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01-07-2014

Size discrepancy between endoscopic size and pathologic size is not negligible in endoscopic resection for early gastric cancer

Authors: Choong Nam Shim, Mi Kyung Song, Dae Ryong Kang, Hyun Soo Chung, Jun Chul Park, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee

Published in: Surgical Endoscopy | Issue 7/2014

Abstract

Background

Accurate tumor size measurement is critical for selecting proper candidates for endoscopic resection (ER) of early gastric cancer (EGC). However, size discrepancy between endoscopic size and pathologic size often occurs during ER for EGC.

Objective

The purposes of this study were to investigate the clinicopathological characteristics related to size discrepancy and the clinical implications of size discrepancies in terms of therapeutic outcomes.

Methods

Between April 2006 and June 2013, a total of 820 patients with 826 EGCs underwent ER. Enrolled lesions were categorized into the following three groups based on size discrepancy between endoscopic size and pathologic size: well-estimated (N = 308), underestimated (N = 215), or overestimated (N = 303) lesions. The well-estimated group was defined as lesions with a ratio of endoscopic size to pathologic size from 0.7 to 1.3.

Results

The overall median size discrepancy was 5.0 mm (interquartile range 2.0–9.0). Size, location, macroscopic type, primary tumor stage, and histology differed significantly between the three groups. Larger size [odds ratio (OR) 5.07, 95 % confidence interval (CI) 3.38–7.59, p < 0.001], flat/depressed type (OR 1.71, 95 % CI 1.15–2.55, p = 0.008), and undifferentiated histology (OR 2.24, 95 % CI 1.31–3.83, p = 0.003) were independent risk factors for endoscopic size underestimation in multivariate analysis. Smaller size (OR 10.95, 95 % CI 4.64–25.87, p < 0.001) was the only independent predictor for endoscopic overestimation of size. Significantly lower complete resection and curative resection rates were detected in the underestimated group compared with the well-estimated group, while the complete resection rate in the overestimated group tended to be higher than in the well-estimated group. There was no significant difference of curative resection rate between the overestimated and the well-estimated groups.

Conclusions

Larger size, flat/depressed type, and undifferentiated histology of EGC carry a significant risk for endoscopic underestimation of lesion size, which results in the lower rates of complete and curative resections for EGC. Further studies to reduce size discrepancy are warranted.

Murakami T (1971) Pathomorphological diagnosis. Definition and gross classification of early gastric cancer. Gann Monogr Cancer Res 11:53–55

Ahn YO, Park BJ, Yoo KY, Kim NK, Heo DS, Lee JK, Ahn HS, Kang DH, Kim H, Lee MS et al (1991) Incidence estimation of stomach cancer among Koreans. J Korean Med Sci 6(1):7–14PubMedCentralPubMed

Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, Adachi Y, Yakeishi Y, Matsukuma A, Enjoji M (1992) Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy. Cancer 70(5):1030–1037PubMedCrossRef

Tada M, Murakami A, Karita M, Yanai H, Okita K (1993) Endoscopic resection of early gastric cancer. Endoscopy 25(7):445–450PubMedCrossRef

Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, Yokota T (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50(4):560–563PubMedCrossRef

Probst A, Pommer B, Golger D, Anthuber M, Arnholdt H, Messmann H (2010) Endoscopic submucosal dissection in gastric neoplasia: experience from a European center. Endoscopy 42(12):1037–1044PubMedCrossRef

Farhat S, Chaussade S, Ponchon T, Coumaros D, Charachon A, Barrioz T, Koch S, Houcke P, Cellier C, Heresbach D, Lepilliez V, Napoleon B, Bauret P, Coron E, Le Rhun M, Bichard P, Vaillant E, Calazel A, Bensoussan E, Bellon S, Mangialavori L, Robin F, Prat F (2011) Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy 43(8):664–670PubMedCrossRef

Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (version 3). Gastric Cancer 14(2):113–123CrossRef

Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3(4):219–225PubMedCrossRef

10.

Choi J, Kim SG, Im JP, Kim JS, Jung HC (2013) Endoscopic estimation of tumor size in early gastric cancer. Dig Dis Sci 58(8):2329–2336PubMedCrossRef

11.

Gopalswamy N, Shenoy VN, Choudhry U, Markert RJ, Peace N, Bhutani MS, Barde CJ (1997) Is in vivo measurement of size of polyps during colonoscopy accurate? Gastrointest Endosc 46(6):497–502PubMedCrossRef

12.

