术前超声双重造影评价胃癌淋巴结转移

目的 在判断胃癌术前淋巴结转移中,通过与螺旋CT检查比较各自的正确率,探讨超声双重造影检查(DCUS)的价值.方法 选择150例经胃镜活检证实为胃癌并进行手术切除的患者,在手术前5d内进行DCUS及螺旋CT检查,根据肿瘤位置不同将各组淋巴结分为3站,对淋巴结转移个数和各站淋巴结转移情况进行术前判断,与术后病理检查结果对照得出正确率,并进行相互间比较.结果 根据淋巴结转移个数,DCUS检查和螺旋CT检查对阳性淋巴结判断总的正确率及N1、N2、N3各期的正确率分别为86.0％比81.4％、82.6％比73.9％、78.1％比75.0％及81.0％比76.2％,两者比较差异均无统计学意义(均P＞0.05);根据阳性淋巴结分站不同,DCUS检查对第1站阳性淋巴结判断的正确率为88.6％,高于螺旋CT检查的68.6％(x2=4.158,P＜0.05),对第2站和第3站阳性淋巴结判断的正确率分别为74.1％比81.5％和71.4％比78.6％,两者之间相比差异均无统计学意义(均P ＞0.05).结论 在术前判断胃癌淋巴结转移方面DCUS检查有较好的应用价值,尤其是进行分站评价时,其第1站的正确率高于螺旋CT检查.     

内镜超声检查和多层螺旋CT对胃癌术前T、N分期的比较研究

目的探讨内镜超声(endoscopicultrasonography,EUS)与多层螺旋CT(multi slicespiralCT,MSCT)在胃癌术前T、N分期中的临床应用价值。方法2000年10月至2002年5月,对89例活检证实的胃癌病人术前分别行内镜超声和多层螺旋CT检查,并与手术病理结果对照。结果EUS对胃癌术前T分期的准确率为75.6%,其中T176.5%,T268.8%,T384.4%,T464.7%;MSCT分别79.3%,58.8%,62.5%,90.6%和94.1%。两者差异无统计学意义(P>0.05)。EUS对胃癌术前N分期的准确率为57.5%,其中N095.8%,N145.8%,N232.0%;MSCT分别78.1%,70.8%,75.0%和88.0%。EUS和MSCT对胃癌淋巴结转移的敏感性分别为61.2%和91.8%。EUS对N0分期的准确率显著高于MSCT(P<0.05),MSCT对N和N2分期的准确率及淋巴结转移的敏感性均显著高于EUS(P<0.05,P<0.01,P<0.01)。结论内镜超声检查与多层螺旋CT对胃癌术前TN分期均有较高的准确性。     

超声内镜在胃癌术前诊断中的应用分析

目的探讨超声内镜(EUS)在胃癌术前TN分期中的应用经验。方法术后病理检查证实为胃癌而且使用超声内镜进行了术前TN分期的患者352例,对其资料进行回顾性分析。结果 EUS胃癌术前T分期总正确率为81.25%,其中T1为85.58%,T2为73.91%,T3为82.14%,T4为83.33%,与术后病理结果比较具有高度一致性(Kappa系数为0.75)。EUS对胃癌术前N分期总的正确率为52.84%,其中N0为85.56%,N1为56.69%,N2为28.09%,N3为26.09%,与术后病理结果比较具有一般一致性(Kappa系数为0.33)。将病变部位分为贲门、胃底、胃体、胃窦、幽门,不同部位之间的检测正确率比较,差异无统计学意义(P0.05)。结论EUS在胃癌术前诊断中具有临床意义,其中T分期可为合理制定治疗方案提供依据,N分期准确性有待提高。     

胃癌术前内镜超声检查与肿瘤血管内皮生长因子表达的检测分析

目的探讨内镜超声检查(EUS)对胃癌术前诊断和分期的应用价值及其影像学改变与肿瘤转移相关基因表达的分子生物学基础。方法联合应用电子胃镜和超声内镜诊断胃癌63例,对比胃镜检查加活检与超声内镜对胃癌诊断的准确率,同时应用超声内镜对胃癌进行术前分期,并与病理分期及血管内皮生长因子(VEGF)表达进行比较。结果63例胃癌中胃镜加病理活检诊断的准确率是94%,超声内镜诊断的准确率是92%,胃镜联合超声内镜诊断的准确率是100%。超声内镜对胃癌侵犯深度判断的准确率为81%,其中T1期为78%、T2期为79%、T3期为82%、T4期为83%,对淋巴结转移的准确率为73%。VEGF蛋白在胃癌组织中的阳性表达率为56%,其表达与EUS分期、淋巴结转移关系密切(P<0.05)。结论胃镜联合超声内镜诊断胃癌具有较高的准确率;胃癌术前内镜超声分期与术后病理有较高的一致性;VEGF蛋白表达与胃癌术前EUS分期呈正相关;EUS对胃癌的分期与分子生物学改变有关。     

