Abstract
Endoscopic ultrasonography (EUS) was performed preoperatively in 82 patients with
gastric carcinoma (40 with early and 42 advanced malignancy). Measurements of wall
thickness were performed in each case and showed good correlation with histological
findings. Wall thickening was found to consist of both tumorous and accompanying ulcerous
tissue. Thus, increasing wall thickness, as demonstrated by EUS, may not necessarily
mean progressive tumor growth. The EUS features of gastric carcinoma were analyzed
and four distinct growth patterns found: predominantly intramural (IM) or intraluminal
(IL) growth with preservation (Type 1) or destruction (Type 2) of the submucosal echo-rich
layer. All early carcinomas displayed the IL-type growth pattern on EUS (98 % IL1-type)
and 81 % of advanced tumors showed IM-type features. EUS was able to differentiate
between early and advanced carcinoma in 98 % of cases. The EUS pattern of submucosal
destruction (type IM2 or IL2) corresponded to the expanding type tumor according to
Ming's histopathological classification. On the other hand, 24 of 26 infiltrative
tumors according to Ming were found on EUS to have an intramural growth pattern with
preservation of the submucosa (type IM1). It is concluded that EUS is highly sensitive
in predicting the tumor growth pattern in gastric carcinoma, providing important additional
information to the currently used TNM staging system. Measurements of wall thickness
are reliable but differentiation between tumorous growth and peritumorous changes
is not possible.
