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Annals of Oncology Advance Access published online on October 25, 2006
Annals of Oncology, doi:10.1093/annonc/mdl378
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© 2006 European Society for Medical Oncology
Received July 16, 2006
Revised August 30, 2006
Accepted September 1, 2006

original article

Is endoscopic ultrasound clinically useful for follow-up of gastric lymphoma?

F. Di Raimondo 1 *, L. Caruso 2, G. Bonanno 3, P. Naso 3, A. Chiarenza 1, P. Fiumara 1, A. Bari 1, G. A. Palumbo 1, A. Russo 3, and R. Giustolisi 1

1 Divisione Clinicizzata di Ematologia, Università di Catania, Ospedale Ferrarotto, Catania, Italy
2 Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
3 Cattedra di Gastroenterologia, Università di Catania, Policlinico, Catania, Italy

* To whom correspondence should be addressed.
F. Di Raimondo, E-mail: diraimon{at}unict.it


  Abstract

Background: Endoscopic ultrasound (EUS) is considered the best technique for locoregional staging at diagnosis but its role in the follow-up of patients with gastric lymphoma after organ-conserving strategies has not been established.

Design and methods: We retrospectively evaluated 23 patients with primary gastric lymphoma treated with a stomach-conservative approach. Sixteen of them were affected by MALT lymphoma and seven by diffuse large-B-cell lymphoma (DLBCL). Five patients were treated with Helicobacter pylori (HP) eradication therapy alone (omeprazole + amoxicillin + clarithromycin); eight patients received a treatment including HP eradication and chemotherapy and the remaining 10 patients were treated with chemotherapy alone.

Results: At the end of treatment, a complete remission was documented in 21 (91%) patients by endoscopy with biopsy (E-Bx) but in only seven (30%) patients by EUS. A total of 99 evaluations with both EUS and E-Bx were evaluated and we found concordance between the two methods in 33 occasions (33%) only. No significant difference on the percentage of concordance was recorded between MALT and DLBCL. After a median follow-up of 36.5 months we have not observed any relapse in 12 patients (six DLBCL and six MALT) with a persistent positive EUS but negative E-Bx.

Conclusions: Although the length of follow-up cannot exclude late relapse, we think that in restaging and follow-up of gastric lymphoma, EUS seems not to be a reliable tool if it is abnormal and E-Bx still remains the gold standard. Therefore, after conventional conservative treatment, persistence of EUS abnormality with a negative histology should not be considered as a clinically relevant persistence of disease and should not be a reason for further treatment.

Keywords: endoscopy; EUS; gastric; lymphoma.
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