超声内镜对T2期食管癌术前T分期的诊断价值及影响因素

目的探讨术前超声内镜(endoscopic ultrasonography,EUS)对T2期食管癌(esophageal carcinoma,EC)的诊断价值及影响因素。方法回顾性分析我院2015年3月至2016年1月206例EC手术患者术前EUS的检查结果和术后的病理资料,选取未经术前辅助放化疗治疗且术后病理分期为T2期的81例EC患者纳入本研究,其中男59例、女22例,平均年龄63.9岁,中位年龄63.0岁。将EUS检查T分期(c T)与术后病理T分期(p T)进行比较,采用独立样本卡方检验对纳入患者的性别,年龄,肿瘤位置,肿瘤形态,术后病理分化程度,组织学分型,淋巴结转移及术后病理TNM分期等因素进行比较,分析这些因素对T2分期诊断价值的影响。结果 EUS对病理T2期EC术前T分期准确率为61.7%,过高分期率为38.3%。EUS准确分期组与过高分期组在术后病理TNM分期上差异有统计学意义(P=0.023),术后病理TNM分期在过高T分期组较高;而性别,年龄,肿瘤位置,肿瘤形态,术后病理分化程度,组织学分型和淋巴结转移两组差异无统计学意义。结论 EUS对T2期EC术前T分期有过高的分期率,术后病理TNM分期可能是EUS对T2期EC术前过高T分期的一个影响因素。     

超声内镜联合CT在胃癌术前分期中的应用

目的 探讨胃癌病人运用超声内镜(EUS)联合CT进行术前分期对判定胃癌可切除性及制定优化综合治疗方案的指导意义.方法 对2010年1月至2011年3月行手术治疗的56例胃癌病人术前行EUS和螺旋CT检查分期和术后病理检查报告分期的资料进行比较分析.结果 EUS检查对T1、T2、T4期的判定具有优势,CT检查对T3的判定...     

核磁共振与腔内超声对直肠癌术前局部分期的价值比较

目的 比较核磁共振(MRI)和腔内超声(EUS)对直肠癌术前分期的价值.方法 分别应用MRI和EUS检查对72例和55例直肠癌患者行术前分期,与手术及病理结果对比,比较MRI和EUS对直肠肿瘤浸润深度、区域淋巴结转移判断的准确性.结果 MRI判断T分期总的准确率为76.4％ (55/72),MRI评价N分期的准确率为63.9％ (46/72),EUS判断T分期总的准确率为81.8％(45/55),评价N分期的准确率为65.5％ (36/55).结论 MRI与EUS判断T分期的准确性差异无统计学意义,EUS判断早中期直肠肿瘤浸润层次的准确率高于MRI,两者判断N分期的准确率均较低.     

一种新的胃癌淋巴结分期方案

目的比较AJCC/UICC 1997年第五版胃癌TNM分期中的N分期与以淋巴结转移度为标准的新N分期. 方法行D2或D3术式的胃癌(皆无远处转移)标本用透光法摘取淋巴结,分别按2种方法分期,新法中N1为淋巴结转移度0.01%～10.00%, N2为10.01%～25.00%,N3为＞25.00%.全组随访,资料经统计学处理. 结果本组78例患者共取得淋巴结5388 枚,平均每例69枚(范围30～157枚).全组淋巴结转移率75.64%(59/78).新分期N0、N 1、N2、N3期患者3年生存率分别为100%、68.42%、7.58%、6.78%(χ2=35.85 0,P<0.01, r=0.95). 结论淋巴结转移度是一相对数,在预后的判断上,优于淋巴结转移数目.     

