THE DIAGNOSIS OF DIFFUSE GASTRIC-CARCINOM A WITH ENDOSONOGRAPHY

The diagnosis of diffuse type gastric carcinoma is very difficult. The delay of diagnosis is often due to false-negative endoscopic and hist ologic evaluation. The architecture of the stomach can be clearly visu alized by endosonography. Therefore, already minor destructions of the gastric layers can be found. The endosonographic picture includes the presence of the layers, which are larger and of irregular contour. In infiltrating gastric cancer typically the submucosal layer and the mu scularis are concentrically enlarged and appear folded. Based on the e ndosonographic picture diffuse type gastric carcinoma has been diaagno sed in 32 patients. When compared to the histologic diagnosis after ga strectomy or autopsy the accuracy of the endosonographic diagnosis was 87,5%, (28 out of 32 patients). From the remaining four patients diag nosed to have diffuse type gastric cancer by endosonography three pati ents turned out to have malignant infiltrating tumors of different his tologies. Therefore, the positive predictive value of endosonography i n detection of infiltrating malignant tumors was 96,8% in our group. I n contrast the accuracy of preoperative histologic diagnosis by biopsi es was only 58%. Suspicious results of gastroscopy, especially in comb ination with a negative biopsy, should lead to further evaluation by e ndosonography to detect diffuse type gastric cancer earlier.