Nagahama T, Yao K, Maki S, Yasaka M, Takaki Y, Matsui T, Tanabe H, Iwashita A, Ota A (2011) Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video). Gastrointest Endosc 74(6):1259–1267PubMedCrossRef

13.

Kadowaki S, Tanaka K, Toyoda H, Kosaka R, Imoto I, Hamada Y, Katsurahara M, Inoue H, Aoki M, Noda T, Yamada T, Takei Y, Katayama N (2009) Ease of early gastric cancer demarcation recognition: a comparison of four magnifying endoscopy methods. J Gastroenterol Hepatol 24(10):1625–1630PubMedCrossRef

14.

Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma, 3rd English edn. Gastric Cancer 14(2):101–112CrossRef

15.

Hamilton SR, Aaltonen LA (2000) Pathology and genetics of tumours of the digestive system. In: World Health Organization classification of tumours. International Agency for Research on Cancer, Lyon

16.

Kim WH, Park CK, Kim YB (2005) A standardized pathology report for gastric cancer. Korean J Pathol 39:106–113

17.

Kim JH, Lee YC, Kim H, Song KH, Lee SK, Cheon JH, Kim H, Hyung WJ, Noh SH, Kim CB, Chung JB (2009) Endoscopic resection for undifferentiated early gastric cancer. Gastrointest Endosc 69(4):e1–e9PubMedCrossRef

18.

Park YM, Cho E, Kang HY, Kim JM (2011) The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc 25(8):2666–2677PubMedCrossRef

19.

Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Ohnita K, Mizuta Y, Shiozawa J, Kohno S (2009) Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58(3):331–336PubMedCrossRef

20.

Kim YY, Jeon SW, Kim J, Park JC, Cho KB, Park KS, Kim E, Chung YJ, Kwon JG, Jung JT, Kim EY, Kim KO, Jang B, Lee SH, Yang CH (2013) Endoscopic submucosal dissection for early gastric cancer with undifferentiated histology: could we extend the criteria beyond? Surg Endosc 27(12):4656–4662PubMedCrossRef

21.

Kang KJ, Kim KM, Kim JJ, Rhee PL, Lee JH, Min BH, Rhee JC, Kushima R, Lauwers GY (2012) Gastric extremely well-differentiated intestinal-type adenocarcinoma: a challenging lesion to achieve complete endoscopic resection. Endoscopy 44(10):949–952PubMedCrossRef

22.

Kang HY, Kim SG, Kim JS, Jung HC, Song IS (2010) Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg Endosc 24(3):509–516PubMedCrossRef

23.

Eichenseer PJ, Dhanekula R, Jakate S, Mobarhan S, Melson JE (2013) Endoscopic mis-sizing of polyps changes colorectal cancer surveillance recommendations. Dis Colon Rectum 56(3):315–321PubMedCrossRef

24.

Kiyotoki S, Nishikawa J, Satake M, Fukagawa Y, Shirai Y, Hamabe K, Saito M, Okamoto T, Sakaida I (2010) Usefulness of magnifying endoscopy with narrow-band imaging for determining gastric tumor margin. J Gastroenterol Hepatol 25(10):1636–1641PubMedCrossRef

25.

Yamamoto Y, Fujisaki J, Hirasawa T, Ishiyama A, Yoshimoto K, Ueki N, Chino A, Tsuchida T, Hoshino E, Hiki N, Fukunaga T, Sano T, Yamaguchi T, Takahashi H, Miyata S, Yamamoto N, Kato Y, Igarashi M (2010) Therapeutic outcomes of endoscopic submucosal dissection of undifferentiated-type intramucosal gastric cancer without ulceration and preoperatively diagnosed as 20 millimetres or less in diameter. Dig Endosc 22(2):112–118PubMedCrossRef

26.

Huh CW, da Jung H, Kim JH, Lee YC, Kim H, Kim H, Yoon SO, Youn YH, Park H, Lee SI, Choi SH, Cheong JH, Noh SH (2013) Signet ring cell mixed histology may show more aggressive behavior than other histologies in early gastric cancer. J Surg Oncol 107(2):124–129PubMedCrossRef

27.

Sawada S, Fujisaki J, Yamamoto N, Kato Y, Ishiyama A, Ueki N, Hirasawa T, Yamamoto Y, Tsuchida T, Tatewaki M, Hoshino E, Igarashi M, Takahashi H, Fujita R (2010) Expansion of indications for endoscopic treatment of undifferentiated mucosal gastric cancer: analysis of intramucosal spread in resected specimens. Dig Dis Sci 55(5):1376–1380PubMedCrossRef

28.

