Clinical Endoscopy

Review

Role of contrast-enhanced harmonic endoscopic ultrasonography (EUS) and EUS elastography in pancreatic lesions: Yasunobu Yamashita, Masayuki Kitano; Clin Endosc 2024;57(2):164-174. Published online January 17, 2024; DOI: https://doi.org/10.5946/ce.2023.074

Pancreatic cancers have a poor prognosis, and their incident rates have risen. Endoscopic ultrasonography (EUS) is an efficient and reliable diagnostic modality for pancreatic lesions, providing high spatial resolution. However, while EUS helps to detect minor pancreatic lesions, nearly all solid pancreatic lesions are hypoechoic, which creates difficulty in making differential diagnoses of pancreatic lesions. When diagnosing pancreatic lesions, the performance of image-enhanced EUS techniques is essential, such as EUS elastography or contrast-enhanced harmonic EUS (CH-EUS). CH-EUS diagnosis is based on assessing the vascularity of lesions, whereas tissue elasticity is measured via EUS elastography. Elastography is either strain or shear-wave, depending on the different mechanical properties being evaluated. The usefulness of enhanced EUS techniques is demonstrated in this review for the differential diagnosis of pancreatic lesions, including solid and cystic lesions, and pancreatic cancer staging.

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Endoscopic Contrast-Enhanced Ultrasound and Fine-Needle Aspiration or Biopsy for the Diagnosis of Pancreatic Solid Lesions: A Systematic Review and Meta-Analysis
Giorgio Esposto, Giuseppe Massimiani, Linda Galasso, Paolo Santini, Raffaele Borriello, Irene Mignini, Maria Elena Ainora, Alberto Nicoletti, Lorenzo Zileri Dal Verme, Antonio Gasbarrini, Sergio Alfieri, Giuseppe Quero, Maria Assunta Zocco
Cancers.2024; 16(9): 1658. CrossRef
Endoscopic Ultrasound and Gastric Sub-Epithelial Lesions: Ultrasonographic Features, Tissue Acquisition Strategies, and Therapeutic Management
Marzia Varanese, Marco Spadaccini, Antonio Facciorusso, Gianluca Franchellucci, Matteo Colombo, Marta Andreozzi, Daryl Ramai, Davide Massimi, Roberto De Sire, Ludovico Alfarone, Antonio Capogreco, Roberta Maselli, Cesare Hassan, Alessandro Fugazza, Alessa
Medicina.2024; 60(10): 1695. CrossRef
Endoscopic Ultrasound-Guided Pancreatic Tissue Sampling: Lesion Assessment, Needles, and Techniques
Jahnvi Dhar, Jayanta Samanta, Zaheer Nabi, Manik Aggarwal, Maria Cristina Conti Bellocchi, Antonio Facciorusso, Luca Frulloni, Stefano Francesco Crinò
Medicina.2024; 60(12): 2021. CrossRef

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Original Article

Diagnostic Ability of Convex-Arrayed Endoscopic Ultrasonography for Major Vascular Invasion in Pancreatic Cancer: Yuki Fujii, Kazuyuki Matsumoto, Hironari Kato, Yosuke Saragai, Saimon Takada, Sho Mizukawa, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Shigeru Horiguchi, Noriyuki Tanaka, Hiroyuki Okada; Clin Endosc 2019;52(5):479-485. Published online May 16, 2019; DOI: https://doi.org/10.5946/ce.2018.163

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Background
/Aims: This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascular invasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance.
Methods
In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUS image findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion, types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors and evaluated vessels.
Results
The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in the veins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings were significantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0–742] µm vs. 2,833 [1,076–5,694] µm, p=0.012) and arteries (623 [0–854] µm vs. 3,097 [1,396–6,000] µm, p=0.0061). All cases with a distance of ≥1,000 µm between the tumors and main vessels were correctly diagnosed.
Conclusions
Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.

