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- Title
Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the 'non-extension sign' as a simple diagnostic marker.
- Authors
Nagahama, Takashi; Ohtsu, Kensei; Yamaoka, Rino; Yao, Kenshi; Kojima, Toshiki; Imamura, Kentaro; Chuman, Kenta; Tanabe, Hiroshi; Iwashita, Akinori
- Abstract
Background and aim: The ability to differentiate between mucosal (M) or microinvasive submucosal (SM1: depth of less than 500 µm) and invasive submucosal (SM2: depth of 500 µm or more) cancer is paramount when choosing the method of treatment for early gastric cancer (EGC). The 'non-extension sign' relates to a localized increase in thickness and rigidity due to massive submucosal invasion by a cancer. The present study sought to assess the ability of conventional endoscopy (CE) to correctly identify SM2 cancer using only the non-extension sign. Methods: This is a retrospective study based on a prospectively collected database. EGCs had been diagnosed according to invasion depth as M-SM1 or SM2. In terms of the endoscopic diagnostic criterion, lesions positive for the non-extension sign were classified as SM2 cancers, while those negative for the non-extension sign were classified as M-SM1 cancers. Histopathological findings were used as the gold standard. Results: We examined a total of 863 lesions from 704 patients, comprising 104 true-positive, 733 true-negative, 9 false-positive, and 17 false-negative lesions. This yielded a sensitivity of 92.0 % (95 % confidence interval (CI), 87.0-97.0 %), a specificity of 97.7 % (95 % CI, 96.7-98.8 %), a positive predictive value of 85.9 % (95 % CI, 79.7-92.1 %), a negative predictive value of 98.8 % (95 % CI, 98.0-99.6 %), and a diagnostic accuracy of 96.9 % (95 % CI, 95.8-98.1 %). Conclusion: The non-extension sign may be useful for accurately determining the suitability of minimally invasive endoscopic treatment. Nevertheless, considering the limitations of retrospective analysis, a further prospective study is warranted to confirm the diagnostic reliability of the non-extension sign.
- Subjects
GASTROINTESTINAL cancer treatment; ENDOSCOPY; LYMPH nodes; PREOPERATIVE care; TISSUE wounds
- Publication
Gastric Cancer, 2017, Vol 20, Issue 2, p304
- ISSN
1436-3291
- Publication type
Article
- DOI
10.1007/s10120-016-0612-6