EUS in diagnostics of indolent and aggressive forms of Nonhodgkins gastric lymphomas

Aim of study: To establish endoscopic ultrasonic criteria of diagnostics indolent and aggressive forms of gastric NHL.

Materials and methods: For studying of possibilities of endosonography in diagnostics NHL of a stomach 46 patients have been analyzed during the period since 2005 till 2009. All patients after standard gastroscopy was carried out endoscopic ultrasound scanning, and the tumor biopsy further was made.

Results: We are defined endosonography criteria nonhodgkins lymphomas of a stomach: The tumor starts in deep layers mucosa and submucosal layers, extends mainly on submucosal layer, it is marked multicentrical defeats, echoic of the tumors is always lowered or heteroechoic with hypoechoic inclusions. On the basis of this data we are defined endosonography criterias various morphoimmunological variants of NHL of a stomach which we have divided into three cores of type of displays: 1. I type – a tumour is visualised like heperechoic formations with plural hypoechoic small dots –14 patients. 2. II type – a tumour is defined in the form of massive hypoechoic tumor infiltration –26 patients. 3. III type – hyperechoic formation within mucosa and submucosal layers with infringement of their differentiation (similar to postulcer scars) –6 patients. We established that I type of changes on ours endosonography classifications is characteristic for indolent NHL; II type – in 73.1% meets at aggressive NHL (diffuse B-cell lymphomas), and III type – is characteristic for indolent MALT lymphoma of a stomach.

Conclusion: Estimating possibilities of endoscopic ultrasonic diagnostics has been revealed that its diagnostic accuracy is 87.7%. In 84.9% at use EUS it is possible to assume authentically presence NHL of a stomach and in 94.7% EUS will allow to exclude authentically pathological process in a stomach. Endosonography has allowed us to reveal changes in locoregional lymph nodes and to carry out differenzial diagnostics of the found out changes between hyperplastic and metastatic. In our research at 24 (52.2%) patients from 46 have been found out increased locoregional lymph nodes: In 16 (34.8%) cases metastatic character of increase, in 8 (17.4%) supervision – hyperplastic is ascertained.