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Role of Endoscopic Ultrasound in Staging and Vascular Assessment of Pancreatic Cancer
Mohammed A El-Nady, Khalid A Ead, Mustafa A Haridy, Nour Shaheen, Abdulqadir J Nashwan, Saad R Abdelwahid, Mohammed F Mohammed, Omran Mohamed, Safwat S Sawy, Emad Abdelrazzak, Amro M Hassan
Cureus.2024;[Epub] CrossRef
The diagnostic accuracy of endoscopic ultrasound vs. contrast-enhanced computed tomography in local staging of pancreatic adenocarcinoma: a bi-national multicenter study
Wisam Sbeit, Mahmoud Salman, Abed Khalaileh, Ahmad Zoabi, Zakhar Bramnik, David Hovel, Mahmud Mahamid, Eran Israeli, Lior Katz, Reem Khoury, Nama Mubariki, Andrea Lisotti, Halim Awadie, Tawfik Khoury
European Journal of Gastroenterology & Hepatology.2023; 35(9): 974. CrossRef
Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef
The expanding role of endoscopic ultrasound elastography
Jahnvi Dhar, Jayanta Samanta
Clinical Journal of Gastroenterology.2022; 15(5): 841. CrossRef
Experience of introduction of endoscopic ultrasonography into daily clinical practice in a surgical hospital
A.V. Zhdanov, E.G. Solonitsyn, E.A. Korymasov
Endoskopicheskaya khirurgiya.2020; 26(5): 24. CrossRef
Endoscopic Ultrasonography for Vascular Invasion in Pancreatic Cancer
Seong-Hun Kim
Clinical Endoscopy.2019; 52(5): 397. CrossRef

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Focused Review Series: Endoscopic Submucosal Dissection for Colorectal Tumors

Estimation of Invasion Depth: The First Key to Successful Colorectal ESD: Bo-In Lee, Takahisa Matsuda; Clin Endosc 2019;52(2):100-106. Published online March 27, 2019; DOI: https://doi.org/10.5946/ce.2019.012

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Colorectal tumors with superficial submucosal invasion, which cannot be removed by snaring, are one of the most optimal indications for colorectal endoscopic submucosal dissection (ESD). Therefore, estimation of the invasion depth is the first key to successful colorectal ESD. Although estimation of the invasion depth based on the gross morphology may be useful in selected cases, its diagnostic accuracy could not reach the clinical requirement. The Japan Narrow-band Imaging (NBI) Expert Team (JNET) classification of NBI magnifying endoscopy findings is a useful method for histologic prediction and invasion depth estimation. However, magnifying chromoendoscopy is still necessary for JNET type 2B lesions to reach a satisfactory diagnostic accuracy. Endocytoscopy with artificial intelligence is a promising technology in invasion depth estimation; however, more data are needed for its clinical application.

