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Advances in the use of ultrasound endoscopy in gastric lymphoma: a systematic review and perspectives

evidence-based-medicine
gastroenterology-and-hepatology
oncology
radiology-and-medical-imaging

Abstract

Background: Endoscopic ultrasound (EUS) has been widely used in the diagnosis and treatment of gastric lymphoma. To better evaluate its clinical value, a comprehensive assessment of the current strength and quality of evidence is needed.

Methods: We systematically searched PubMed, Embase, and the Cochrane Library from the time of construction to February 5, 2025, for studies investigating EUS in gastric lymphoma. Data extraction included disease subtype, EUS classification, imaging findings, treatment regimens, and follow-up outcomes.

Results: Mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B cell lymphoma (DLBCL) are the primary subtypes of gastric lymphoma, with DLBCL being the most prevalent. Endoscopic multisite sampling is a key diagnostic technique for gastric lymphoma. If biopsy results are negative, EUS and EUS-guided sampling are valuable for diagnosis and differentiation. EUS-fine needle aspiration (EUS-FNA) combined with flow cytometry (FCM) enhances the sensitivity and accuracy of gastric lymphoma diagnosis. EUS-fine needle biopsy (EUS-FNB) may be more advantageous than EUS-FNA, and rapid on-site evaluation (ROSE) and sample classification further improve diagnostic accuracy. The role of magnified gastroscopy and magnifying endoscopy with narrow-band imaging (ME-NBI) in diagnosing gastric lymphoma is increasingly recognized. Ultrasound elastography and contrast enhancement assist in identifying perigastric lymph nodes. EUS is instrumental in the follow-up of MALT lymphoma, particularly in patients with eradicated Helicobacter pylori (HP) infections. Microprobe ultrasound endoscopy is preferred, whereas linear-array ultrasound endoscopy is also suitable for follow-up. The utility of EUS in monitoring DLBCL remains debated. During follow-up, EUS combined with biopsy facilitates improved monitoring of disease progression.

Conclusion: MALT lymphoma and DLBCL are the primary types of gastric lymphoma. EUS examination and guided retrieval are advantageous for diagnosing and differentiating gastric lymphoma, and EUS can also be utilized for the follow-up of MALT lymphoma.

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