Ochiai Yorinari, Kikuchi Daisuke, Inoshita Naoko, Hayasaka Junnosuke, Suzuki Yugo, Tanaka Masami, Nomura Kosuke, Odagiri Hiroyuki, Yamashita Satoshi, Matsui Akira, Iizuka Toshiro, Kitagawa Masanobu, Hoteya Shu
Department of Gastroenterology, Toranomon Hospital, 105-8470 Tokyo, Japan.
Department of Pathology, Tokyo Medical and Dental University, 113-8519 Tokyo, Japan.
Gastroenterol Res Pract. 2020 Mar 2;2020:6525098. doi: 10.1155/2020/6525098. eCollection 2020.
Endoscopic submucosal dissection (ESD) is widely performed for early gastric cancer (EGC). We have sometimes encountered gastric cancer lesions for which ESD was performed and at which pathologically advanced cancer was found. In this study, we performed clinicopathological examination of lesions whose endoscopic diagnosis and pathology differed substantially.
ESD was performed for 2,194 gastric cancer lesions (1,753 cases) in our institute from April 2005 through March 2015. The vertical margin was positive or status unknown in 51 lesions (2.3%); among these, muscularis propria (MP) or deeper infiltration was identified in 6 lesions from specimens obtained during subsequent surgery. In 1 lesion with MP invasion, the vertical margin was negative. We evaluated the clinicopathological features of these 7 lesions and retrospectively reviewed endoscopic indicators of submucosal invasion for EGC on white light imaging (WLI), narrow-band imaging magnifying endoscopy (NBI-ME), and endoscopic ultrasonography (EUS) performed previously.
Average age was 73.2 ± 7.2 years, and all cases were men. The 7 lesions diagnosed as advanced cancer were 0.32% of 2,194 lesions and were all located in the U region (fundus). On retrospective review of endoscopic findings, 2 of 7 lesions on WBI, 3 of 6 lesions on NBI-ME, and 2 of 5 lesions on EUS met the criteria for indicating submucosal invasion of EGC. No lesions had findings on all 3 modalities.
In rare cases, advanced gastric cancer could not be accurately diagnosed by endoscopy using various modalities. Each case had special characteristics making identification of deep infiltration difficult.
内镜黏膜下剥离术（ESD）广泛应用于早期胃癌（EGC）的治疗。我们有时会遇到已接受ESD治疗但术后病理检查发现为进展期癌的胃癌病变。本研究对内镜诊断与病理结果存在显著差异的病变进行了临床病理检查。
2005年4月至2015年3月期间，在本院对2194例胃癌病变（1753例患者）进行了ESD治疗。51例病变（2.3%）的垂直切缘阳性或情况不明；其中，在后续手术获取的标本中，6例病变发现肌层固有层（MP）或更深层浸润。在1例存在MP侵犯的病变中，垂直切缘为阴性。我们评估了这7例病变的临床病理特征，并回顾性分析了此前针对EGC在白光成像（WLI）、窄带成像放大内镜（NBI-ME）及内镜超声（EUS）下黏膜下浸润的内镜指标。
平均年龄为73.2±7.2岁，所有病例均为男性。这7例被诊断为进展期癌的病变占2194例病变的0.32%，均位于U区（胃底）。回顾内镜检查结果，WBI检查的7例病变中有2例、NBI-ME检查的6例病变中有3例、EUS检查的5例病变中有2例符合EGC黏膜下浸润的指征。没有病变在所有三种检查方式下均有阳性表现。
在罕见情况下，使用多种检查方式的内镜检查无法准确诊断进展期胃癌。每个病例都有其特殊特征，难以识别深层浸润。