PLAC1/CP1蛋白在结直肠癌组织中的表达及其临床意义

目的 检测PLAC1/CP1(cancer-placenta 1)基因在结直肠癌肿瘤组织中的表达,探讨其与临床病理因素的关系.方法 免疫组化方法检测PLAC1/CP1基因在125例结直肠癌配对癌组织、癌旁组织芯片中的蛋白表达.统计学采用χ2检验.结果 PLAC1/CP1蛋白在125例结直肠癌组织中的表达率为57.6%(72/125).在原发腺癌中的表达率为56.7%(55/97),在低分化腺癌、中分化腺癌和高分化腺癌的表达分别为78.9%(15/19)、55.7%(34/61)、35.3%(6/17),差异有统计学意义(χ2=7.026,P=0.03);在TNMⅢ+Ⅳ期中的表达率为71.2%(37/52),明显高于Ⅰ+Ⅱ期的表达(40%,18/45)(χ2=9.537,P=0.002);在有淋巴结转移的原发灶中的表达率为69.6%(32/46)明显高于无淋巴结转移者的45.1%(23/51)(χ2=5.897,P=0.015);随淋巴结转移数目的增多,PLAC1/CP1在原发灶的表达显著增高(χ2=13.353,P=0.001).结论 PLAC1/CP1基因的蛋白表达与结直肠癌的组织学分化程度、TNM分期、淋巴结转移有关.     

腔内超声对直肠癌术前分期的诊断价值

目的探讨腔内超声(Endoluminal ultrasound,ELUS)对术前直肠癌分期评价的临床应用价值。方法对69例直肠癌患者术前进行ELUS检查进行术前分期诊断,并且与术后病理诊断进行对照。结果术前ELUS检查T1期诊断正确率为93.33%(14/15),T2期为83.33%(15/18),T3期为74.07%(20/27),T4期为66.67%(6/9)。ELUS诊断正确率为79.71%(55/69)。ELUS对转移淋巴结诊断总正确率为65.22%(45/69),灵敏度为76.19%,特异度为61.71%。结论 ELUS对于直肠癌癌组织的浸润程度以及周围转移淋巴结诊断与术后病理诊断的正确率较高,有希望成为直肠癌术前分期的有效方法。     

Double contrast-enhanced ultrasonography for the preoperative evaluation of gastric cancer: a comparison to endoscopic ultrasonography with respect to histopathology

Background

This study was designed to compare the accuracy of endoscopic ultrasound (EUS) with double contrast–enhanced ultrasound (DCUS) in the staging of gastric malignancies. DCUS is a transabdominal ultrasound technique using both intravenous and intraluminal contrast to enhance sonographic visualization.

Methods

This retrospective study included 162 patients with biopsy-proven gastric cancer who underwent DCUS and EUS preoperatively with the ultrasound results compared with the pathologic findings of the resected specimens.

Results

The overall accuracy of DCUS and EUS for tumor (T) staging was 77.2% and 74.7%, respectively_. Comparison of ultrasound techniques for T staging revealed that DCUS was superior to EUS only for a tumor depth of T3 (chi-square, P = .025). Lymph nodes were staged correctly with DCUS and EUS in 78.4% and 57.4% of cases, respectively (chi-square, P = .001).

Conclusions

DCUS offers a noninvasive approach for the staging of gastric cancer. DCUS was comparable to EUS in tumor depth evaluation but offered an advantage in lymph node detection.     

食管癌与贲门癌患者术前内镜超声检查28例分析

目的 通过对比内镜超声及CT在食管癌、贲门癌术前进行T、N分期中的准确度,评价内镜超声的临床应用价值. 方法 对28例食管癌、贲门患者术前均行内镜超声扫描和CT扫描,并分别进行T、N分期,以术后病理为金标准,比较两者分期的准确性有无差异,同时对比两者对淋巴结转移的准确率(即真实性)的差异,判断内镜超声的应用价值. 结果 本组28例病例中,T分期准确率内镜超声为89.3%(25/28),高于CT的46.4%(13/28),差异有统计学意义(P=0.004,P＜0.01).N分期中,内镜超声与CT的准确率分别为82.1%(23/28)及50.0%(14/28),差异有统计学意义(P=0.035,P＜0.05).对转移淋巴结的分组统计中,内镜超声与CT的准确率分别为88.7%及72.2%,有显著性差异(χ2=7.031,P=0.008,P＜0.01).结论 内镜超声在食管癌、贲门癌术前分期中有重要作用,其T分期准确率明显高于传统CT扫描.以淋巴结短径、S/L(淋巴结短径/淋巴结长径)并结合淋巴结的超声显像特征进行分析,提高了判断淋巴结转移以及N分期的准确性.     