Zambelli A (2010) Can virtual chromoendoscopy measure up to histology in early gastric cancer? Dig Liver Dis 42(10):677–678PubMedCrossRef

29.

Abe S, Oda I, Suzuki H, Nonaka S, Yoshinaga S, Odagaki T, Taniguchi H, Kushima R, Saito Y (2013) Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Endoscopy 45(9):703–707PubMedCrossRef

30.

Park J, Choi KD, Kim MY, Lee JH, Song HJ, Lee GH, Jung HY, Kim JH (2012) Is endoscopic resection an acceptable treatment for undifferentiated EGC? Hepatogastroenterology 59(114):607–611PubMedCrossRef

31.

Okada K, Fujisaki J, Yoshida T, Ishikawa H, Suganuma T, Kasuga A, Omae M, Kubota M, Ishiyama A, Hirasawa T, Chino A, Inamori M, Yamamoto Y, Yamamoto N, Tsuchida T, Tamegai Y, Nakajima A, Hoshino E, Igarashi M (2012) Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy 44(2):122–127PubMedCrossRef

32.

Goto O, Fujishiro M, Kodashima S, Ono S, Omata M (2009) Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 41(2):118–122PubMedCrossRef

33.

Lee H, Yun WK, Min BH, Lee JH, Rhee PL, Kim KM, Rhee JC, Kim JJ (2011) A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc 25(6):1985–1993PubMedCrossRef

34.

Ahn JY, Jung HY, Choi KD, Choi JY, Kim MY, Lee JH, Choi KS, Kim do H, Song HJ, Lee GH, Kim JH, Park YS (2011) Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 74(3):485-493

35.

Yamaguchi N, Isomoto H, Fukuda E, Ikeda K, Nishiyama H, Akiyama M, Ozawa E, Ohnita K, Hayashi T, Nakao K, Kohno S, Shikuwa S (2009) Clinical outcomes of endoscopic submucosal dissection for early gastric cancer by indication criteria. Digestion 80(3):173–181PubMedCrossRef

36.

Min BH, Lee JH, Kim JJ, Shim SG, Chang DK, Kim YH, Rhee PL, Kim KM, Park CK, Rhee JC (2009) Clinical outcomes of endoscopic submucosal dissection (ESD) for treating early gastric cancer: comparison with endoscopic mucosal resection after circumferential precutting (EMR-P). Dig Liver Dis 41(3):201–209PubMedCrossRef

37.

Sako A, Kitayama J, Ishikawa M, Yamashita H, Nagawa H (2006) Impact of immunohistochemically identified lymphatic invasion on nodal metastasis in early gastric cancer. Gastric Cancer 9(4):295–302PubMedCrossRef

38.

Luinetti O, Fiocca R, Villani L, Alberizzi P, Ranzani GN, Solcia E (1998) Genetic pattern, histological structure, and cellular phenotype in early and advanced gastric cancers: evidence for structure-related genetic subsets and for loss of glandular structure during progression of some tumors. Hum Pathol 29(7):702–709PubMedCrossRef

39.

Zheng HC, Li XH, Hara T, Masuda S, Yang XH, Guan YF, Takano Y (2008) Mixed-type gastric carcinomas exhibit more aggressive features and indicate the histogenesis of carcinomas. Virchows Arch 452(5):525–534PubMedCentralPubMedCrossRef

40.

Bok GH, Jeon SR, Cho JY, Cho JH, Lee WC, Jin SY, Choi IH, Kim HG, Lee TH, Park EJ (2013) The accuracy of probe-based confocal endomicroscopy versus conventional endoscopic biopsies for the diagnosis of superficial gastric neoplasia (with videos). Gastrointest Endosc 77(6):899–908PubMedCrossRef

Title: Size discrepancy between endoscopic size and pathologic size is not negligible in endoscopic resection for early gastric cancer
Authors: Choong Nam Shim
Mi Kyung Song
Dae Ryong Kang
Hyun Soo Chung
Jun Chul Park
Hyuk Lee
Sung Kwan Shin
Sang Kil Lee
Yong Chan Lee
Publication date: 01-07-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3453-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Size discrepancy between endoscopic size and pathologic size is not negligible in endoscopic resection for early gastric cancer

Abstract

Background

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

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