Endoscopic prediction of tumor depth of gastric carcinoma for assessing the indication of its limited resection

Limited surgery for an early gastric carcinoma is advocated, since certain carcinomas have no nodal involvement. However, the endoscopic accuracy of d istinguishing each cancer-depth has not been detailed from the standpoint o f limited surgery. We retrospectively reviewed a total of 2,628 patients to assess the diagnostic accuracy of their endoscopic infiltration-depth with the nature of the tumors. Endoscopic distinction of early from advanced ca rcinomas was satisfactory with a reliability of 86.5%, sensitivity of 87.1% , and specificity of 85.9%. In the 1,354 early gastric carcinomas the micro scopic infiltration-depth was significantly related to macroscopic appearan ce, histologic differentiation and tumor size. Accompanying ulcer or scar s ignificantly suggested that the carcinoma had spread vertically and horizon tally. Macroscopically elevated and differentiated carcinomas without ulcer are usually limited to the mucosa, and undifferentiated and/or ulcer-posit ive carcinomas are more invasive than predicted by most present clinical st andards. Endoscopically differential diagnosis of the infiltration-depth of gastric carcinomas is reliable, and the indication for limited surgery can be endoscopically determined in many individual patients.