小野寺营养预后指数在胃癌患者预后评估中的价值

目的探讨应用小野寺营养预后指数(Onodera's prognostic nutritional index,Onodera's PNI)评估胃癌患者预后的价值。方法 2000年1月~2014年1月收治的胃癌患者386例,收集患者术前血液检查结果(包括血清白蛋白水平、外周血总淋巴细胞计数),计算每~例患者术前Onodera's PNI。根据PNI分为营养较好组(201例,PNI≥48)和营养较差组(185例,PNI48)。分析PNI与临床病理特征、术后并发症及预后的相关性,并通过Cox回归模型筛选影响胃癌患者的预后因素。结果 386例患者术前平均PNI为50.6±5.7。年龄≥65岁者平均PNI为48.5±5.7,65岁者为51.8±5.4,两组比较差异有统计学意义(P0.01);pT3/T4期及有淋巴结转移者与pT1/T2期及无淋巴结转移者比较平均PNI均明显降低(P0.01)。两组患者术后总体并发症发生率分别为6.5%(13/201)和15.6%(29/185),差异有统计学意义(P0.01)。有并发症组平均PNI值为(49.2±5.4),无并发症组为(51.6±5.3),两组比较差异有统计学意义(P0.05)。相关分析显示,PNI与患者年龄、肿瘤侵润深度、淋巴结转移状况、术后总体并发症率具有相关性(P0.05)。营养较好组和营养较差组术后5年总体生存(OS)率及无瘤生存(DFS)率分别为86.2%比52.1%(χ~2=9.28,P0.01)及83.5%比53.7%(χ~2=9.36,P0.01)。多因素Cox回归分析证实,营养预后指数是影响胃癌患者预后的独立预测因素(HR=2.16,95%CI:1.57~3.26,P0.01)。结论小野寺营养预后指数能较好地反映胃癌患者的营养状态、手术风险及预后,是独立于TNM分期的一种胃癌患者长期结果的预测指标,其获得简单方便。     

Endoscopic ultrasonography for gastric cancer

BACKGROUND: This study aimed to evaluate the utility and shortcomings of endoscopic ultrasound (EUS) in tumor node metastasis (TNM) staging of gastric cancer and its influence on treatment. METHODS: The series included 126 patients (65 men and 44 women) with gastric cancer who underwent EUS from July 1997 to June 2003 at the National University Hospital, Singapore. The final analysis included 109 patients ranging in age from 29 to 97 years (mean, 63.13 years). RESULTS: EUS staging for primary disease: Specimen histology was available for 102 of the 109 patients who underwent surgery. The accuracy was 79% for T1, 73.9% for T2, 85.7% for T3, and 72.7% for T4. The overall accuracy was 80.4%. EUS staging for nodes: The sensitivity of EUS for detecting nodal disease was 74.2% for N0, 78% for N1, 53.8% for N2, and 50% for N3. Overall, the N staging by EUS showed a sensitivity of 82.8%, a specificity of 74.2%, a positive predictive value of 85.4%, a negative predictive value of 70.2%, and an accuracy of 77.7%. Radical gastrectomy was proposed for 95 patients on the basis of the staging with EUS and computed tomography (CT) scan, and 87 patients (91.6%) underwent the surgery. Preoperative staging accurately predicted the operative strategy for 89% of the patients. No significant predictor for accuracy was achieved by performing a logistic regression analysis for the correct staging of T stage using EUS and adjusting for tumor location (middle part/distal third/whole stomach vs proximal/cardioesophageal) (p = 0.873), operator (p = 0.546), and subject's sequence (initial 50 vs last 50 cases) (p = 0.06). CONCLUSION: Ultrasound is the most accurate and reliable method for the preoperative staging of gastric carcinomas, and it is mandatory if a tailored therapeutic approach is planned according to stage.     

