Estimation of subepithelial lateral extent in submucosal early gastric cancer: retrospective histological analysis
Estimation of subepithelial lateral extent in submucosal early gastric cancer: retrospective histological analysis
复制标题
粘膜下早期胃癌上皮下横向范围的估计：回顾性组织学分析
DOI：
10.1007/s10120-014-0427-2
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发表时间：
2014
期刊：
影响因子：
7.4
通讯作者：
et al.
中科院分区：
文献类型：
--
作者：
Goto O;et al.
背景内镜全层切除术（EFTR）有望使早期胃癌（EGC）的微创局部切除成为可能。然而，在内窥镜检查确定切除区域时应设定多远的最佳安全裕度，目前尚未达成共识。我们的目的是通过测量肿瘤的上皮下范围 (SE) 来研究 EGC 的最佳侧缘，这可能是 EFTR 的候选者。方法在 60 个手术切除的 4 cm 或更小的粘膜下 EGC 中，评估了 595 个制备的载玻片，这些玻片在上皮表面和上皮下层上都显示了侧向肿瘤边界。在显微镜下测量上皮与上皮下肿瘤边缘之间的距离，然后分析测量的SE与组织学特征之间的关系。结果平均值和中位SE分别为1.1 mm（标准差1.8 mm）和0.3 mm（范围0-12.3 mm）。第 99 个百分位数为 8.8 毫米。就组织学类型而言，弥漫型肿瘤的中位 SE 显着高于肠型肿瘤（0.9 mm vs 0 mm，p < 0.0001）。关于上皮下肿瘤边缘的位置，粘膜下层的中位SE显着大于粘膜层（2.6 mm vs 0.3 mm，p<0.0001）。结论在大多数病变中，SE小于1 cm。粘膜下 EGC 的 EFTR 中的安全裕度可设置为 1 厘米。
BackgroundEndoscopic full-thickness resection (EFTR) is expected to make possible minimally invasive local resection of early gastric cancer (EGC). However, no consensus exists regarding how far an optimal safety margin should be set in determining the resection area by endoscopy. We aimed to investigate the optimal lateral margin of EGC which could be a candidate for EFTR by measuring the subepithelial extent (SE) of tumors.MethodsIn 60 surgically resected submucosal EGCs 4 cm or smaller, 595 prepared slides which showed lateral tumor borders both on the epithelial surface and on the subepithelial layer were assessed. The distance between the epithelial and the subepithelial tumor edge was measured under microscopic observation, followed by analyses of the relationship between the measured SE and the histological characteristics.ResultsThe average and the median SE were 1.1 mm (standard deviation 1.8 mm) and 0.3 mm (range 0–12.3 mm), respectively. The 99th percentile was 8.8 mm. With regard to the histological type, the median SE was significantly greater in diffuse-type tumor than in intestinal-type tumor (0.9 mm vs 0 mm,p< 0.0001). With regard to the location of the subepithelilal tumor edge, the median SE was significantly greater in the submucosal layer than in the mucosal layer (2.6 mm vs 0.3 mm,p< 0.0001).ConclusionsIn most lesions, the SE was less than 1 cm. A safety margin may be set at 1 cm in EFTR of submucosal EGC.