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ORIGINAL ARTICLE
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Value of EUS in determining infiltration depth of early carcinoma and associated precancerous lesions in the upper gastrointestinal tract


 Department of Gastroenterology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang Uygur Autonomous Region, China

Correspondence Address:
Weigang Chen,
Department of Gastroenterology, The First Affiliated Hospital, Shihezi University School of Medicine, 107 North Second Road, Shihezi 832000, Xinjiang Uygur Autonomous Region
China
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00218

Objective: The objective is to evaluate the value of EUS in the determination of infiltration depth of early carcinoma and precancerous lesions in the upper gastrointestinal tract and to analyze the various factors affecting the accuracy of EUS. Methods: One hundred and sixty-three patients diagnosed with early gastric cancer or early esophageal cancer, and associated precancerous lesions, who were seen in our hospital in the recent 10 years were selected. These patients received EUS before endoscopic submucosal dissection or surgery. With a pathological diagnosis as the gold standard, the accuracy, sensitivity, specificity, and misjudgment rate of EUS in determining the invasion depth were evaluated using the pathological stratification (mucosa, M1/2; muscularis mucosa, M3; submucosa, [SM]; and muscularis propria) or TN stratification (mucosa, T1a; SM, T1b), and the possible causes of miscalculation were analyzed. Results: Based on the pathological stratification, the overall accuracy of EUS was 78.5%, and the overestimation and underestimation rates were 17.8% and 3.7%, respectively. Based on the TN stratification, the overall accuracy of EUS was 81%, and the overestimation and underestimation rates were 16.6% and 2.5%, respectively. There was a significant difference between the groups in terms of overestimation and underestimation rates (P < 0.05), indicating that EUS was more likely to overestimate the depth. Univariate analysis showed that the factors affecting accuracy included lesion size, macroscopic features, sunken mucosa, mucosa with granular and nodular changes, and ulceration. Multivariate logistic regression analysis revealed that larger lesions, mucosa with granular and nodular changes, and ulceration were independent risk factors for the overestimation of infiltration depth by EUS. Conclusion: EUS is highly accurate in determining the infiltration depth of early cancer and precancerous lesions in the upper gastrointestinal tract. It also has a good reference value for treatment selection and prognostication. However, attention should be paid to its overestimation, especially accompanied by the aforementioned factors.


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    -  Chen H
    -  Wang X
    -  Shao S
    -  Zhang J
    -  Tan X
    -  Chen W
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