Specificity Of Endoscopic Ultrasonography Research Articles

Comparison of Endoscopic Ultrasound and Transabdominal Ultrasound in the Detection of Gallbladder and Common Bile Duct Microlithiasis.

Endoscopic ultrasonography (EUS) is an emerging method with a wide range of potential uses in gastroenterology, including the detection of bile duct stones and the identification of early ductal alterations in suspected patients. This study was designed to compare the diagnostic yield of EUS and transabdominal ultrasound (TUS) in the detection of gallbladder and common bile duct (CBD) microlithiasis. Patients with biliary colic with normal initial TUS were the subjects of this prospective study. EUS scan was performed on all recruited patients and linear endoscopes were used for the EUS examination. Cholecystectomy and histological analysis were done in patients within two weeks after EUS revealing cholelithiasis whereas the cases of CBD stone/microlithiasis were confirmed by endoscopic retrograde cholangiopancreatography (ERCP). The mean values of all hematological characteristics were independently determined for males and females and then compared using Student's t-test. For statistical significance, a p-value of 0.05 or below was used. A total of 131 patients, including 77 females and 54 males, with a mean age of 38.41 ± 14.78 years were examined. All 78 (59.5%) individuals who had cholecystectomy were found to have gallstones or microlithiasis as successfully diagnosed by EUS. The sensitivity and specificity of EUS were 92.9% and 100%, respectively, for CBD stones and 98.8% and 100%, respectively, for the detection of gallbladder microlithiasis. The agreement between EUS and TUS was fair for CBD stones (κ = 0.214) and very weak for microlithiasis (κ = -0.093). EUSdemonstrates a superior yield over TUSin detecting gallbladder stones and CBD microlithiasis, offering a more reliable diagnostic modality. This was a single-center study.

Diagnostic Performance of Endoscopic Ultrasonography with Water-Filled Balloon Method for Superficial Esophageal Squamous Cell Carcinoma.

Endoscopic ultrasonography (EUS) is a commonly used tool for preoperative depth diagnosis of superficial esophageal squamous cell carcinoma (ESCC). Probing EUS using the water-filled balloon method is a simple and safe examination. The aim of this study was to clarify the diagnostic performance of EUS with the water-filled balloon method for superficial ESCC compared to magnifying narrow-band imaging (ME-NBI). We retrospectively examined 403 lesions in 393 consecutive patients diagnosed with ESCC and evaluated them with ME-NBI and EUS. Clinicopathological findings were collected, and the accuracy of the preoperative diagnosis was compared between ME-NBI and EUS-B. EUS examiners were not blinded to prior ME-NBI results, and EUS results may have been influenced by ME-NBI results. The pathological tumor depth of the EP/LPM in 152 lesions, MM/SM1 in 130 lesions, and deep submucosa (SM2/SM3) in 121 lesions was examined. The proportion of total lesions with an accurate diagnosis was significantly higher in EUS than in ME-NBI (67.7% versus 62.0%, P = 0.015). When analyzed by clinical depth diagnosis using ME-NBI, the proportion of lesions with an accurate diagnosis was significantly higher for EUS in MM/SM1 (55.7% versus 46.1%, P = 0.033). The sensitivity was significantly higher in EUS for SM2/SM3 lesions (76.0% versus 54.5%, P < 0.001). The accuracy and specificity of EUS, which differentiate MM/SM1 from EP/LPM or SM2/SM3, were significantly higher than those of ME-NBI. The median endoscopic ultrasonography procedure time was approximately 6.5min. EUS with the water-filled balloon method is a safe and straightforward method that can be performed on lesions clinically diagnosed as MM/SM1 using ME-NBI. We retrospectively reviewed lesions in patients diagnosed with ESCC and evaluated them using magnifying endoscopy with narrow-band imaging (ME-NBI) and endoscopic ultrasound using the water-filled balloon method (EUS-B). We conclude that EUS-B can increase the diagnostic accuracy.

Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones

BACKGROUNDCholedocholithiasis develops in up to 20% of patients with gall bladder stones. The challenge in diagnosis usually occurs with small stones that may be missed by magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasound (EUS) is accurate in detecting common bile duct (CBD) stones missed by MRCP, especially the small ones or those impacted at the distal CBD or the papillary region. AIMTo evaluate the accuracy of EUS in detecting CBD stones missed by MRCP. METHODSPatients with an intermediate likelihood of choledocholithiasis according to ESGE guidelines and those with acute pancreatitis of undetermined cause were included. The presence of choledocholithiasis was evaluated by MRCP and EUS, and then results were confirmed by endoscopic retrograde cholangiopancreatography (ERCP). The sensitivity and specificity of EUS and MRCP were compared regarding the presence of stones, the size, and the number of detected stones. RESULTSNinety out of 100 involved patients had choledocholithiasis, while ten patients were excluded as they had pancreatic or gall bladder masses during EUS examination. In choledocholithiasis patients, the mean age was 52.37 ± 14.64 years, and 52.2% were males. Most patients had biliary obstruction (74.4%), while only 23 (25.6%) patients had unexplained pancreatitis. The overall prevalence of choledocholithiasis was 83.3% by EUS, 41.1% by MRCP, and 74.4% by ERCP. Also, the number and size of CBD stones could be detected accurately in 78.2% and 75.6% by EUS and 41.1% and 70.3% by MRCP, respectively. The sensitivity of EUS was higher than that of MRCP (98.51% vs 55.22%), and their predictive value was statistically different (P < 0.001). Combination of both tools raised the sensitivity to 97.22% and specificity to 100%. CONCLUSIONEUS could be a useful tool in assessing patients with suspected choledocholithiasis especially if combined with MRCP. However, its usefulness depends on its availability and the experience of the local centers.

Systematic review and meta-analysis of endoscopic ultrasonography in staging diagnosis of esophageal cancer after neoadjuvant radiotherapy and chemotherapy.

BackgroundClinically, it is necessary to evaluate the overall situation of the tumor before treatment, understand the disease stage of the patient, and choose the most reasonable treatment plan. Therefore, it is necessary to seek an efficient and accurate staging diagnosis method. Endoscopic ultrasonography (EUS) is widely used in staging esophageal cancer, but its accuracy will be affected by the experience of endoscopic diagnosis physicians.MethodsComputer retrieval PubMed, MEDLINE, EBSCO, Science Direct, Cochrane Library, China National Knowledge Infrastructure (CNKI). Relevant literatures published from the database establishment to January 2022 were searched using “Endoscopic ultrasound, esophageal cancer, neoadjuvant chemotherapy, diagnosis, tumor node metastasis” as the detection term. Quality assessment of diagnostic accuracy studies (QUADAS) was used to evaluate the quality of the included literatures, Q test and heterogeneity (I2) was adopted to evaluate the heterogeneity among various studies, and the sensitivity and specificity of EUS were calculated and compared in evaluating various stages of esophageal cancer.ResultsA total of 12 articles and 824 patients were included. 12 literatures on EUS in diagnosis of T staging were included for heterogeneity test, the combined sensitivity of T1–T4 stage was 0.16 (95% CI: 0.05–0.39), 0.34 (95% CI: 0.20–0.52), 0.78 (95% CI: 0.63–0.88), 0.16 (95% CI: 0.04–0.50). The combined specificity was 0.99 (95% CI: 0.94–1.00), 0.52 (95% CI: 0.36–0.68), 0.98 (95% CI: 0.95–0.99). According to the heterogeneity test of EUS n staging in 9 literatures, the combined sensitivities of N0-N1 stage was 0.62 (95% CI: 0.53–0.71) and 0.65 (95% CI: 0.58–0.72), combined specificities was 0.65 (95% CI: 0.58–0.71) and 0.63 (95% CI: 0.54–0.72).DiscussionBased on the results, EUS is not a good diagnostic test for TNM staging.

Endoscopic Ultrasonography (EUS) Compared with Magnetic Resonance Cholangiopancreatography (MRCP) in Diagnosing Patients with Malignancy Causing Obstructive Jaundice

