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A specific role of endoscopic ultrasonography for therapeutic decision-making in patients with gastric cardia cancer

 Chan Hyuk Park  ;  Jun Chul Park  ;  Hyunsoo Chung  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
 Surgical Endoscopy , Vol.30(10) : 4193-4199, 2016 
Journal Title
 Surgical Endoscopy  
Issue Date
Adenocarcinoma/diagnostic imaging* ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Aged ; Cardia/diagnostic imaging* ; Cardia/pathology ; Clinical Decision-Making* ; Endoscopic Mucosal Resection/methods ; Endoscopy ; Endosonography* ; Female ; Gastrectomy ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms/diagnostic imaging* ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery ; Tumor Burden
Cardia ; Endoscopic ultrasonography ; Gastric cancer ; Invasion depth ; Underestimation
BACKGROUND: The role of endoscopic ultrasonography (EUS) in gastric cardia cancer should be further evaluated because the accuracy of EUS depends on tumor location. We aimed to identify a specific role of EUS for therapeutic decision-making in patients with gastric cardia cancer. METHODS: Initial EUS examinations for treatment-na?ve gastric cancer that were followed by endoscopic resection or surgery were included in the study. Lesions were classified as cardiac and non-cardiac cancer according to tumor location. The diagnostic performance of EUS in predicting invasion depth was compared between the two groups. RESULTS: The overall accuracy of EUS in predicting invasion depth did not differ between the cardiac and non-cardiac cancer groups (44.4 vs. 52.3 %, P = 0.259). The underestimation rate was higher in the cardiac cancer group than in the non-cardiac cancer group (37.0 vs. 18.5 %, P = 0.001). When the depth of invasion was predicted to be deeper than the mucosa (submucosal or deeper) by EUS, the positive predictive value was 82.1 [95 % confidence interval (CI), 66.5-92.5 %] and 62.9 % (95 % CI, 60.5-66.9 %) in the cardiac and non-cardiac cancer groups, respectively (P = 0.015). In multivariable analysis, tumor location in the cardia was found to be an independent factor for the underestimation of invasion depth [odds ratio (95 % CI) = 2.242 (1.156-4.349)]. CONCLUSIONS: The underestimation rate in predicting invasion depth was significantly higher for cardiac cancers than for non-cardiac cancers. Therefore, selection of the treatment method for gastric cardia cancer via EUS should be done carefully.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Chung, Hyun Soo(정현수)
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