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Acta Endoscopica

, 25:441 | Cite as

Ultrasonographie endoscopique de l’estomac de patients porteurs de gastropathie à gros plis, lésions infiltrantes et lymphome primaire

  • G. C. Caletti
  • A. Ferrari
  • P. Bocus
  • T. H. Togliani
  • C. L. Scalorbi
  • L. Barbara
Article

Résumé

Le lymphome gastrique primaire représente 2 à 8 % de la totalité des lésions malignes de l’estomac et son incidence semble s’accroître. Le lymphome gastrique a un meilleur pronostic que le carcinome de l’estomac compte tenu de sa sensibilité à la radiothérapie (RT) ou de la chimiothérapie (CT), d’où l’importance de poser un diagnostic préopératoire correct entre lymphome gastrique et cancer même si généralement un tel diagnostic est considéré comme difficile.

L’ultrasonographie endoscopique (USE) est susceptible d’investiguer la paroi intestinale et de reconnaître les 5 couches ultrasonographiques d’échogénicités différentes. Le diagnostic des affections gastro-intestinales par USE est possible sur base des modifications structurelles des couches de la paroi intestinale.

Une USE a été réalisée dans 82 cas de lymphomes gastriques primaires. L’USE a fourni un diagnostic correct de lymphome chez 76/82 patients avec une sensibilité de 93 %. La valeur prédictive positive était de 91 %, la spécificité de 98 % et la valeur prédictive négative de 98 %. La sécurité du diagnostic est atteinte dans 97 % des cas. L’USE permet, dans 87 % des cas, une évaluation correcte du degré de pénétration du lymphome. L’USE a permis l’identification d’adénopathies péri-gastriques chez 15/27 patients avec une sensibilité de 56 %. La valeur prédictive positive a été de 100 %, la spécificité 100 %, et la valeur prédictive négative de 82 %. La précision du diagnostic atteignait 85 %.

Le diagnostic différentiel par USE entre lymphome, linite plastique et maladie de Ménétrier fut difficile. Une macrobiopsie est recommandée lorsque le diagnostic différentiel par USE demeure incertain.

En conclusion, on peut affirmer que l’USE représente un progrès majeur dans le diagnostic et la stadification pré-thérapeutique des lymphomes gastriques primaires. Enfin l’USE semble une méthode sensible d’évaluation de l’effet des radiations ou de la chimiothérapie chez les patients traités pour lymphome gastrique primaire.

Mots-clés

cancer gastrique echoendoscopie glos plis gastriques lymphome gastrique maladie de Ménétrier 

Endoscopic ultrasonography of the stomach in patients with large folds, infiltrative disorders and primary lymphoma

Summary

Primary gastric lymphoma accounts for 2–8 % of all gastric malignancies and its incidence has increased. Gastric lymphoma has a better prognosis than gastric carcinoma, owing to the sensitivity of the former to radiation therapy (RT) or chemotherapy (CT). It is therefore important to establish a correct preoperative diagnosis between gastric lymphoma and cancer even if such a diagnosis is generally considered difficult.

Endoscopic Ultrasonography (EUS) is able to investigate the intestinal wall which is made up of five ultrasonographic layers of different echogenicity. The diagnosis of gastrointestinal diseases by EUS has been possible on the basis of changes of the layer structure of the gastrointestinal wall.

EUS was performed in 82 primary gastric lymphomas. EUS made a correct diagnosis of lymphoma in 76/82 patients with a sensitivity of 93 %. Positive predictability was 91 %, specificity 98 %, and negative predictability 98 %. Diagnostic accuracy was 97 %. In the evaluation of lymphoma depth invasion EUS was correct in 87 % of cases. EUS displayed metastatic perigastric lymphnodes in 15/27 patients with a sensitivity of 56 %. Positive predictability was 100 %, specificity 100 %, and negative predictability 82 %. Diagnostic accuracy was 85 %.

Differential diagnosis on EUS basis among lymphoma, linitis plastica and Menetrier’s disease was difficult. Large particle biopsy has to be considered when EUS diagnosis of these diseases remain uncertain.

In conclusion it is possible to affirm that EUS has represented a big step forward in the diagnosis and pretreatment staging of primary gastric lymphoma. Finally EUS appears to be a sensitive method for assessing the response to radiation and chemotherapy for patients with primary gastric lymphoma.

Key-words

endoscopic ultrasonography gastric carcinoma large gastric folds Menetrier’s disease primary gastric lymphoma staging 

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Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • G. C. Caletti
    • 1
  • A. Ferrari
    • 1
  • P. Bocus
    • 1
  • T. H. Togliani
    • 1
  • C. L. Scalorbi
    • 1
  • L. Barbara
    • 1
  1. 1.BolognaItaly

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