Endoscopic prediction of tumor invasion depth in early gastric cancer
Endoscopic prediction of tumor invasion depth in early gastric cancer
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DOI：
10.1016/j.gie.2010.11.053
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发表时间：
2011-05-01
影响因子：
7.7
通讯作者：
Song, In Sung
中科院分区：
文献类型：
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作者：
Choi, Jeongmin;Kim, Sang Gyun;Song, In Sung
背景：虽然常规胃镜是评估早期胃癌(EGC)肿瘤深度(T分期)的一种很好的诊断工具，但其准确性尚未确定，对于标准的胃镜标准也没有达成共识。目的：评估胃镜T分期的诊断准确性，并确定粘膜(T1m)和粘膜下(T1sm)肿瘤的特点。设计：回顾性研究。患者：连续2105例有虫卵的患者接受手术(n=1624)或内窥镜(n=481)切除。干预：根据T1m(表面光滑突起或凹陷、凹陷、凹陷)的内窥镜标准，经2名内窥镜医师一致同意进行内窥镜分期。T1sm(表面不规则，边缘抬升明显，汇聚褶皱棒状/突然切割/融合)。结果：胃镜分期的总准确率为78.0%(1642/2105)。T1m分期的敏感度、特异度、阳性预测值和阴性预测值分别为85.5%、73.9%、82.0%和78.5%，而T1m分期的敏感度、特异度、阳性预测值和阴性预测值分别为72.6%、81.9%、71.9%和82.4%。胃镜对细小肿瘤的预测准确率仅为72%。结论：常规胃镜检查可提供可靠的T分期准确性，可能是评估穿透深度的一种有效方法。对肿瘤的基底部、边缘和会聚皱褶进行详细的内窥镜评估可能会为确定肿瘤深度和选择最佳治疗策略提供有用的信息，特别是对于内窥镜切除。(胃肠内膜2011；73：917-27。)
Background: Although conventional endoscopy is a good diagnostic tool to evaluate tumor depth (T staging) in early gastric cancer (EGC), its accuracy has not been determined and no consensus has been reached regarding standard endoscopic criteria.Objective: To evaluate the diagnostic accuracy of endoscopic T staging and to identify the characteristic endoscopic features for mucosal (T1m) and submucosal (T1sm) tumors.Design: Retrospective study.Patients: A consecutive 2105 patients with EGG who underwent either surgical (n = 1624) or endoscopic (n = 481) resection.Intervention: Endoscopic staging was performed by consensus of 2 endoscopists based on the characteristic endoscopic criteria of T1m (smooth surface protrusion or depression, slight marginal elevation, and the smooth tapering of converging folds) and T1sm (irregular surface, marked marginal elevation, and clubbing/abrupt cutting/fusion of converging folds). The endoscopic staging was compared with the pathologic staging of the resected specimen.Results: The overall accuracy of endoscopic staging was 78.0% (1642/2105). The sensitivity, specificity, and positive and negative predictive values of T1m endoscopic staging were 85.5%, 73.9%, 82.0%, and 78.5%, whereas those for T1sm were 72.6%, 81.9%, 71.9%, and 82.4%, respectively.Limitations: Retrospective study. Endoscopic predictions for Thin tumors were correct in only 72% of cases.Conclusions: Conventional endoscopy was found to provide reliable accuracy for T staging in EGG and may be an effective method for assessing penetration depth. A detailed endoscopic evaluation regarding tumor base, margin, and converging folds may provide useful information to determine tumor depth and to select the optimal therapeutic strategy, particularly for endoscopic resection. (Gastrointest Endosc 2011;73:917-27.)