Predictive Value Of White Light Endoscopy,Longitudinal-endoscopic Ultrasonography And Mini Probe EUS For Submucosal Invasion Of Early Gastric Cancer

Objective: To evaluate the predictive value of white light endoscopy（WLE）,longitudinal endoscopic ultrasonography（EUS）and their combination for predicting submucosal invasion of early gastric cancer（EGC）patients.To compare the predictive value between longitudinal EUS and mini-probe EUS in predicting submucosal invasion in EGC patients.Method: The clinicopathologic data of 86 patients with pathologically confirmed EGC after endoscopic or surgical resection from March 2018 to June 2021 in the second affiliated hospital of Anhui Medical University were retrospectively analyzed.All patients underwent longitudinal EUS（N = 47）or mini probe EUS（N = 39）for staging.The invasion depth evaluated by WLE,EUS and pathology was categorized into no invasion of submucosa（< T1b）and invasion of submucosa or deeper（≥ T1b）.The diagnosis of WLE,longitudinal EUS and their combination were compared with postoperative pathology.We also analyzed the clinicopathologic factors influencing the accuracy of predicting submucosal invasion.Taking the postoperative pathological results as the gold standard,we evaluated the predictive value of WLE,longitudinal EUS and their combination for predicting submucosal invasion of EGC patients.We also compared the predictive value between longitudinal EUS and mini probe EUS in predicting submucosal invasion in EGC patients;The clinicopathologic factors influencing the accuracy of longitudinal EUS predicting submucosal invasion were analyzed.Results:1.The diagnostic accuracy for submucosal invasion in EGC of WLE was 72.3%（34/47）,and the sensitivity,specificity,positive predictive value,negative predictive value,over staging rate and under staging rate were 83.3%,70.7%,29.4%,96.7%,25.5% and 2.1%,respectively.The diagnostic accuracy for submucosal invasion in EGC of longitudinal EUS was 83.0%（39/47）,and the sensitivity,specificity,positive predictive value,negative predictive value,over staging rate and under staging rate were 100%,80.5%,42.9%,100%,17.0%,0,respectively.The overall accuracy of longitudinal EUS in predicting submucosal invasion of EGC was higher than that of WLE,but no statistically significant differences were noted（P = 0.267）.2.The diagnostic accuracy for submucosal invasion in EGC of the combination of WLE and longitudinal EUS was 89.4%（42/47）,and the sensitivity,specificity,positive predictive value,negative predictive value,over staging rate and under staging rate were 83.3%,90.2%,55.6%,97.4%,8.5%,2.1%,respectively.The accuracy（P = 0.008）and specificity（P = 0.004）of combined diagnosis of submucosal invasion were significantly higher than those of WLE.3.The diagnostic accuracy for submucosal invasion in EGC of mini probe EUS was 76.9%（30/39）,and the sensitivity,specificity,positive predictive value,negative predictive value,over staging rate and under staging rate were 69.2%,80.8%,64.3.0%,84.0%,12.8%,10.3%,respectively.Before and after propensity score matching analysis,there was no significant difference in all diagnostic indexes between longitudinal EUS and mini probe EUS.We used the receiver operating curve（ROC）to evaluate the diagnostic performance of longitudinal EUS and mini-probe EUS for submucosal invasion of EGC,and the area under the ROC was 0.90 and 0.75 for longitudinal EUS and mini-probe EUS,respectively.4.Univariate analysis showed that the accuracy of longitudinal EUS significantly reduced in the diagnosis of ulcerative EGC（P = 0.001）and undifferentiated-type EGC（P = 0.013）.For lesions located in the lower third of the stomach or diameter greater than 3.0 cm,the accuracy of longitudinal EUS tends to decline,but the difference was not statistically significant.The multivariate analysis identified that EGC with the presence of ulceration（P = 0.003,OR 18.093,95% CI 2.602-125.824）was an independent risk factor for the accuracy of longitudinal EUS in predicting submucosal invasion.Conclusion: Longitudinal EUS has higher accuracy than WLE in predicting submucosal invasion in EGC.Compared with WLE alone,WLE combined with longitudinal EUS can significantly improve the accuracy and specificity;Longitudinal EUS may be superior than mini probe EUS in predicting submucosal invasion in EGC.EGC with the presence of ulceration was an independent risk factor for the accuracy of longitudinal EUS in predicting submucosal invasion.