Evaluation of preoperative endoscopic ultrasonography for diagnostic and therapeutic decision making in superficial gastric cancers

Objective To study the value of endoscopic ultrasonography (EUS) for diagnostic and therapeutic decision making in superficial gastric cancers. Methods In the period between January 2006 and December 2014, 77 patients diagnosed as having gastric cancers pathologically on biopsies who underwent EUS prior to therapy were reviewed. All lesions were resected either endoscopically or surgically. Final pathology was achieved in 83 lesions, including 72 early gastric cancers(EGC) and 11 advanced gastric cancers. Diagnostic value of EUS was evaluated by sensitivity, specificity and diagnostic accuracy, with the pathology of the resected specimen as the golden standard. Risk factors for EUS diagnosis were investigated by multivariable analysis. Results The sensitivity, specificity and diagnostic accuracy of EUS for EGC were 91.7%(66/72), 81.8%(9/11) and 90.4%(75/83), respectively. The diagnostic accuracy for mucosal cancer and submucosal cancer was 66.7%(48/72), and positive predictive value was 91.3%(42/46). Logistic multivariable analysis showed independent factors of EUS mis-staging included ulcers (OR=7.513, 95%CI: 1.735-32.541, P<0.05) and undifferentiated carcinoma (OR=8.194, 95%CI: 1.602-41.903, P<0.05). Conclusion EUS has a high diagnostic accuracy of early gastric cancers. Endoscopic resection could be considered for those mucosal lesions reported by EUS. But for those submucosal lesions by EUS, endoscopic manifestations are needed for therapeutic decisions. Key words: Endoscopic ultrasonography; Superficial gastric cancer; Depth of invasion; Impact factor; Therapeutic decision