Department of Gastroenterology, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, China.
Shandong Second Provincial General Hospital, Jinan, 250022, China.
BMC Gastroenterol. 2023 Nov 23;23(1):409. doi: 10.1186/s12876-023-03044-3.
To present a study to identify the characteristics of coexisting early gastric cancer (EGC) and benign submucosal lesions, with the aim of reducing the adverse consequences of overdiagnosis and overtreatment.
In this retrospective study, we searched the endoscopic databases of three tertiary centers. We screened of patients suspected of early gastric cancer submucosal infiltration by conventional endoscopy and ultimately selected for endoscopic submucosal dissection treatment after endoscopic ultrasonography and magnifying endoscopy with narrow-band imaging examination. Patients with coexisting EGC and benign submucosal lesions in histological sections were included. Clinical data and endoscopic images were reviewed. To evaluate the precision of endoscopists' diagnoses for this type of lesion, eight endoscopists with different experiences were recruited to judge the infiltration depth of these lesions and analyze the accuracy rate.
We screened 520 patients and retrospectively identified 18 EGC patients with an invasive cancer-like morphology. The most common lesion site was the cardia (12/18, 66.67%). The coexisting submucosal lesions could be divided into solid (5/18, 27.78%) and cystic (13/18, 72.22%). The most common type of submucosal lesion was gastritis cystica profunda (12/18, 66.67%), whereas leiomyoma was the predominant submucosal solid lesion (3/18, 16.67%). Ten (55.56%) patients < underwent endoscopic ultrasonography; submucosal lesions were definitively diagnosed in 6 patients (60.00%). The accuracy of judgement of the infiltration depth was significantly lower in cases of coexistence of EGC with benign submucosal lesions (EGC-SML) than in EGC (38.50% versus 65.60%, P = 0.0167). The rate of over-diagnosis was significantly higher within the EGC-SML group compared to the EGC group (59.17% versus 10.83%, P < 0.0001).
We should be aware of the coexistence of EGC and benign submucosal lesions, the most common of which is early cardiac-differentiated cancer with gastritis cystica profunda.
介绍一项研究，以识别共存的早期胃癌（EGC）和良性黏膜下病变的特征，旨在减少过度诊断和过度治疗的不良后果。
本回顾性研究在三家三级中心的内镜数据库中进行。我们对常规内镜怀疑黏膜下浸润的早期胃癌患者进行筛查，最终在超声内镜和窄带成像放大内镜检查后选择内镜黏膜下剥离治疗。纳入组织学切片中存在共存 EGC 和良性黏膜下病变的患者。回顾性分析患者的临床资料和内镜图像。为了评估不同经验内镜医师对这类病变诊断的准确性，招募了 8 名内镜医师判断这些病变的浸润深度并分析准确率。
我们共筛查了 520 例患者，回顾性识别出 18 例具有侵袭性癌样形态的 EGC 患者。最常见的病变部位是贲门（12/18，66.67%）。共存的黏膜下病变可分为实性（5/18，27.78%）和囊性（13/18，72.22%）。最常见的黏膜下病变类型是胃底腺囊肿（12/18，66.67%），而黏膜下实性病变以平滑肌瘤为主（3/18，16.67%）。10 例（55.56%）患者未进行超声内镜检查；6 例（60.00%）患者明确诊断为黏膜下病变。EGC 合并良性黏膜下病变（EGC-SML）患者浸润深度判断的准确性明显低于 EGC 患者（38.50%比 65.60%，P=0.0167）。EGC-SML 组的过度诊断率明显高于 EGC 组（59.17%比 10.83%，P<0.0001）。
我们应该意识到 EGC 和良性黏膜下病变的共存，其中最常见的是早期贲门分化型胃癌合并胃底腺囊肿。
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