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Deep Learning in Endoscopic Ultrasound: A Breakthrough in Detecting Distal Cholangiocarcinoma
Rares Ilie Orzan, Delia Santa, Noemi Lorenzovici, Thomas Andrei Zareczky, Cristina Pojoga, Renata Agoston, Eva-Henrietta Dulf, Andrada Seicean
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Comparison of two pathological processing methods for large endoscopic submucosal dissection (ESD) specimens
Zixiang Yu, Dongxian Jiang, Wen Huang, Rongkui Luo, Haixing Wang, Jieakesu Su, Jia Liu, Chen Xu, Yingyong Hou
Journal of Clinical Pathology.2023; 76(11): 757. CrossRef
Endoscopic submucosal dissection for colorectal polyps: outcome determining factors
Chi Woo Samuel Chow, Tak Lit Derek Fung, Pak Tat Chan, Kam Hung Kwok
Surgical Endoscopy.2023; 37(2): 1293. CrossRef
Endoscopic management of patients with high-risk colorectal colitis–associated neoplasia: a Delphi study
Michiel T.J. Bak, Eduardo Albéniz, James E. East, Nayantara Coelho-Prabhu, Noriko Suzuki, Yutaka Saito, Takayuki Matsumoto, Rupa Banerjee, Michal F. Kaminski, Ralf Kiesslich, Emmanuel Coron, Annemarie C. de Vries, C. Janneke van der Woude, Raf Bisschops,
Gastrointestinal Endoscopy.2023; 97(4): 767. CrossRef
Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
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Feng Liang, Shu Wang, Kai Zhang, Tong-Jun Liu, Jian-Nan Li
World Journal of Gastrointestinal Oncology.2022; 14(1): 124. CrossRef
Linear-array EUS improves the accuracy of predicting deep submucosal invasion in non-pedunculated rectal polyps compared with radial EUS: a prospective observational study
Zhixian Lan, Kangyue Sun, Yuchen Luo, Haiyan Hu, Wei Zhu, Wen Guo, Jing Wen, Wenting Mi, Junsheng Chen, Xiang Chen, Venkata Akshintala, Ying Huang, Side Liu, Yue Li
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Ryosuke Tonozuka, Takao Itoi, Naoyoshi Nagata, Hiroyuki Kojima, Atsushi Sofuni, Takayoshi Tsuchiya, Kentaro Ishii, Reina Tanaka, Yuichi Nagakawa, Shuntaro Mukai
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Comparison of long-term recurrence-free survival between primary surgery and endoscopic resection followed by secondary surgery in T1 colorectal cancer
Eun Hye Oh, Nayoung Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Chang Sik Yu, Jin Cheon Kim, Jeong-Sik Byeon
Gastrointestinal Endoscopy.2021; 94(2): 394. CrossRef
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R. Zinicola, R. Nascimbeni, R. Cirocchi, G. Gagliardi, N. Cracco, M. Giuffrida, G. Pedrazzi, G. A. Binda
Techniques in Coloproctology.2021; 25(9): 997. CrossRef
Role of Artificial Intelligence in Video Capsule Endoscopy
Ioannis Tziortziotis, Faidon-Marios Laskaratos, Sergio Coda
Diagnostics.2021; 11(7): 1192. CrossRef
Controversies in EUS: Do we need miniprobes?
Hans Seifert, Pietro Fusaroli, PaoloGiorgio Arcidiacono, Barbara Braden, Felix Herth, Michael Hocke, Alberto Larghi, Bertrand Napoleon, Mihai Rimbas, BogdanSilvio Ungureanu, Adrian Sãftoiu, AnandV Sahai, ChristophF Dietrich
Endoscopic Ultrasound.2021; 10(4): 246. CrossRef
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Namjoo Kim, Jeong-An Gim, Beom Jae Lee, Byung il Choi, Seung Bin Park, Hee Sook Yoon, Sang Hee Kang, Seung Han Kim, Moon Kyung Joo, Jong-Jae Park, Chungyeul Kim, Han-Kyeom Kim
Functional & Integrative Genomics.2021; 21(3-4): 513. CrossRef
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Ahmad El Hajjar, Jean-François Rey
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Evelien Dekker, Britt B. S. L. Houwen, Ignasi Puig, Marco Bustamante-Balén, Emmanuel Coron, Daniela E. Dobru, Roman Kuvaev, Helmut Neumann, Gavin Johnson, Pedro Pimentel-Nunes, David S. Sanders, Mario Dinis-Ribeiro, Marianna Arvanitakis, Thierry Ponchon,
Endoscopy.2020;[Epub] CrossRef
Use of artificial intelligence in improving adenoma detection rate during colonoscopy: Might both endoscopists and pathologists be further helped
Emanuele Sinagra, Matteo Badalamenti, Marcello Maida, Marco Spadaccini, Roberta Maselli, Francesca Rossi, Giuseppe Conoscenti, Dario Raimondo, Socrate Pallio, Alessandro Repici, Andrea Anderloni
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Endoscopic imaging techniques for detecting early colorectal cancer
Ignasi Puig, Carlos Mármol, Marco Bustamante
Current Opinion in Gastroenterology.2019; 35(5): 432. CrossRef

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Original Article

Diagnostic Accuracy and Interobserver Agreement in Predicting the Submucosal Invasion of Colorectal Tumors Using Gross Findings, Pit Patterns, and Microvasculatures: Hye Jung Choi, Bo-In Lee, Hwang Choi, Kyu Yong Choi, Sang-Woo Kim, Joo Yong Song, Jeong Seon Ji, Byung-Wook Kim; Clin Endosc 2013;46(2):168-171. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.168

Abstract PDF PubReader ePub

Background/Aims

Depth of invasion is one of the most important factors for establishing treatment strategy for colorectal tumors.