Background: The common etiologies of obstructive jaundice were biliary stone and biliary neoplasms. The gold standard to diagnose malignancy causing obstructive jaundice is endoscopic retrograde cholangiopancreatography (ERCP) with sensitivity and specificity of 95% and 100%. However, ERCP is an invasive procedure associated with several complications such as bleeding, pancreatitis, and perforation. Other modalities include endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). Thus, we aim to evaluate the sensitivity and specificity of EUS with MRCP in patients with malignancy causing obstructive jaundice.Method: This was a cross-sectional study that calculates the sensitivity and specificity of EUS and MRCP in diagnosing malignancy causing obstructive jaundice compared with the gold standard, histopathology examination from ERCP. The study was conducted in the Medical Record Unit, Gastroenterology Division, Dr. Cipto Mangunkusumo National General Hospital, on January – March 2019 by using a consecutive sampling method. The date of diagnosis was collected from the medical record within five years. Subjects were selected based on inclusion criteria which include patients aged ≥ 18 years old who were diagnosed with malignancy causing obstructive jaundice by ERCP, and had underwent EUS or MCRP with a maximum interval of 3 months to ERCP. The exclusion criteria include patients with previous evidence of biliary tract malignancy or concurrent parenchymal jaundice. Statistical analysis was performed using IBM SPSS Statistics 20.Results: There were 54 subjects with a mean age of 56.48 ± 11.37 years. Subjects consisted of 29 (53.7%) males and 25 (46.3%) females. The median period between EUS to ERCP was 0-33 days, while MRCP to ERCP was 1-53 days. The sensitivity, specificity, positive predictive value, and negative predictive value to diagnose obstructive jaundice due to malignancy were 96%, 60%, 96%, 60% in EUS, and 90%, 40%, 94%, 29% in MRCP, respectively.Conclusion: EUS was more superior to MRCP in the diagnosis of malignancy causing obstructive jaundice.

Determining when endoscopic ultrasound (EUS) changes management for patients with pancreatic cystic neoplasms.

641 Background: Pancreatic cystic neoplasms (PCNs) are being incidentally detected at an increased rate due to the widespread use of CT and MRI. CT and MRI cannot always differentiate between malignant and benign PCNs. EUS is an emerging tool that provides higher quality descriptions of pancreatic cysts and can be used to differentiate between benign and malignant features. Considering that EUS is a resource dependent tool, we hope to identify the PCN cases in which EUS changes management. Methods: We conducted a retrospective case-control chart review evaluating patients, who were diagnosed with pancreatic cysts and underwent EUS for analysis between January 1, 2010 and December 31, 2017. We determined whether EUS correctly identified high-risk features (HRFs) relative to CT/MRI and whether EUS upstaged or downstaged the CT/MRI diagnosis to change overall patient management. Results: EUS was found to have a high specificity (&gt; 95%) for all high-risk features identified in the AGA and FG guidelines and a low sensitivity ( &lt; 70%) for all high risk features except cyst size &gt; 3cm (82.35%) and mural nodule &lt; 5mm (100%). EUS was found to change management in 29.4% of cases (18.2% upstaged, 11.2% downstaged). EUS screening led to a total of three adenocarcinoma diagnoses, in which two were reported to be invasive. Conclusions: The high specificity of EUS supports its use in the differentiation of high risk PCNs identified on cross-sectional imaging. Its low sensitivity indicates that the reliance on operator experience may be a substantial limitation resulting in inconclusive diagnoses. In conclusion, considering that EUS is successful in changing patient management of PCNs, it should be readily referred when any HRF is identified on cross-sectional imaging.

Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy in Gastrointestinal Subepithelial Tumors.

The incidence of asymptomatic and incidentally found upper gastrointestinal subepithelial tumors (SETs) is increasing with the implementation of national cancer screening and the development of high-resolution endoscopy in Korea. However, endoscopy alone cannot be used to determine whether SETs are benign or malignant. Endoscopic ultrasound (EUS) is used to further characterize these lesions through the examination of their layered structure, internal echogenicity, size, and relationship to the extramural structure. These provide additional information on whether the lesion is benign or malignant. Nevertheless, the sensitivity and specificity of EUS alone in predicting malignancy is unsatisfactory. Recent guidelines have recommended deciding the timing of EUS-fine needle aspiration and biopsy (EUS-FNA/B) for SETs based on tumor size, malignant features on endoscopy, and high-risk features on EUS. The diagnostic accuracy of EUS-FNA/B is reportedly influenced by factors including needle size, number of needle passes, use of suction, use of a stylet in the needle assembly, fanning technique, availability of an on-site cytopathologist, and experience of the endosonographer. Therefore, according to the characteristics of the SETs, various subsequent methods and techniques should be appropriately employed to improve the diagnostic yield of EUS-FNA/B.

