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Endoscopy 2001; 33(10): 832-837
DOI: 10.1055/s-2001-17327
Original Article

© Georg Thieme Verlag Stuttgart · New York

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

N. Lügering 1 , J. Menzel 1 , T. Kucharzik 1 , P. Koch 2 , H. Herbst 3 , M. Tiemann 4 , W. Domschke 1
  • 1 Dept. of Medicine B, University of Münster, Münster, Germany
  • 2 Dept. of Medicine A, University of Münster, Münster, Germany
  • 3 Dept. of Pathology, University of Münster, Münster, Germany
  • 4 Dept. of Hematopathology, University of Kiel, Kiel, Germany
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Publication History

Publication Date:
20 September 2001 (online)

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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
    PubMedSearch in Google Scholar
  • 2 Isaacson P G, Norton A J. Extranodal lymphomas.  Edinburgh; Churchill Livingstone, 1994
    Search in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 7 Kösling S, Steingruber K, Heywang-Kobrunner S H, et al. Spiral CT of the stomach in hypotonia.  Eur Radiol. 1995;  5 255-258
    PubMedSearch in Google Scholar
  • 8 Menzel J, Domschke W. Gastrointestinal miniprobe sonography: the current status.  Am J Gastroenterol. 2000;  95 605-616
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 10 Chak A. Endoscopic ultrasonography.  Endoscopy. 2000;  32 146-152
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 13 Rösch T, Classen M. A new ultrasonic probe for endosonographic imaging for upper GI tract.  Endoscopy. 1990;  22 41-46
    PubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Tio T L. The TNM-staging system.  Gastrointest Endosc. 1996;  43 S19-S24
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 17 Furukawa T, Tsukamoto Y, Naitoh Y, et al. Evaluation of intraductal ultrasonography in the diagnosis of pancreatic cancer.  Endoscopy. 1994;  25 577-581
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 21 Frank N, Grieshammer B, Zimmermann W. A new miniature ultrasonic probe for gastrointestinal scanning: feasibility and preliminary results.  Endoscopy. 1994;  26 4603-4608
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar

N. Lügering,M.D. 

Dept. of Medicine B
University of Münster

Albert-Schweitzer-Strasse 33

48129 Münster
Germany


Fax: + 49-251-8347570

Email: lugering@uni-muenster.de