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Review
, 9 (6), 243-254

Endoscopic Ultrasound in Oncology: An Update of Clinical Applications in the Gastrointestinal Tract

Affiliations
Review

Endoscopic Ultrasound in Oncology: An Update of Clinical Applications in the Gastrointestinal Tract

Manuel Valero et al. World J Gastrointest Endosc.

Abstract

An accurate staging is necessary to select the best treatment and evaluate prognosis in oncology. Staging usually begins with noninvasive imaging such as computed tomography, magnetic resonance imaging or positron emission tomography. In the absence of distant metastases, endoscopic ultrasound plays an important role in the diagnosis and staging of gastrointestinal tumors, being the most accurate modality for local-regional staging. Its use for tumor and nodal involvement in pre-surgical evaluation has proven to reduce unnecessary surgeries. The aim of this article is to review the current role of endoscopic ultrasound in the diagnosis and staging of esophageal, gastric and colorectal cancer.

Keywords: Colorectal cancer; Endoscopic ultrasound; Esophageal cancer; Gastric cancer; Gastrointestinal cancer; Staging.

Conflict of interest statement

Conflict-of-interest statement: The authors have no conflict of interests.

Figures

Figure 1
Figure 1
Esophageal carcinoma staging by endoscopic ultrasound T2 N1. The tumor is being measure (13.3 mm × 20.2 mm). It invades up to the muscularis propria (white arrow). A round, sharply demarcated and hypoechoic lymph node can be seen next to the tumor. EUS images were obtained using a Hitachi-Avius console with a radial scope EG-3630URK (from Pentax Medical). EUS: Endoscopic ultrasound.
Figure 2
Figure 2
Gastric adenocarcinoma staging by endoscopic ultrasound T3 N0. The tumor overcomes the muscularis propria (blue arrow) and penetrates the subserosal connective tissue (white arrow). EUS images were obtained using a Hitachi-Avius console with a radial scope EG-3630URK (from Pentax Medical). EUS: Endoscopic ultrasound.
Figure 3
Figure 3
Rectal adenocarcinoma staging by endoscopic ultrasound T4 N0. The tumor invasion overcomes the rectal wall and penetrates the prostate. There is a lack of separation plane between the tumor and the prostate (white arrow).
Figure 4
Figure 4
A lymph node being evaluated by elastography, for a gastric tumor staging. A: Qualitative elastography (color tones red-green-blue) shows the lesion with a blue-predominant color tone, which represents a hard tissue and suggest malignancy. The Strain Ratio (quantitative elastography) is being calculated by compering two different areas (A and B). Area A includes as much of the target lesion as possible. Area B is selected within a soft (red) reference area outside the target lesion. The result (B/A = 141.7) suggests malignancy; B: Shows the round, sharply demarcated and hypoechoic lymph node (white arrow). The endoscopic ultrasound-elastography was done using a Hitachi-Avius console with a radial scope EG-3630URK (from Pentax Medical).
Figure 5
Figure 5
The same lesion presented in Figure 3 being evaluated by contrast enhanced ultrasonography. The white arrow shows the lymph node with no enhancement after the contrast application, which suggests malignancy. The endoscopic ultrasound-contrast enhancement was done using a Hitachi-Avius console with a radial scope EG-3630URK (from Pentax Medical) and a Sonovue contrast agent (from Bracco).
Figure 6
Figure 6
Rectal adenocarcinoma staging by 3D endoscopic ultrasound T1 N1. The yellow arrows on the left show the muscularis propria. The tumor invades up to the submucosa. A white submucosa plane can be seen between the tumor (TU) and the muscularis propria. The yellow arrow on the right shows a round lymph node. The 3D image was obtained using a transanal rigid probe with an ultrasound from bk medical.

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