An investigation into the sensitivity of endoscopic ultrasound in the diagnosis of malignant bile duct in patients with idiopathic acute pancreatitis.

Introduction and Objective:Acute pancreatitis (AP) is an inflammatory process of the pancreas characterized by abdominal pain and increased pancreatic enzymes. This disease is diagnosed clinically. Endoscopic ultrasound (EUS), which is a technique with high sensitivity and specificity, is used to diagnose biliary disease. This study aimed to determine the sensitivity of EUS in the diagnosis of malignant bile duct in patients with idiopathic AP.Methods:This descriptive study was performed on 146 patients with pancreatitis hospitalized in the gastrointestinal tract section of the Imam Khomeini Hospital of Ahwaz Jundishapur University of Medical Sciences. The collected data were analyzed by the SPSS 22.0 and the significance level of the test was <0.05.Results:According to the results, 79 (54%) out of the 146 patients were female and 67 (46%) were male. The mean and standard deviation of the patients’ age were 52.5 and 19.6 years, respectively. The findings showed that the sensitivity and specificity of the EUS were 33% and 99%, respectively. Compared to the endoscopic retrograde cholangiopancreatography (ERCP), the sensitivity and specificity of the abdominal ultrasound were 62% and 62.5%, respectively. Compared to the ERCP, the sensitivity and specificity of EUS were 92% and 50%, respectively.Conclusion:The findings of this study showed that the sensitivity and specificity of EUS were higher than those of abdominal ultrasound. Moreover, EUS was the preferred method to detect common bile duct stones (CBDS).

Magnetic Resonance Cholangiopancreatography versus Endosonography in Diagnosing Biliary Ducts Obstruction

Background: biliary obstruction or cholestasis is a common medical or surgical problem. Broadly speaking, the causes can be divided into intrahepatic and extrahepatic. The diagnosis of biliary tree can be done by different imaging modalities starting from transabdominal ultrasonography, to magnetic resonance cholangeopancreatograpy (MRCP) to endoscopic ultrasonography (EUS) and endoscopic cholangeopancreatography (ERCP) for diagnosis and treatment. Aim of the present work: this study aimed to evaluate the accuracy of these different modalities when compared to ERCP as diagnostic methods for diagnosis of different biliary tree abnormalities. Patients and methods: eighty-four patients with obstructive jaundice were included and categorized into two groups group I: 56 patients with calcular obstructive jaundice, group II: 28 patients with non-calcular obstruction. Patients underwent history taking, clinical examination and routine laboratory investigations as well as tumor markers. Patients were examined by US, MRCP, EUS, ERCP and the findings of each modality were compared to ERCP. Results: the sensitivity and specificity of US in diagnosis of intrahepatic biliary dilatation (IHBRD) and common bile duct (CBD) dilatation were 81% , 100% and 33% and 100% for diagnosis of pancreatic tumors respectively. The sensitivity and specificity of MRCP in diagnosis of IHBRD was 97% and 100% successively and for CBD dilatation 79% and 100% successively and for diagnosis of pancreatic tumors 100% and 96% successively. The sensitivity and specificity of EUS in diagnosis of IHBRD were 100% and 100% successively and for CBD dilatation were 100% and 100% successively but in diagnosis of pancreatic tumors were 100% and 94% successively. Conclusion: Both MRCP and EUS were good diagnostic modalities for biliary obstruction and pancreatic tumors with sensitivity and specificity of >90% when compared to ERCP.

RA08.04: IMPORTANT ENDOSCOPIC AND HISTOPATHOLOGICAL CHARACTERISTICS FOR PREDICTING SUBMUCOSAL TUMOR INVASION IN SUPERFICIAL BARRETT ADENOCARCINOMA

