pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann. Surg. 2005;242:566–575. doi: 10.1097/01.sla.0000184211.75970.85. - DOI - PMC - PubMed
    1. Liu L., Hofstetter W., Rashid A., Swisher S.G., Correa A.M., Ajani J.A., Hamilton S.R., Wu T.T. Significance of the depth of tumor invasion and lymph node metastasis in superficially invasive (T1) esophageal adenocarcinoma. Am. J. Surg. Pathol. 2005;29:1079–1085. doi: 10.1097/01.pas.0000168175.63782.9e. - DOI - PubMed
    1. Japan Esophageal Society Japanese Classification of Esophageal Cancer, 11th Edition: Part II and III. Esophagus. 2017;14:37–65. doi: 10.1007/s10388-016-0556-2. - DOI - PMC - PubMed