Section 12
Chapter 11,915

Current problems and the future prospects for endoscopic diagnosis of early gastric cancer - How have magnified endoscopy and endoscopic submucosal dissection techniques changed the status of endoscopic diagnosis of early gastric cancer?

Yao, K.; So, S.; Kikuchi, Y.; Et-Al

Stomach and Intestine (Tokyo) 40(1): 49-64


Accession: 011914612

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Aim : The aim of the study was to clarify current problems in preoperative diagnosis of early gastric cancer.Methods : We investigated the following subjects by reviewing the endoscopic findings, the endoscopic reports and the histopathological findings of 97 consecutive early gastric cancers which have been diagnosed and resected during the last 12 months. (1) The incidence and characteristics of early gastric cancer which did not reveal typical endoscopic morphology characteristic of carcinoma, (2) the accuracy of diagnosis of the depth of invasion of carcinomas, and (3) the incidence and the morphology of lesions whose margins could not be determined by endoscopic findings alone.Results : (1) The incidence of atypical lesions was 15 %. The characteristic morphologies of these lesions were minute cancers, early gastric cancers of the superficial flat-type, early gastric cancers of the superficial-elevated type that showed little change in color and surface structure and early gastric cancers of the superficial-depressed type that revealed no irregularity at the margin. However, these cases could be correctly diagnosed by magnified endoscopy based on microvascular architecture. (2) The diagnostic accuracy of the depth of invasion of the carcinoma was 95 %. which was accurate enough to accept for clinical practice. ( 3) The incidence of lesions whose entire margins could not be determined by ordinary endoscopy was 18 %. Nevertheless, magnifying endoscopy was successful in determining the entire margin in 15 % out of the 18 % of lesions with unclear margins.Conclusions : Magnified endoscopic examination was able to contribute significantly to the accurate diagnosis of early gastric cancer even in the cases of lesions which, by ordinary endoscopy alone, showed atypical findings for carcinoma.

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