Endoscopic diagnosis of the depth of invasion in early gastric cancer / 대한내과학회지

BACKGROUND: In order to decide on a strategy of the treatment against gastric cancer, an accurate preoperative evaluation of the depth of tumor invasion is essential. We have studied the depth of invasion in early gastric cancer by endoscopic findings.METHODS: The preoperative endoscopic diagnosis of the depth of invasion was compared with pathologic findings in a total of 108 cases with early gastric cancers (EGC) which were confirmed pathologically in resected specimen. RESULTS: Of one hundred eight EGCs, forty-one were elevated type, others were flat-depressed type. There was no relationship between the depth of invasion and macroscopic type of EGC. All of the elevated typed EGCs were differentiated carcinoma. In the depressed typed EGCs, Forty-five percent was differentiated carcinoma and fifty-five percent was undifferentiated carcinoma. The incidence of lymph node metastasis in submucosal cancers (14.8%) was significantly more than in mucosal cancers (1.6%). Among the submucosal cancers, the incidence of nodal metastasis in double lesions (100%) was significantly more than in single lesions (14.8%). In the elevated typed EGCs, mucosal cancers were small in size less than 3.0 cm (83%), and contained whitish patches, and showed uneveness and erosion. Submucosal cancers were large in size, and contained ulcers, and showed submucosal tumor-like shapes and bridging folds. In the depressed typed EGCs, it was difficult to determine endoscopically the depth of invasion. Submucosal cancers showed the fusion of converging folds and unevenness of the depressed base. The regularity of the depressed base without ulcer was primarily found in mucosal cancer. CONCLUSION: When the tumor was elevated, the endoscopic diagnosis for the depth of invasion was determined easily by size of the lesion and features of the elevated surface. For the depressed tumor, diagnostic clues were the pattern of the base of the depression and the converging fold, and the endoscopic diagnosis of the depth of invasion was much more difficult than the elevated type EGC.

Correspondence of Endoscopic Findings with Histologic Differentiation in Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to investigate the endoscopic findings of early gastric cancer according to histological differentiation. METHODS: One hundred eight cases of early gastric cancer (EGC) which had been confirmed surgically over a 1 year and 7 month period, were studied to assess the relationship between histological differentiation and endoscopic findings. RESULTS: All elevated types of EGC (41 cases) were found to be differentiated carcinoma. 48.2% (30/67 cases) of the depressed type EGC was determined to be differentiated carcinoma, while the others (51.8%) were undifferentiated carcinoma. Twenty-four of thirty cases with differentiated depressed type EGC showed a reddish discolored surface (80%), and the others manifested a whitish or mixed colored surface of red and white. In the undifferentiated depressed type EGC, 73% (27/37 cases) revealed a whitish or mixed colored surface, while the others (27%) showed a reddish discoloration. In the differentiated depressed type EGC, the character of the depressed surface was mainly regular and soft or fine granular (77%), while that of the undifferentiated cases appeared as uneven large granules (43.2%) or fine granules (43.2%), sclerotic (2.8%) and/or elevated (10.8%). The margin of the depressed type EGC with differentiated carcinoma was mainly of a shoaling beach type (83.3%), and that of the undifferentiated carcinoma was not uniform and existed as a cliff type (60%), Riasis coast type (11.4%) and shoaling beach type (28.6%). CONCLUSIONS: All elevated types of EGC showed differentiated types, and histological differentiation of depressed type EGC was macroscopically determined by the size of lesions, color, and character of the depressed surface and margin of the depression.

Endoscopic Review of Early Gastric Cancer / 대한소화기내시경학회지

In order to decide on appropriate treatment strategy against gastric cancer, an accurate preoperative evaluation of the depth of cancer invasion is essential. We studied 165 cases(19%) of early gastric cancer among 706 cases of gastric cancer. resected over a 6 year period. A retrospective study of early gastric cancer was done to evaluate the endoscopic accuracy and lymph node metastasis status, the following results were obtained: 1) The proportion of EGC according to macroscopic type was 68.5% of depressed type(II, III, IIa+III, IIc+III, III+IIc, IIb+IIc), 26% of elevated type(I, IIa, IIa+ IIb, IIa+IIc), 5.5% of flat type(IIb). 2) In the view of accuracy of endoscopic diagnosis, the rate of accurate diagnosis suitable for postoperative macroscopic type was 37.5%, the rate of unsuitable typed EGC was 33.3%, overestimation(diagnosed to AGC) was 20.6% and underestimation(diagnosed to benign diseases)was 8.6%. Overall accuracy of endoscopic diagnosis was 70.8%. 3) The cases confined to the mucosa were 40.6% and others were submucosal cancers(59.4%). 4) Positive lymph node metastasis was found in 1.5% of M-cancer and 18.4% of SM-cancer(overall 11.5%). 5) Node positive rate of differentiated cancer was 10.5%, undifferentiated carcinoma was 15.4%. There was no signficant difference in frequency of nodal metastasis according tumor size and macroscopic type. 6) Tumors which satisfy the following criteria may not metastasize to lymph nodes:(1) confined to the mucosa; (2) less than 2.0cm in diameter; (3) macroscopically elevated or flat; (4) histologically well or moderately differentiated.