Abstract Background Predicting the depth of invasion of superficial Barrett adenocarcinoma (s-BA) is important for choosing an appropriate treatment. This study aimed to evaluate the endoscopic and histopathological characteristics related to s-BA submucosal invasion. Methods We retrospectively reviewed 67 lesions in 63 cases with pathologically defined s-BA (SSBE, n = 56; LSBE, n = 7) that underwent endoscopic resection at our hospital from January 2004 to December 2017. Initial treatment included endoscopic mucosal resection (EMR) (n = 4), endoscopic submucosal dissection (ESD) (n = 99), and surgery (n = 33). We grouped 133 lesions into two groups based on depth of tumor invasion: group M comprised 87 intramucosal tumors and group SM comprised 49 submucosal tumors. We defined characteristic criteria for submucosal invasion as follows: tumor size ≥ 21 mm, complex macroscopic type; composed of &gt; 2 macroscopic types, biopsy-por; biopsy specimens including poorly differentiated adenocarcinoma. Endoscopic ultrasound (EUS) was performed only in cases in which predicting the depth of tumor invasion was difficult. Results In group M, the median tumor diameter was 13 (range, 1–82) mm and included 68 SSBEs and 19 LSBEs. In group SM, the median tumor diameter was 23 (range, 4–55) mm and included 41 SSBEs and 8 LSBEs. Tumors larger than 21 mm were seen in 12 (13.8%) patients in group M and 25 (51.0%) in group SM. Complex macroscopic type tumors were present in 20 patients (23.0%) in group M and 30 (61.2%) in group SM. Biopsy-por was present in 2 (2.3%) in group M and 12 (24.5%) in group SM. Multivariate analysis indicated the above three characteristics as independent predictors of submucosal invasion; in particular, biopsy-por was highly significant (P &lt; 0.001, odds ratio, 10.81). EUS was performed in 55 lesions including 28 tumors invading the submucosa. Sensitivity, specificity, positive predictive value, and negative predictive value of EUS for predicting submucosal invasion were 46.4%, 70.4%, 61.9%, and 57.5%, respectively. Conclusion Tumor size ≥ 21 mm, complex macroscopic type, and biopsy specimens including poorly differentiated adenocarcinoma were independent predictors of submucosal invasion. Specificity of EUS was relatively high for cases that were difficult to predict depth of tumor invasion. Disclosure All authors have declared no conflicts of interest.

Preoperative accuracy of gastric cancer staging in patient selection for preoperative therapy: race may affect accuracy of endoscopic ultrasonography.

Over the last 15 years, large randomized controlled studies have validated the benefit of preoperative therapy for patients with resectable gastric cancer. Computed tomography (CT) and endoscopic ultrasonography (EUS) are commonly used to select patients for preoperative treatment, but studies of preoperative staging accuracy that focus on patient selection for preoperative therapy are rare; therefore, whether CT or EUS can reliably identify patients eligible for preoperative therapy is still unclear. Our purpose was to determine the accuracy of EUS and CT for preoperative staging of gastric cancer and to identify factors that may affect their usefulness in selecting patients for preoperative therapy. We reviewed the medical records of 8,260 patients with gastric or gastroesophageal adenocarcinoma treated at our institution from 1995 to 2013, identifying those who underwent gastrectomy without preoperative treatment. We compared T stage and N status from preoperative EUS and CT reports with those drawn from surgical pathology reports. Clinicopathologic and demographic variables associated with incorrect preoperative staging were investigated using univariate and multivariate analyses. We identified 187 patients who underwent preoperative staging by EUS (n=145) and/or CT (n=134) before gastrectomy. The accuracy, sensitivity, and specificity of EUS in distinguishing stage T1 from more advanced tumors were 82%, 78%, and 85%, respectively. Variables associated with underestimation of EUS T stage were lymphovascular invasion [odds ratio (OR), 7.51; 95% confidence interval (CI), 1.91-29.50; P<0.01] and white race (OR, 3.75; 95% CI, 1.31-10.75; P=0.01). The accuracies, sensitivities, and specificities for determining N status were, respectively, 65%, 49%, and 79% with CT and 66%, 29%, and 95% with EUS. Lymphovascular invasion was associated with a false negative result (OR, 3.79; 95% CI, 1.34-10.70; P=0.01), and well- or moderately differentiated histology was associated with a false positive result for CT N status (OR, 7.14; 95% CI, 2.00-25.44; P<0.01). EUS is accurate in distinguishing T1 from T2-T4 lesions; both CT and EUS have low sensitivities and high specificities in determining N status. These accuracies and variables associated with inaccurate staging, including race, should be considered when selecting gastric cancer patients for preoperative therapy.