Methods

Three blinded experts reviewed electronic photos and video clips of 33 early colorectal cancer-like lesions. They estimated the depth of invasion based on conventional white light endoscopy (CWE), magnifying chromoendoscopy (MCE), and magnifying narrow band imaging endoscopy (MNE).

Results

The lesions included nine mucosal low-grade neoplasias, 16 mucosal high grade neoplasias, and eight carcinomas with invasion to the submucosal layer or beyond. The diagnostic accuracy for submucosal invasion by CWE ranged from 67% to 82%, while those by MCE and MNE ranged from 85% to 88% and 85% to 88%, respectively. The diagnostic accuracy significantly differed between CWE and MCE (p=0.034) and between CWE and MNE (p=0.039). The kappa values for CWE, MCE, and MNE among the endoscopists were 0.564, 0.673, and 0.673, respectively.

Conclusions

The estimation of submucosal invasion for early colorectal cancer-like lesions based on MCE or MNE is more accurate than CWE. MCE and MNE were demonstrated to have substantial agreement for predicting submucosal invasion.

Citations

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Underwater Versus Conventional Endoscopic Mucosal Resection for Colorectal Laterally Spreading Tumors: A Post Hoc Analysis of Efficacy
Quang Dinh Le, Nhan Quang Le, Duc Trong Quach
JGH Open.2024;[Epub] CrossRef
Estimation of Invasion Depth: The First Key to Successful Colorectal ESD
Bo-In Lee, Takahisa Matsuda
Clinical Endoscopy.2019; 52(2): 100. CrossRef
Comparison of endoscopic ultrasonography and magnifying endoscopy for assessment of the invasion depth of shallow gastrointestinal neoplasms: a systematic review and meta-analysis
Zhang Tao, Chen Yan, He Zhao, Jiawei Tsauo, Xiaowu Zhang, Bing Qiu, Yanqing Zhao, Xiao Li
Surgical Endoscopy.2017; 31(12): 4923. CrossRef
Use of confocal laser endomicroscopy with a fluorescently labeled fatty acid to diagnose colorectal neoplasms
Feihong Deng, Yuan Fang, Zhiyong Shen, Wei Gong, Tao Liu, Jing Wen, Wanling Zhang, Xianjun Zhu, Hui Zhong, Tong Wang, Fachao Zhi, Biao Nie
Oncotarget.2017; 8(35): 58934. CrossRef
Higher net change of index of hemoglobin values between colon polyp and nonpolyp mucosa correlates with the presence of an advanced colon adenoma
Wei‐Chun Cheng, Hsiu‐Chi Cheng, Po‐Jun Chen, Jui‐Wen Kang, Er‐Hsiang Yang, Bor‐Shyang Sheu, Wei‐Ying Chen
Advances in Digestive Medicine.2016; 3(4): 161. CrossRef
Brief Education on Microvasculature and Pit Pattern for Trainees Significantly Improves Estimation of the Invasion Depth of Colorectal Tumors
Joon Sung Kim, Bo-In Lee, Hwang Choi, Bong Koo Kang, Jong In Kim, Hae Mi Lee, Eun-Joo Im, Byung-Wook Kim, Sang-Woo Kim, Myung-Gyu Choi, Kyu Yong Choi
Gastroenterology Research and Practice.2014; 2014: 1. CrossRef
Clinical Usefulness of Magnifying Chromoendoscopy and Magnifying Narrow Band Imaging Endoscopy for Predicting the Submucosal Invasion of Early Colorectal Cancers
Kwang An Kwon, Yang Suh Ku
Clinical Endoscopy.2013; 46(2): 113. CrossRef

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Focused Review Series: What Should We Know about EUS-FNA?

Endoscopic Ultrasound-Guided Fine Needle Aspiration in Hollow Viscus Cancer: Eun Young Kim; Clin Endosc 2012;45(2):124-127. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.124

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Accurate cancer staging is essential in patients with hollow viscus malignancy to decide therapeutic modalities. Endoscopic ultrasound (EUS) is considered as the best modality for local staging of hollow viscus cancer. EUS-guided fine needle aspiration (FNA) is a minimally invasive and effective sampling method. EUS-FNA should be applied when positive diagnosis of malignancy can possibly change the choice of therapeutic options. EUS in conjunction with EUS-FNA can optimize stage-directed therapy which is helpful in selecting minimally invasive treatment option including endoscopic treatment and avoiding unnecessary surgery in advanced cases.

