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A study on the diagnosis of gastric cancer by endoscopic ultrasonography evaluation of the depth of invasion stroma and infiltrative growth



A study on the diagnosis of gastric cancer by endoscopic ultrasonography evaluation of the depth of invasion stroma and infiltrative growth



Journal of Tokyo Medical College 47(5): 789-800



A study was performed on the diagnosis of the depth of invasion, stroma and infiltrative growth (INF) by endoscopic ultrasonography (EUS). EUS was performed in 66 patients; gastric cancers were resected after this test. By EUS, the normal gastric wall was demonstrated as a 5-layered structure. By comparison of the ultrasonic images with the pathological findings, it is confirmed that the 1st hyperechoic and the 2nd hypoechoic layers correspond to mucous, the mucosa and the mucosal muscle, the 3rd hyperechoic layer corresponds to the submucosal layer, the 4th hypoechoic layer corresponds to the proper muscular layer, and the 5th hyperechoic layer corresponds to the subserosal layer and the serosa. Based on the changes on scans in these layers' structures, the depth of invasion, stroma and INF could be evaluated. The rate of correct diagnosis of the depth of invasion was 60.0% in subserosal layer and 83.3% in serosal layer or deeper tissues. The internal echo patterns in the gastric cancer were classified into four types. According to this classification, the gastric cancers showing A-type were diagnosed as a medullary type, those showing B or C type as a scirrhous type, those showing D type as an intermediate type. The rate of correct diagnosis of stroma was 76.9% in the medullary type, 80.9% in the intermediate type, 80.0% in the scirrhous type and 79.6% as a whole. According to margin echo patterns and diagnosis of the depth of invasion and stroma by EUS, the rate of correct diagnosis of INF was 68.4% in INF.alpha., 61.5% in INF.beta., 93.8% in INF.gamma. and 72.1% as a whole. Our results showed the usefulness of EUS for preoperative determination of the stage, the surgical procedure and the prognosis.

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Accession: 006970613

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