Lgr5蛋白和E-钙黏蛋白在胃癌组织中表达的研究

目的检测胃癌组织中Lgr5及E-钙黏蛋白(E-cad)的蛋白表达情况并分析其与胃癌患者临床病理特征及预后的关系。方法采用免疫组织化学SABC方法检测69例胃癌组织及30例癌旁正常胃黏膜组织中Lgr5及E-cad的蛋白表达情况,同时分析其与胃癌患者临床病理特征和生存的关系。结果Lgr5和E-cad蛋白分别在60例(87.0%)和30例(43.5%)胃癌患者的胃癌组织中呈阳性表达,分别有5例(16.7%)和30例(100%)在癌旁正常胃黏膜组织中呈阳性表达,二者在不同组织中的蛋白表达阳性率比较差异均有统计学意义(Lgr5蛋白:χ^2=45.814,P<0.001;E-cad蛋白:χ^2=11.249,P=0.001)。Lgr5和E-cad蛋白在胃癌组织中的阳性表达均与分化程度和浸润深度有关(P<0.05),Lgr5蛋白在胃癌组织中的阳性表达还与淋巴结转移和幽门螺杆菌(HP)感染有关(P<0.05)而E-cad蛋白阳性表达却与此无关(P>0.05)。Lgr5蛋白表达阳性和阴性患者的5年总生存情况比较差异无统计学意义(χ^2=1.819,P=0.117),而E-cad蛋白表达阳性胃癌患者的5年总生存情况明显优于E-cad蛋白表达阴性胃癌患者(χ^2=5.814,P=0.016)。Lgr5蛋白表达与E-cad蛋白表达呈明显的负相关(rs=-0.355,P=0.003)。结论Lgr5蛋白可能参与了肿瘤组织局部浸润、淋巴结转移过程,与肿瘤恶生程度有关,未发现其阳性表达与预后有关;E-cad的表达可能参与了肿瘤的肿瘤局部侵袭和进展且与患者预后有关。     

超声内镜和CT检查对判断食管癌根治性切除的临床价值

目的探讨超声内镜（EUS）和CT对判断食管癌能否根治性切除的临床价值。方法回顾性分析经手术治疗的746例食管癌患者的临床资料．按术前所行检查分为CT组（480例）、EUS组（151例）和EUS加CT组（115例）,采用双盲法,对EUS和CT影像进行回顾性阅片,并将各组结果和手术病理结果进行对照研究。结果CT组、EUS组和EUS加CT组患者的手术根治性切除率分别为91．0％、93．4％和93．9％：3组间差异无统计学意义（X2=1．551,P=0．484）。CT组、EUS组和EUS加CT组术前判断手术根治切除率分别为81．7％、94．7％和96．5％（Xz=15．131,P=0．000;x2=15．662,P=0．000：X2=0．502．P=0．346）;诊断主动脉受侵率分别为91．3％、98．7％和98．3％（X2=9．764,P=0．000;x2=6．659,P=0．004;x2=0．076,P=0．581）;诊断气管支气管受侵率分别为91.3％、96．0％和98．3％（X2=3．729,P=0．034;X2=6．659,P=0．004;X2=1．117,P=0．248）。结论EUS诊断食管癌根治切除和主动脉受侵的临床价值高于CT：EUS和CT诊断气管支气管受侵的价值均较低：与单独应用EUS相比．CT和EUS的联合应用未能显著提高诊断食管癌的根治切除率。     

改良T分期应用于肝门部胆管癌的临床价值

目的 评价改良T分期用于肝门部且日管癌术前评估与预后判断的临床价值.方法 回顾性分析1999-2007年98例肝门部胆管癌患者的If缶床资料,按改良T-分期标准分期;采用χ~2检验、Log rank及Breslow检验评析不同分期的切除率、根治性切除率、联合肝叶及门静脉部分切除率、较低组织分化及淋巴结转移率与生存率差异.结果 T1、T2、,13期分别有43、37、18例,切除率为65%、40%、11%,根治性切除率为46%、21%、0,均随T分期升高而下降(前者χ~2=15,P<0.01;后者χ~2=14,P<0.01);T1与T2期切除病例中分别有60%与73%联合肝叶切除(χ~2=0.6,P>0.05)、3%与33%联合门静脉部分切除(χ~2=4,P<0.05)、71%与40%较低分化类型(χ~2=4,P<0.05)、50%与40%淋巴结转移(χ~2=0.4,P>0.05);T1与T2期1、3、5年生存率分别为58%、30%、18%与43%、11%、0%,而T3期1、2年生存率依次为12%、0,T1与T2期显著高于T3期(T1与T3:Log rank χ~2=14,Breslow χ~2=12,P<0.01;T2与13:Log rank χ~2=6,Breslow χ~2=4,P<0.05),T1与T2期差异无统计学意义(Log rank χ~2=2,Breslow χ~2=1,P值均>0.05).结论 改良T分期有较好的术前评估作用;但仍需阐明其与组织分化和淋巴结转移的相关性.     

