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.