Depth-predicting score for differentiated early gastric cancer

Abstract

Background Intramucosal and minute submucosal (M-SM1; \500 lm in depth) differentiated gastric cancers, which have a negligible risk of lymph node metastasis, are the targets for endoscopic resection. However, there have been few reports about the endoscopic distinction between these cancers and cancers with deeper submucosal invasion (SM2; C500 lm in depth). The aim of this retrospective study was to analyze the differences in the endoscopic features between M-SM1 and SM2 cancers, and to develop a simple scoring model to predict the depth of these early gastric cancers. Methods We analyzed 853 differentiated early gastric cancers treated endoscopically or surgically as a derivation group. Endoscopic images were reviewed to determine the relationship between depth of invasion and the following endoscopic features: tumor location, macroscopic type, tumor size, and endoscopic findings (remarkable redness, uneven surface, margin elevation, ulceration, and enlarged folds). Secondly, we created a depth-predicting model based on the obtained data and applied the model to 211 validation samples.Results On logistic regression analysis, tumor size more than 30 mm, remarkable redness, uneven surface, and margin elevation were significantly associated with deeper submucosal cancers. A depth-predicting score was created by assigning 2 points for margin elevation and tumor size more than 30 mm, and 1 point for each of the other endoscopic features. When validation lesions of 3 points or more were diagnosed as deeper submucosal cancers, the sensitivity, specificity, and accuracy as evaluated by three endoscopists were 29.7-45.9, 93.1-93.7, and 82.5-84.8%, respectively. Conclusions The depth-predicting score could be useful in the decisions on treatment strategy for differentiated M-SM1 early gastric cancers.

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

“…The first is that previously reported diagnostic markers of invasion depth, such as tumor diameter, macroscopic type, and coloration [4,5,6,7], are markers based on statistical correlations that are independent of histopathological features. In contrast, the non-extension sign is a marker with a direct causal link to the histopathological features of SM2 invasion, which suggests high sensitivity and specificity.…”

“…In previous studies, determination of the depth of invasion has been based on the experience of the endoscopist, using a number of different indices of depth of invasion as derived from statistical analyses of the morphological characteristics of SM2 cancers [4][5][6][7]. Since the morphology of EGCs is readily altered by the degree by which the gastric wall is extended by insufflated air, this diagnostic marker lacks both objectivity and reproducibility.…”

Impact of clinical tumor–node–metastasis staging on survival in gastric carcinoma patients receiving surgery

“…With advancements in endoscopy [8], endoscopic ultrasonography [9], and multidetector computed tomography (MDCT) [10], several techniques have been established that provide satisfactory diagnostic data regarding the appropriate depth of invasion. A previous study regarding LN evaluation reported the improved diagnostic accuracy of MDCT [11].…”

Risk factors for submucosal and lymphovascular invasion in gastric cancer looking indicative for endoscopic submucosal dissection

“…Sekiguchi et al [7] identified submucosal (SM) invasion as an independent risk factor for LV invasion in endoscopically resected gastric cancer. Despite extensive efforts [8,9], correct diagnosis of the invasion depth, prior to ESD remains a challenge. When SM/LV invasion is detected following careful pathological examination of endoscopically resected specimens, further surgical treatment, such as gastrectomy with LN dissection, is needed.…”