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??Role of endoscopic ultrasound in the staging of gastric stump carcinoma WU Qi*??LI Zi-yu??BU Zhao-de,et al. * Endoscopy Center??Institute of Clinical Oncology, Peking University School of Oncology, Beijing100142, China Corresponding author??ZHANG Ji-chang, E-mail??drzhangjichang@sina.com Abstract Objective To investigate the accuracity of endoscopic ultrasound (EUS) for staging the gastric stump carcinoma (GSC). Methods Twenty-one consecutive patients with pathological proved GSC were checked with endoscopic ultrasound between October 2001 and March 2009 at Peking University School of Oncology. All patients subsequently underwent remnant total gastric resection with lymph node dissection. The pathological staging with EUS staging was compared. Results Overall T2,T3,T4,N0,N1,N2,and N3 of EUS staging for GSC in the group were3,9,9,3,6,6 and 6 cases, respectively. On the contrast??T2,T3,T4,N0,N1,N2, and N3 of pathological staging in the group were3,13,5,3??4,4 and 10 cases, respectively. Diagnostic accuracy of EUS for GSC TN stage in the group were 81.0% and 76.2%. Conclusion EUS is a non-invasive technique with high accuracy for TN staging in the GSC patients. However, due to the low specificity with metastasis lymph nodes, it is suggested to ally with CT .     

甘肃河西地区大肠癌与胆囊结石相关性的初步探讨

目的探讨大肠癌发病与胆囊结石之间的相关性。方法对照分析213例大肠癌患者（大肠癌组）和同期432例胃癌患者（对照组）合并胆囊结石的比率,比较大肠癌组内胆囊结石患者与非胆囊结石患者在肿瘤发生部位、性别、年龄、各影响因素分布等方面的差异。结果 （1）大肠癌组合并胆囊结石41例（19.25%）,对照组合并胆囊结石37例（8.56%）,两组合并胆囊结石的比率比较,χ^2=15.318,P=0.000,差异有高度统计学意义,大肠癌组合并胆囊结石的比率明显升高。（2）大肠癌组内,合并胆囊结石的大肠癌患者与不合并胆囊结石的患者在肿瘤解剖部位间的差异无统计学意义（χ^2=5.386,P=0.068）;但在性别间的差异有高度统计学意义（χ^2=11.056,P=0.001）,女性大肠癌合并胆囊结石的比率明显升高;大肠癌合并胆囊结石的比率在〈50岁、50-60岁、〉60岁3个年龄段间的差异有高度统计学意义（χ^2=10.557,P=0.005）,〉60岁的大肠癌患者合并胆囊结石的比率明显升高;（3）多元素回归分析显示,合并胆囊结石的超重或高血压、糖尿病、肝功能异常、嗜酒、非甾体类抗炎药常规服用等因素与大肠癌发生无相关性,而伴有血脂异常（高血脂）相关（OR=2.742,95%CI：1.114-6.751,P=0.046）。结论胆囊结石可能是大肠癌发生的高危因素之一;女性胆囊结石、〉60岁的胆囊结石以及伴有血脂异常的胆囊结石并发大肠癌的风险明显升高。     

Endoscopic ultrasound in routine clinical practice for staging adenocarcinomas of the stomach and distal esophagus]

PROBLEM: Endoscopic ultrasound (EUS) is an important diagnostic tool for determining the best therapeutic strategy (primary resection, neoadjuvant therapy or palliation only) to offer esophageal or gastric cancer patients. PATIENTS AND METHODS: In the present study (1992-2001),we evaluated the accuracy of EUS in adenocarcinomas of the distal esophagus and stomach and compared our results with pathologists findings as the gold standard. RESULTS: Of the 222 patients studied, the precise examination of 11% EUS was not completely possible due to severe tumor stenosis. The accuracy of EUS with respect to T, N+/- and TN+/- amounted to 51%, 65% and 34% in 131 patients with adenocarcinomas of the esophageal gastric junction and to 50%, 66% and 37% in 91 patients with adenocarcinomas located in the fundus, corpus or antrum of the stomach respectively. With respect to T-stage, the overstaging of tumors was more common than understaging, especially in pT2b-carcinomas. The subgroup analysis of the 131 EGJ adenocarcinoma patients showed that the results obtained by EUS were slightly better in type I (distal esophageal cancer) than in type II and III cardia carcinomas (proximal gastric cancer).When comparing two observation periods (1992-1996 and 1997-2001), the accuracy of endoscopic ultrasound staging was very similar in both periods for T-category (51% vs 49%) and N-category (63% vs 64%) as well as for combined TN-staging (36% vs 35%) respectively. CONCLUSIONS: In clinical routine examinations of adenocarcinomas of the stomach and the distal esophagus, the accuracy of EUS is not as good as the excellent results in the past--mostly obtained under study conditions--may suggest.