Diagnostic value of endoscopic ultrasonography for staging of early gastric cancer

Objective To analyze the diagnostic value of endoscopic ultrasonography (EUS) for staging of early gastric cancer(EGC) and its influential factors. Methods Clinical information of 120 EGC patients admitted from February 2009 to January 2016 was reviewed. Diagnostic accuracy and the influencing factors of EUS for the invasive depth were analyzed by comparing the results of preoperative EUS and the pathology. Results Thirty-six patients were over-staged by EUS, and 10 patients were under-staged among 120 EGC patients. The accuracy, sensitivity, specificity of EUS for the submucosal invasion were 61.67%(74/120), 58.33%(14/24), 62.50%(60/96) respectively. The accuracy, sensitivity and specificity for protruded EGCs (Type I) diagnosis were 74.36%(29/39), 50.00%(6/12), 85.19%(23/27) respectively; these three variables were 59.02%(36/61), 83.33%(5/6), 56.36%(31/55) respectively for flat EGCs(Type Ⅱ), and 45.00%(9/20), 50.00%(3/6), 42.86%(6/14)respectively for excavated EGCs(Type Ⅲ). The univariate factor results showed that differentiated degree, location and endoscopic morphology of the tumor were possible influential factors for over-stage. Multivariate factor results showed that flat type (OR=3.667, 95%CI: 1.086-12.386, P<0.05)and excavated type(OR=6.552, 95%CI: 1.421-30.218, P<0.05) were independent risk factors. Gender, age and tumor maximum diameter were not factors influencing the diagnostic accuracy of EUS. Conclusion The EUS shows higher clinical value for diagnosing the invasive depth in EGC. Tumor differentiated degree, location and endoscopic morphology may be the influencing factors for diagnostic accuracy of EUS. Flat type and excavated type may lead to over-staging. Key words: Endoscopic ultrasonography; Early gastric cancer; Neoplasm stage; Risk factors

Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis: The Indonesian Experience.

Background/AimsBiliary stone disease is one of the most common conditions leading to hospitalization. In addition to endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) are required in diagnosing choledocholithiasis. This study aimed to compare the sensitivity and specificity of EUS and MRCP against ERCP in diagnosing choledocholithiasis. MethodsThis retrospective study was conducted after prospective collection of data involving 62 suspected choledocholithiasis patients who underwent ERCP from June 2013 to August 2014. Patients were divided into two groups. The first group (31 patients) underwent EUS and the second group (31 patients) underwent MRCP. Then, ERCP was performed in both groups. Sensitivity, specificity, and diagnostic accuracy of EUS and MRCP were determined by comparing them to ERCP, which is the gold standard. ResultsThe male to female ratio was 3:2. The mean ages were 47.25 years in the first group and 52.9 years in the second group. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for EUS were 96%, 57%, 87%, 88%, and 80% respectively, and for MRCP were 81%, 40%, 68%, 74%, and 50%, respectively.ConclusionsEUS is a better diagnostic tool than MRCP for diagnosing choledocholithiasis.

Preoperative accuracy of gastric cancer staging in patient selection for neoadjuvant therapy.

34 Background: Because gastric cancers stage ≥ T2 or ≥ N1 are considered for neoadjuvant treatment, accuracy of preoperative staging is critical. The purpose of this study was to identify preoperative staging accuracies of computed tomography scan (CT) and endoscopic ultrasound (EUS) in gastric cancer and their utilities in selecting patients for neoadjuvant therapy. Methods: Medical records of 8,260 patients with gastric or gastroesophageal adenocarcinoma (presented 1995-2013) were reviewed to identify those who underwent gastrectomy but not neoadjuvant treatment. We reviewed preoperative EUS reports and CT images to identify detailed T stage (based on AJCC 7thedition) and lymph node positivity (short axis diameter ≥ 6mm). T stage and N status were compared with those from the surgical pathology report. Clinicopathologic variables associated with incorrect preoperative staging were also examined. Results: We identified 187 patients who underwent preoperative staging by EUS (n = 145) and/or CT (n = 134) for gastrectomy. The accuracy, sensitivity, and specificity of EUS in distinguishing T1 from more advanced tumors were 82%, 78%, and 85%, respectively. In univariate analysis, tumor location and lymphovascular invasion were associated with incorrect EUS T staging. In multivariate analysis, variables associated with underestimation of EUS T stage was lymphovascular invasion (OR 7.51, 95% CI 1.91-29.5, p &lt; 0.01) and Caucasian race (OR 3.75, 95% CI 1.31-10.75, p = 0.01). The accuracies, sensitivities, and specificities for N status were, respectively, 65%, 49%, and 79% with CT and 66%, 29%, and 95% with EUS. In univariate analysis, poor differentiation and lymphovascular invasion were associated with incorrect diagnosis of CT N status. In multivariate analysis, lymphovascular invasion was associated with false-negative (OR 3.79, 95% CI 1.34-10.7, p = 0.01), and differentiated histology was associated with false-positive CT N status (OR 7.14, 95% CI 2.00-25.44, p &lt; 0.01). Conclusions: EUS has reasonable accuracy in T stage, while both CT and EUS have low sensitivities and high specificities in N status. These accuracies should be considered when selecting patients for neoadjuvant treatment.

Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer.

Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer.

Pancreatobiliary Diseases Management by Endoscopic Ultrasonography/Endoscopic Retrograde Cholangiopancreatography Interface in Kurdistan Centre for Gastroenterology &amp; Hepatology

Background: Pancreatobiliarydiseases (PBD) comprises diseases of both biliary system and pancreas and their diagnosis depends on appropriate clinical evaluation and investigations including imaging modalities like transabdominal ultrasound (TAUS), Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT); Endoscopic ultrasound(EUS) have been found to be more sensitive than other imaging modality for detecting PBD, and less invasive than endoscopic retrograde cholangiopancreatography (ERCP). Aim of study: To compare the sensitivity and specificity of EUS with other imaging studies like ERCP, TAUS, CT scan, and MRCP/MRI for diagnosing PBD. Patients & Methods: This study conducted in Kurdistan Centre for Gastroenterology and Hepatology (KCGH) from December 2013 through December 2014, after approval of institutional board ethical committee and taking written informed consents from all patients. A total number of 100 patients were enrolled in the study. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of EUS, MRCP, and TAUS for PBD (benign & malignant). ERCP was used as a reference standard for comparison. Results: 60% were females and 40% were males; the main presenting symptoms were combined abdominal pain and obstructive jaundice. The sensitivity, specificity, PPV, NPV, and accuracy of EUS for detecting benign biliary diseases like (bile duct stone and its complications) were 96.1%, 65.2%, 86%, 83.3%, and 89%, respectively; and for detecting pancreatobiliary tumors (PBT) were 84.6%, 97.7%, 84.6%, 97.7%, and 96%, respectively. The sensitivity of TAUS, MRCP for diagnosing biliary diseases were 58%, and 60%, respectively; and their sensitivity for detecting PBT were 37.5%, and 50%, respectively. The comparison between CT scan and ERCP was not feasible statistically. Conclusion: EUS has a higher sensitivity in comparison to other imaging modalities in detecting PBD; we can depend on it in selecting patients for therapeutic ERCP, in order to avoid unnecessary ERCP and its complications. The sensitivity and specificity of EUS in KCGH is comparable to other studies elsewhere.

Staging accuracy of endoscopic ultrasound for esophageal cancer after neoadjuvant chemotherapy: a meta-analysis and systematic review.

This study aims to evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer after neoadjuvant chemotherapy (NAC). Articles were searched in Medline, Pubmed, Cochrane Database of Systemic Reviews, Google scholar, and EMBASE. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios (LR), and diagnostic odds ratio (DOR). Pooling was conducted using either fixed-effects model or random-effects model depending on the heterogeneity across studies. Sixteen studies (n = 724) were included in this analysis. The pooled sensitivity and specificity of EUS to diagnose T1 stage tumor was 23% (95% confidence interval [CI] 16-32%) and 95% (95%CI 93-97%), respectively. For T2 stage, EUS had a pooled sensitivity and specificity of 29% (95%CI 19-41%) and 84% (95%CI 77-88%). The pooled sensitivity and specificity of EUS were 81% (95%CI 72-88%) and 42% (95%CI 33-52%) in determining T3 stage tumor. To diagnose T4 stage tumor, EUS had a pooled sensitivity of 43% (95%CI 31-56%) and specificity of 96% (95%CI 94-97%), respectively. In determining N stage, the pooled sensitivity and specificity of EUS were 69% (95%CI 58-79%) and 52% (95%CI 42-62%). EUS is a moderately accurate technique in staging esophageal cancer after NAC. Its sensitivity is relatively high in T3 while specificity is high in other T stages (T1, T2, and T4). Tumors restaged by EUS as T4 should not be assigned to surgery because it is very likely to be inoperable. EUS is not reliable for N staging with its poor sensitivity and specificity. Subgroup analysis shows that staging accuracy did not improve with time.

