Diagnostic Value Of White Light Endoscopy Combined With Endoscopic Ultrasonography In The Invasion Depth Of Early Gastric Cancer

Objective To analyze the diagnostic value of white light endoscopic(WLE)combined with endoscopic ultrasonography(EUS)in the invasion depth of early gastric cancer(EGC).Method The pathological data of 125 patients with EGC diagnosed after endoscopic or surgical resection from March 2013 to December 2018 in the second Hospital of Lanzhou University were collected and the static images of WLE,EUS before operation were read.Taking the pathological results as the gold standards,we investigated retrospectivly the accuracy,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)in WLE,EUS and their combination in judging the invasion depth of EGC;The clinicopathological factors affecting the accuracy of WLE and EUS in the diagnosis of invasion depth were analyzed;The diagnostic efficacy of WLE and EUS in different clinicopathological factors were compared.Results1.The overall accuracy of WLE,EUS and the combination of them were73.9%,79.9% and 89.6%;For intramucosal carcinoma,the sensitivity,specificity,PPV and NPV of WLE were 76.6%,40.0%,94.1%,12.1%,the sensitivity,specifici ty,PPV and NPV of EUS were 80.6%,70.0%,97.1%,22.6%,the sensitivity,specifi city,PPV and NPV of the combination were 94.4%,30.0%,94.4%,30.0%;For sub mucosal carcinoma,the sensitivity,specificity,PPV and NPV of WLE were 40.0%,76.6%,12.1%,94.1%,the sensitivity,specificity,PPV and NPV of EUS were 70.0%,80.6%,22.6%,97.1%,the sensitivity,specificity,PPV and NPV of the combina tion were 30.0%,94.4%,30.0%,94.4%.2.There was a a decreasing trend in the accuracy of the WLE,EUS and thecombination of the them in the invasion depth of EGC when the lesions with diameter>3cm,with depressed lesions,complicated with ulcers,with undifferentiated pathological types and with submucosal infiltration.Univariate analysis showed that the diagnostic accuracy of EUS would significantly decline when the lesions with diameter>3cm,complicated with ulcers.The diagnostic accuracy of WLE with submucosal invasion was significantly lower than that with mucosal invasion;Multivariate analysis demonstrated that lesions associated with ulcers was an independent risk factor for EUS,while submucosal infiltration was an independent risk factor for the accuracy of WLE.3.WLE has high diagnostic value for intramucosal carcinoma.For the lesions diagnosed by WLE as the submucosal infiltration,EUS could effectively improve the accuracy.Conclusion: The accuracy of WLE or EUS in the diagnosis of EGC was low,while the accuracy could be improved by the combination of them;Submucosal infiltration,lesion associated with ulcers were independent risk factors affecting the accuracy of WLE,EUS respectively;WLE has high diagnostic value for intramucosal carcinoma.For the lesions diagnosed by WLE as the submucosal infiltration,EUS could effectively improve the accuracy.