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Endoscopic Ultrasound, Where Are We Now in 2012?
Eun Young Kim
Clinical Endoscopy.2012; 45(3): 321. CrossRef

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Diagnostic Accuracy of Computed Tomography for the Lymph Node Staging of Endoscopically Resectable Early Gastric Cancer: Tae-Hoon Oh, M.D., Ban-Suck Lee, M.D., Min-Geun Kim, M.D., Jeong Soo Ahn, M.D., Tae Joo Jeon, M.D., Dong Dae Seo, M.D., Won Choong Choi, M.D., Won Chang Shin, M.D., Myeong-Ja Jeong, M.D.* and Hyun-Jung Kim, M.D.^†; Korean J Gastrointest Endosc 2008;37(2):90-96. Published online August 30, 2008

Abstract PDF: Background/Aims: Accurate staging of the lymph nodes (LNs) before endoscopic mucosal resection (EMR) is important. We evaluated the accuracy of CT for LN staging in patients the endoscopically resectable early gastric cancer (EGC). Methods: The medical records of 155 EGCs patients who had undergone an operation were analyzed. The pre-operatively performed multidetector CT scans and the post-operative histopathologic findings were reviewed for comparing the LN staging with that using the Japanese classification system. Endoscopically resectable EGC was defined as EGC without LN metastasis and also the EGC that satisfied the EMR criteria according to the Japanese guideline. Results: The diagnostic efficacy of CT for LN staging of all the enrolled EGC patients was as follow: accuracy 65.2%, overstaging rate 29.7%, understaging rate 5.2%. The overall accuracy and the overstaging rate of CT for LN staging of endoscopically resectable EGC were as follows: EGC without LN metastasis [69.8% (97/139), 30.2% (42/139)], EGC satisfying extended criteria [72.5% (58/80), 27.5% (22/80)] and EGC satisfying limited criteria [79.2% (19/24), 20.8% (5/24)]. The accuracy of the EMR criteria for predicting node negative EGC were as follows: the extended criteria 98.8% (79/80), the limited criteria 100% (24/24). Conclusions: Our study showed that prediction of LN metastasis before EMR according to CT staging had limited value due to the tendency of overestimation. Therefore, we should preferentially consider the treatment strategy according to the EMR criteria. (Korean J Gastrointest Endosc 2008;37:90-96)

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The Usefulness of Endoscopic Ultrasonoraphy for Discriminating Gastric Mucosal Cancer from Submucosal Invasion: Seung Hyun Lee, M.D., Yong Seok Jang, M.D., Sang Hoon Jeon, M.D., Seong Yeol Kim, M.D., Byoung Kuk Jang, M.D., Woo Jin Chung, M.D., Kwang Bum Cho, M.D., Kyung Sik Park, M.D. and Jae Seok Hwang, M.D.; Korean J Gastrointest Endosc 2007;34(5):244-250. Published online May 30, 2007

Abstract PDF: Background/Aims: Endoscopic ultrasonography (EUS) has been used to discriminate gastric mucosal cancer (T1m) from submucosal invasion (T1sm). Thus the aims of this study are 1) to determine the accuracy of EUS for diagnosing tumor depth, 2) to compare the accuracy of EUS with the endoscopic impressions of variously experienced endoscopists and 3) to compare the accuracy of performing EUS by one doctor according to the experience. Methods: The EUS and pathologic reports of early gastric cancer patients were analyzed. The same endoscopic images were reviewed again by 3 endoscopists, who had one-, three- and five-years experience, respectively. The accuracies of EUS and conventional endoscopy were analyzed. Results: 77 patients were included from November 2003 to October 2005. The κ of the EUS for actual examiner and conventional endoscopy for reviewer 1, reviewer 2 and reviewer 3 were 0.421, 0.134, 0.359 and 0.307, respectively and accuracies were 68.8%, 45.5%, 67.5% and 62.3%, respectively. Of the 52 T1m patients, 23 (44.2%) were overstaged as T1sm with performing EUS. But of 25 T1sm patients, only 1 (4.0%) was understaged as T1m with performing EUS. The accuracy and κ of the EUS for one doctor during the first-year experience were 60.6% and 0.316, respectively, and they were 75.0% and 0.508, respectively during the second-year experience. Conclusions: EUS is useful for complementing the conventional endoscopic discrimination of gastric mucosal cancer from submucosal invasion. Yet physician should keep in mind the relatively common overstaging. (Korean J Gastrointest Endosc 2007;34:244⁣250)