INDICATIONS OF ENDOSCOPIC ULTRASOUND IN THE DIAGNOSIS AND TREATMENT OF GASTROINTESTINAL AND PANCREATICO – BILIARY DISEASES

The gastrointestinal and pancreatico-biliary diseases are very common in Vietnam and lead to severe complications. In the 1980s, Endoscopic Ultrasound (EUS) was invented, and then rapidly EUS has become an useful diagnosis in gastrointestinal and pancreatico-biliary diseases. Most of scientific researches in the word has demonstrated the sensitivity and specificity of EUS in diagnosis for gastrointestinal and pancreatico-biliary diseases. In addition, Endoscopic ultrasound therapy such as: Endoscopic ultrasound - Fine Needle Aspiration (EUS-FNA), Endoscopic ultrasound drainage and Endoscopic ultrasound-guided celiac plexus neurolysis/block were evaluated to have the highest specificity and sensitivity in diagnosis, treatment and follow up gastrointestinal and pancreatico-billiary diseases. Therefore, EUS has an important significance in development and completion of the EUS procedure in Vietnam. This new medical procedure is highly practicable in the gastrointestinal and pancreatico- biliary diagnosis in the early period. The aim of this review was to describe some current indications of EUS in gastrointestinal and pancreatico-billiary diseases.

The Role of Endoscopic Ultrasonography in T Staging: Early Gastric Cancer and Esophageal Cancer

While a number of diagnostic methods have been developed, endoscopic ultrasound (EUS) still takes the most important role in the preoperative evaluation of esophageal cancer. EUS can detect lesions of all esophageal cancer and can accurately perform T staging. In a recent meta-analysis of EUS in esophageal cancer, the sensitivity and specificity of EUS on esophageal cancer were 81.6% and 99.4% in T1, 81.4% and 96.3% in T2, 91.4% and 94.4% in T3, and 92.4% and 97.4% in T4, respectively. The use of EUS can reduce unnecessary surgeries and lead to apply proper treatments to patients. The advance of endoscopic submucosal dissection have necessitated the presurgical detection of early cancer lesions without lymph node metastasis. Understanding the practical meanings of images shown by EUS is important to decide patients for whom endoscopic treatments can be effective. In early gastric cancer, EUS can accurately predict mucosal and SM1 (invasion into the submucosal layer of less than 500 µm from muscularis mucosa) lesions, which are considered as good indications for endoscopic treatments.

Endoscopic ultrasound, endoscopic sonoelastography, and strain ratio evaluation of lymph nodes with histology as gold standard

Accurate lymph node staging is essential for the selection of an optimal treatment in patients with upper gastrointestinal cancer. Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are considered to be the most accurate method for locoregional staging. Endoscopic sonoelastography (ESE) assesses the elasticity of lymph nodes and has been used to differentiate lymph nodes with promising results. The aim of this study was to evaluate the use of EUS, EUS - FNA, ESE, and ESE-strain ratio using histology as the gold standard. Patients with upper gastrointestinal cancer who were referred for EUS examination were enrolled if surgical treatment was planned and the patient had a lymph node that was accessible for EUS - FNA and EUS-guided fine-needle marking (FNM). The lymph node was classified using EUS, ESE, and ESE-strain ratio. Finally, EUS - FNA and EUS - FNM were performed. The marked lymph node was isolated during surgery for histological examination. The marked lymph node was isolated for separate histological examination in 56 patients, of whom 22 (39 %) had malignant lymph nodes and 34 (61 %) had benign lymph nodes. There were no complications of EUS - FNM. The sensitivity of EUS for differentiation between malignant and benign lymph nodes was 86 % compared with 55 % - 59 % for the different ESE modalities. The specificity of EUS was 71 % compared with 82 % - 85 % using ESE modalities. The use of the EUS - FNM technique enabled the identification of a specific lymph node and thereby the use of histology as gold standard. ESE and ESE-strain ratio were no better than standard EUS in differentiating between malignant and benign lymph nodes in patients with resectable upper gastrointestinal cancer.