Saito Y, Fujii T, Kondo H, Mukai H, Yokota T, Kozu T, Saito D
Dept. of Gastrointestinal Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104, Japan.
Endoscopy. 2001 Aug;33(8):682-6. doi: 10.1055/s-2001-16213.
Laterally spreading tumors (LST) of the colon are best removed by endoscopic mucosal resection (EMR) as they extend laterally rather than vertically. Since they sometimes invade deeply into the submucosal layer, it is important to assess the depth of invasion endoscopically before treatment. In the present study, we examined the endoscopic features of a large number of LSTs in order to assess which features correlated with depth of invasion.
257 LSTs removed at the National Cancer Center Hospital, Tokyo, between January 1988 and September 1998 were retrospectively analyzed.
With univariate analysis, unevenness of nodules, presence of large nodules, size, histological type, and presence of depression in the tumor were significantly associated with depth of invasion. Multivariate analysis revealed that histological type and depression in the tumor were independent factors predicting massive submucosal invasion. When an LST showed: 1) even nodules without depression, or 2) uneven nodules without depression and less than 3 mm in diameter, the risk of massive submucosal invasion was 0 % (0/121) and 3.7 % (3/82), respectively.
When LSTs meet the above endoscopic criteria, EMR should be the first-line treatment because of the low risk of massive submucosal invasion.
结肠侧向发育型肿瘤（LST）最好通过内镜黏膜切除术（EMR）切除，因为它们是侧向而非垂直生长。由于它们有时会深深侵犯黏膜下层，因此在治疗前通过内镜评估浸润深度很重要。在本研究中，我们检查了大量LST的内镜特征，以评估哪些特征与浸润深度相关。
回顾性分析了1988年1月至1998年9月期间在东京国立癌症中心医院切除的257例LST。
单因素分析显示，结节不均匀、存在大结节、大小、组织学类型以及肿瘤内存在凹陷与浸润深度显著相关。多因素分析表明，组织学类型和肿瘤内凹陷是预测大量黏膜下浸润的独立因素。当LST表现为：1）结节均匀且无凹陷，或2）结节不均匀且无凹陷且直径小于3mm时，大量黏膜下浸润的风险分别为0%（0/121）和3.7%（3/82）。
当LST符合上述内镜标准时，由于大量黏膜下浸润风险低，EMR应作为一线治疗方法。
