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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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1/2021
vol. 16
 
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abstract:
Original paper

Preoperative imaging evaluation of the absolute indication criteria for endoscopic submucosal dissection in early gastric cancer patients

Hong-Peng Shi
1
,
Wei Wu
2
,
Ben-Yan Zhang
3
,
Maneesh-Kumarsing Beeharry
4
,
Tie-Nan Feng
5
,
Zheng-Gang Zhu
1
,
Fei Yuan
3
,
Zhenglun Zhu
1

  1. Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  2. Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  3. Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  4. Department of Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  5. Clinical Research Insititute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Videosurgery Miniinv 2021; 16 (1): 45–53
DOI: https://doi.org/10.5114/wiitm.2020.94270
Online publish date: 2020/04/07
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Introduction
Gastric cancer (GC) is a common malignant tumor with a high mortality rate.

Aim
To determine the accuracy of preoperative imaging information obtained from the combined use of general gastroscopy (GS), endoscopic ultrasonography (EUS), and multi-detector computed tomography (MDCT) regarding absolute indication of endoscopic submucosal dissection (ESD) in early gastric cancer (EGC).

Material and methods
The relationship between clinical features of 794 EGC patients and lymph node metastasis (LNM) was analyzed. Multivariate logistic regression analysis was used to investigate the risk factors for LNM. Additionally, the accuracy of diagnosis of imaging techniques for ESD indications was determined by receiver operating characteristic (ROC) analysis.

Results
Data showed that tumor size > 2 cm (p = 0.0071), T1b stage (p < 0.0001), undifferentiated histology (p < 0.0001), and vascular invasion (p = 0.0007) were independent risk factors for LNM in patients with EGC. Indications for ESD have a specificity of 100% for the diagnosis of patients with LNM. Additionally, the diagnostic efficacy of the use of GS, EUS, and MDCT in identifying node positive status, T1a disease, tumor size ≤ 2 cm, and ulceration was found to be moderate with area under the curve (AUC) of receiver operating characteristic curve (ROC) of 0.71, 0.64, 0.72, and 0.68, respectively. Furthermore, the use of imaging techniques for overall indication criteria for ESD had a moderate utility value with an AUC of 0.71.

Conclusions
Our data suggested that, based on the combined use of GS, EUS, and MDCT, a high specificity of patient selection for ESD treatment can be achieved.

keywords:

early gastric cancer, endoscopic submucosal dissection, absolute indication
  
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