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위암의 병기 결정에 있어서 내시경초음파검사와 위에 물을 채우고 시행하는 복부초음파검사의 비교 ( A Comparison of Endoscopic Ultrasonography with Transabdominal Ultrasonography of Water-Filled Stomach in the Accuracy of Staging of Gastric Cancer ): Korean J Gastrointest Endosc 1999;19(5):721-729. Published online November 30, 1998

Abstract PDF: Background
/Aims: There was no single method satisfying accuracy, patient compliance and cost in preoperative staging of gastric cancer. A transabdominal ultrasonography of water-filled stomach (TUS) was compared with endoscopic ultrasonography (EUS) for TN staging in operated gastric cancer. Methods: We performed EUS conventionally and TUS immediately after 600 mL deaerated water ingested in 40 patients with gastric cancer prior to operation. All the cases were operated and the histological findings were compared with the results of preoperative TN staging. Results: The overall T-staging accuracy rate of TUS was 62.5% and 55.0% for EUS. Both TUS and EUS could differentiate EGC from AGC in 85.0%. There was no statistical difference in the accuracy for the depth of cancer invasion between EUS and TUS. Differentiation of the cancer defined within the gastric wall (T3) from the cancer invading adjacent organs (T4) was possible in 92.5% for TUS and 87.5% for EUS. The accuracy of determining the depth of invasion was tent to be lower in fundus than in antrum and body. Lymph node metastasis was correctly diagnosed in 67.5% for TUS and in 70.0% for EUS. Conclusions: TUS may be a considered to be a relatively accurate and simple method for preoperative staging of gastric cancer in the absence of available EUS. (Korean J Gastrointest Endosc 19: 721∼729, 1999)

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직직장암의 수술전 병기판정을 위한 경직장 초음파단층촬영술의 효용성 (The Efficacy of Endorectal Ultrasonography in the Preoperative Staging of Rectal Cancer): Korean J Gastrointest Endosc 1999;19(2):200-208. Published online November 30, 1998

Abstract PDF: Background
/Aims: The precise preoperative staging of rectal cancer is of great im-portance for the selection of an appropriate treatment. Endorectal ultrasonography (EUS) has been proven as an efficient tool for staging in rectal cancer. Moreover, its technical advancement has been enhancing resolution and applications. We evaluated the accuracy of preoperative staging using EUS in rectal cancer and examined whether staging by EUS was an efficient procedure. Methods: EUS was performed in 79 patients with rectal cancer diagnosed by colonoscopic biopsy from January to December, 1996. Endoscopic examina-tion was used with Olympus, GF-UM20 and Br?l and Kjaer type 2001 Scanner. The staging by EUS was based on UICC classification. Results: Preoperative staging by EUS was equal to pathologic staging in 70.9% (56/79) of cases. Overstaging was found in 17.7% (14/79) and downstaging in 11.4% (9/79). The prediction of lymph node metastases was accurate in 50 of 79 cases (63.3%). Conclusion: EUS seems to be an efficient diagnostic method to assess rectal cancer staging. More accurate imaging and further experience in the interpretation is needed to improve the efficacy of EUS. (Korean J Gas-trointest Endosc 19: 200 ∼208, 1999)

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식도암의 심달도 판정에 있어서 내시경적 초음파검사의 유용성 (Role and Limit of Endoscopic Ultrasonography in Staging for Esophageal Cancer ): Korean J Gastrointest Endosc 1999;19(2):178-185. Published online November 30, 1998

