Endoscopic diagnosis of the depth of invasion in early gastric cancer

Seo, Seung Weon; Jeong, Hyun Yong; Lee, Seug Min; Lee, Byoung Seok; Kim, Jin Hee; Kim, Nam Jae; Rho, Seung Moo; Song, Kyu Sang; Shin, Kyung Sook; Cho, June Sik

Abstract

BACKGROUND: In order to decide on a strategy of the treatment against gastric cancer, an accurate preoperative evaluation of the depth of tumor invasion is essential. We have studied the depth of invasion in early gastric cancer by endoscopic findings.METHODS: The preoperative endoscopic diagnosis of the depth of invasion was compared with pathologic findings in a total of 108 cases with early gastric cancers (EGC) which were confirmed pathologically in resected specimen.
RESULTS
Of one hundred eight EGCs, forty-one were elevated type, others were flat-depressed type. There was no relationship between the depth of invasion and macroscopic type of EGC. All of the elevated typed EGCs were differentiated carcinoma. In the depressed typed EGCs, Forty-five percent was differentiated carcinoma and fifty-five percent was undifferentiated carcinoma. The incidence of lymph node metastasis in submucosal cancers (14.8%) was significantly more than in mucosal cancers (1.6%). Among the submucosal cancers, the incidence of nodal metastasis in double lesions (100%) was significantly more than in single lesions (14.8%). In the elevated typed EGCs, mucosal cancers were small in size less than 3.0 cm (83%), and contained whitish patches, and showed uneveness and erosion. Submucosal cancers were large in size, and contained ulcers, and showed submucosal tumor-like shapes and bridging folds. In the depressed typed EGCs, it was difficult to determine endoscopically the depth of invasion. Submucosal cancers showed the fusion of converging folds and unevenness of the depressed base. The regularity of the depressed base without ulcer was primarily found in mucosal cancer.
CONCLUSION
When the tumor was elevated, the endoscopic diagnosis for the depth of invasion was determined easily by size of the lesion and features of the elevated surface. For the depressed tumor, diagnostic clues were the pattern of the base of the depression and the converging fold, and the endoscopic diagnosis of the depth of invasion was much more difficult than the elevated type EGC.