Impact of Miniprobes Compared to Conventional Endosonography in the Staging of Low-Grade Gastric MALT Lymphoma

Background and Study Aims: In patients with low-grade gastric MALT lymphoma, conventional endoscopic ultrasonography (EUS) is considered to be the most accurate modality for locoregional staging. The aim of this study was to evaluate the diagnostic role of ultrasonic miniprobes as part of routine clinical staging.

Patients and Methods: A total of 39 patients who were histologically diagnosed with low-grade MALT lymphoma were reviewed retrospectively before treatment (n = 15) and during follow-up (n = 24). Assessment of tumor penetration into the gastric wall was based on the TNM system. Pathological lymph-node involvement was suggested by the presence of inhomogeneous hypoechoic echo patterns, with clearly demarcated borders. All examinations were carried out using a mechanical miniprobe (Olympus; diameter 2.4 mm, 12 MHz) introduced through the working channel of the endoscope. Ultrasonic miniprobe findings were compared with conventional EUS data and histology.

Results: Using pretreatment endoscopic ultrasonography, gastric lymphomas presented endoscopically with an ulcer (in five of 15 patients) or a diffuse infiltrative pattern (ten of 15 patients). The ultrasonic miniprobe identified a T1 lesion in 53 % (T2, 33 %) and EUS in 60 % (T2, 20 %) of cases. Pathological lymph-node involvement in T1-T2 lesions was diagnosed with the ultrasonic miniprobe in 53 % of cases and with EUS in 60 %. Using endoscopic ultrasonography during the follow-up period, in patients with normal miniprobe ultrasonography (n = 15), the histological examination confirmed a complete remission in all patients. Hypoechoic thickening of the mucosa or submucosa, or both, was seen in nine patients. Endoscopic biopsies in four of these nine patients revealed recurrent lymphoma.

Conclusions: The ultrasonic miniprobe can be recommended as part of routine care in patients with gastric MALT lymphoma, both initially and during the follow-up period. The clinical significance of ultrasonic miniprobe examinations is that they can be performed as a single-step procedure during diagnostic endoscopy.

References

• 1 Isaacson P G, Spencer J. Malignant lymphoma of mucosa-associated lymphoid tissue.  Histopathology. 1987;  11 445
• 2 Isaacson P G, Norton A J. Extranodal lymphomas.  Edinburgh; Churchill Livingstone, 1994
• 3 Cogliatti S B, Schmid U, Schumacher U, et al. Primary B-cell gastric lymphoma: a clinicopathological study of 145 patients.  Gastroenterology. 1991;  101 1159-1170
• 4 Suekane H, Iida M, Yao T, et al. Endoscopic ultrasonography in primary gastric lymphoma: a correlation with endoscopic and histologic findings.  Gastrointest Endosc. 1993;  39 139-145
• 5 Palazzo L, Roseau G, Ruskone-Fourmestraux A, et al. Endoscopic ultrasonography in the local staging of primary gastric lymphoma.  Endoscopy. 1993;  25 502-508
• 6 Fusjishima H, Misawa T, Maruoka A, et al. Staging and follow-up of primary gastric lymphoma by endoscopic ultrasonography.  Am J Gastroenterol. 1991;  86 719-724
• 7 Kösling S, Steingruber K, Heywang-Kobrunner S H, et al. Spiral CT of the stomach in hypotonia.  Eur Radiol. 1995;  5 255-258
• 8 Menzel J, Domschke W. Gastrointestinal miniprobe sonography: the current status.  Am J Gastroenterol. 2000;  95 605-616
• 9 Menzel J, Domschke W, Brambs H J, et al. Miniprobe ultrasonography in the upper gastrointestinal tract: state of the art 1995 and prospects.  Endoscopy. 1996;  28 508-513
• 10 Chak A. Endoscopic ultrasonography.  Endoscopy. 2000;  32 146-152
• 11 Hünerbein M, Ghadimi B M, Haensch W, Schlag P M. Transendoscopic ultrasound of esophageal and gastric cancer using miniaturized ultrasound catheter probes.  Gastrointest Endosc. 1998;  48 371-375
• 12 Okamura S, Tsutsui A, Muguruma N, et al. The utility and limitations of an ultrasonic miniprobe in the staging of gastric cancer.  J Med Invest. 1999;  46 40-53
• 13 Rösch T, Classen M. A new ultrasonic probe for endosonographic imaging for upper GI tract.  Endoscopy. 1990;  22 41-46
• 14 Menzel J, Hoepffner N, Nottberg H, et al. Preoperative staging of esophageal carcinoma: miniprobe sonography versus conventional endoscopic ultrasound in a prospective histopathologically verified study.  Endoscopy. 1999;  31 291-297
• 15 Tio T L. The TNM-staging system.  Gastrointest Endosc. 1996;  43 S19-S24
• 16 Catalano M F, Sivak M V, Bedford R A, et al. Observer variation and reproducibility of endoscopic ultrasonography.  Gastrointest Endosc. 1995;  41 115-120
• 17 Furukawa T, Tsukamoto Y, Naitoh Y, et al. Evaluation of intraductal ultrasonography in the diagnosis of pancreatic cancer.  Endoscopy. 1994;  25 577-581
• 18 Yasuda K, Mukai H, Nakajima M, Kawai K. Clinical application of ultrasonic probes in the biliary and pancreatic duct.  Endoscopy. 1992;  24 370-375
• 19 Menzel J, Hoepffner, Sulkowski U, et al. Polypoid tumors of the major duodenal papilla - preoperative staging with intraductal US, EUS, and CT: a prospective, histopathologically controlled study.  Gastrointest Endosc. 1999;  49 349-357
• 20 Seifert E, Schulte F, Weismüller J, et al. Endoscopic and bioptic diagnosis of malignant non-Hodgkin’s lymphoma of the stomach.  Endoscopy. 1993;  25 497-501
• 21 Frank N, Grieshammer B, Zimmermann W. A new miniature ultrasonic probe for gastrointestinal scanning: feasibility and preliminary results.  Endoscopy. 1994;  26 4603-4608
• 22 Haim N, Leviov M, Ben-Arieh Y, et al. Intermediate and high-grade gastric non-Hodgkin’s lymphoma: a prospective study of non-surgical treatment with primary chemotherapy, with or without radiotherapy.  Leuk Lymphoma. 1995;  17 321-326
• 23 Willich N A, Reinartz G, Horst E J, et al. Operative and conservative management of primary gastric lymphoma: interim results of a German multicenter study.  Int J Radiat Oncol Biol Phys. 2000;  46 895-901
• 24 Fischbach W, Dragosics B, Kolve-Goebeler M E, et al. Primary gastric B-cell lymphoma: results of a prospective multicenter study.  Gastroenterology. 2000;  119 1191-1202
• 25 Akahoshi K, Chijiiwa Y, Sasaki I, et al. Pre-operative TN-staging of gastric cancer using a 15-MHz ultrasound miniprobe.  Br J Radiol. 1997;  70 703-707
• 26 Chak A, Canto M I, Rösch T, et al. Endosonographic differentiation of benign and malignant stromal cell tumors.  Gastrointest Endosc. 1997;  45 468-473