Abstract PDF: Background
Despite the technical developments in diagnosis and therapy, esophageal cancer is highly lethal disease and the survival is largely dependent upon the stage of the disease. Preoperative cancer staging is crucial in choosing a therapeutic option as well as in predicting the prognosis of the patients. Staging has been based on computerized tomography (CT) and transabdominal ultrasonography. However CT has a limit in pre-cisely discriminating the depth of invasion or the lymph node metastases. With the devel-opment of endoscopic ultrasonography (EUS) and with its superiority in delineating wall structure and detecting lymph node metastases, its usefulness in staging for esophageal cancer has been cknowledged. In order to evaluate the accuracy of EUS, we compared EUS with pathologic findings in patients with esophageal carcinoma. Methods: From July 1990 to August 1997, 136 patients with esophageal cancer received preoperative cancer staging with EUS. Among them, 48 patients who underwent surgical procedures with the intention of radical resection were included. We compared the EUS and pathologic find-ings and analysed the accuracy of EUS for preoperative staging. Results: The overall accu-racy of EUS for T-staging was 43.8%. Twenty five percents of the patients (12/48) pre-sented high-grade tumor strictures, which precluded the passage of the endoscope. There was no statistical significance according to tumor site, size or gross morphology. However theaccuracy was significantly lower in tumors with ulceration than in tumors without ulceration (35.3% vs 64.3%, p=0.004). Mainly, ulceration in tumors caused significant overstaging of the T-stage. In the assessment of regional lymph node metastasis, the overall accuracy achieved by EUS was 66.6%; the sensitivity was 95.5%, specificity 42.3%, positive predictive value 58.3%, and negative predictive value 91.7%. Tumors with more than 2 lymph nodes rendered more accurate N-staging than tumors with less than 2 lymph nodes. Conclusions: In conclusion, the accuracy of the EUS for preoperative staging of esophageal cancer was not satisfactory, mostly influenced by ulceration in tumors and its resultant inflammatory reactions around the tumors, therefore more systematic study will be needed to establish the precise diagnostic criteria of EUS staging. (Korean J Gastrointest Endosc 19: 178 ∼185, 1999)

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위암의 심달도 판정에 있어서 내시경초음파검사상 오진된 예들의 병리조직학적소견의 검토 ( Pathologic Findings Affecting the Diagnostic Accuracy in Determining the Depth of Invasion of Gastric Cancer by Endoscopic Ultrasonography ( EUS ) ): Korean J Gastrointest Endosc 1993;13(3):545-549. Published online November 30, 1992

Abstract PDF: Endoscopic ultrasonography(EUS) has been used in assessing the depth of cancer invasion of the stomach. However, there are pathologic findings coexisting cancers which are unable to be detected by EUS resulting in mis-staging preoperatively. To find out the causes of mis-staging in determining the depth of cancer invasion, we analysed the pathologic findings of mis-staged cases of gastric cancer by EUS. (continue...)

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식도암의 병기결정에 있어서 내시경초음파검사의 유용성 : 예비보고 ( The Role of Endoscopic Ultrasonography in Staging of Esophageal Cancer : Preliminary Report ): Korean J Gastrointest Endosc 1993;13(3):539-543. Published online November 30, 1992

Abstract PDF: The prognosis of esophageal cancer is poor and strategies for treatment depend on the tumor stage at the time of diagnosis. Surgery is the main therapeutic modality in esophageal cancer and known as the only treatment for cure. Preoperatively it is most important to assess whether the primary tumor is completely resectable or not. Previous staging modality such as CT can not clearly define the depth of invasion and lymph node metastasis of esophageal cancer which is the most important factor in assessing the possibility of curative resection. Endoscopic ultrasonography is now considered as an useful method in evaluating staging and resectability of esophageal cancer. We compared the findings of endoscopic ultrasonography with pathology result to evaluate the accuracy of this new technique in staging of esophageal cancer in 4 esophageal cancer patients who received surgery among the 23 patients assessed by endoscopic ultrasonography due to esophageal cancer, The depth of invasion, lymph node metastasis, and staging was correct in 3 among 4 patients. We consider endoscopic ultrasonography is an useful technique in staging of esophageal cancer.

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