Mori Hirohito, Kobara Hideki, Tsushimi Takaaki, Nishiyama Noriko, Fujihara Shintaro, Masaki Tsutomu
Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan; Department of Gastroenterological Surgery, Ehime Rosai Hospital, Niihama, Japan.
Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan.
PLoS One. 2015 Apr 9;10(4):e0121798. doi: 10.1371/journal.pone.0121798. eCollection 2015.
Objective evaluation of resected specimen and tumor size is critical because the tumor diameter after endoscopic submucosal dissection affects therapeutic strategies. In this study, we investigated whether the true tumor diameter of gastrointestinal cancer specimens measured by flexible endoscopy is subjective by testing whether the specimen is correctly attached to the specimen board after endoscopic submucosal dissection resection and whether the size differs depending on the endoscopist who attached the specimen.
Seventy-two patients diagnosed with early gastric cancer who satisfied the endoscopic submucosal dissection expanded-indication guideline were enrolled. Three endoscopists were randomly selected before every endoscopic submucosal dissection. Each endoscopist separately attached the same resected specimen, measured the maximum resection diameter and tumor size, and removed the lesion from the attachment board.
The resected specimen diameters of the 3 endoscopists were 44.5 ± 13.9 mm (95% Confidence Interval (CI): 23-67), 37.4 ± 12.0 mm (95% CI: 18-60), and 41.1 ± 13.3 mm (95% CI: 20-63) mm. Comparison among 3 groups (Kruskal Wallis H- test), there were significant differences (H = 6.397, P = 0.040), and recorded tumor sizes were 38.3 ± 13.1 mm (95% CI: 16-67), 31.1 ± 11.2 mm (95% CI: 12.5-53.3), and 34.8 ± 12.8 (95% CI: 11.5-62.3) mm. Comparison among 3 groups, there were significant differences (H = 6.917, P = 0.031).
Human errors regarding the size of attached resected specimens are unavoidable, but it cannot be ignored because it affects the patient's additional treatment and/or surgical intervention. We must develop a more precise methodology to obtain accurate tumor size.
University hospital Medical Information Network UMIN No. 000012915.
对切除标本和肿瘤大小进行客观评估至关重要，因为内镜黏膜下剥离术后的肿瘤直径会影响治疗策略。在本研究中，我们通过检测内镜黏膜下剥离切除术后标本是否正确附着于标本板以及所记录的大小是否因附着标本的内镜医师不同而存在差异，来探究经软性内镜测量的胃肠道癌标本的真实肿瘤直径是否具有主观性。
纳入72例符合内镜黏膜下剥离扩大适应证指南的早期胃癌患者。在每次内镜黏膜下剥离术前随机选择3名内镜医师。每名内镜医师分别附着同一切除标本，测量最大切除直径和肿瘤大小，然后将病变从附着板上取下。
3名内镜医师所测切除标本直径分别为44.5±13.9毫米（95%置信区间（CI）：23 - 67）、37.4±12.0毫米（95%CI：18 - 60）和41.1±13.3毫米（95%CI：20 - 63）。3组间比较（Kruskal Wallis H检验），差异有统计学意义（H = 6.397，P = 0.040），所记录的肿瘤大小分别为38.3±13.1毫米（95%CI：16 - 67）、31.1±11.2毫米（95%CI：12.5 - 53.3）和34.8±12.8（95%CI：11.5 - 62.3）毫米。3组间比较，差异有统计学意义（H = 6.917，P = 0.031）。
关于附着切除标本大小的人为误差不可避免，但因其会影响患者的后续治疗和/或手术干预，所以不容忽视。我们必须开发一种更精确的方法来获取准确的肿瘤大小。
大学医院医学信息网络UMIN编号000012915。
