Stomach and Intestine(Tokyo) Volume 42, Issue 1 (January 2007)

Ability of Radiologic Indicators for Assessment of the Depth of Invasion in Cases of Depressed Early Gastric Cancer with Convergence of the Mucosal Folds―Diagnosis of SM1 Carcinoma with Ul and the Diagnostic Limitations Takashi Nagahama 1 , Hiroshi Tanabe 2 , Yasuhiro Takaki 2 , Suketo Sou 3 , Kenshi Yao 1 , Takashi Hisabe 1 , Shizuka Matsuo 1 , Mamoru Nakamura 1 , Masaki Miyaoka 1 , Fumihito Hirai 1 , Sumio Tsuda 1 , Toshiyuki Matsui 1 , Nobuaki Nishimata 2 , Keisuke Ikeda 2 , Kaname Oshige 2 , Atsuko Ohta 2 , Seiji Haraoka 2 , Akinori Iwashita 2 1Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan 2Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan 3Department of Internal Medicine, Tobata Kyoritsu Hospital, Kitakyushu, Japan Keyword: 深達度診断 , X線診断 , 早期胃癌 , SM癌 , ひだ集中所見 pp.47-59
Published Date 2007/1/25
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 Objective : The aim of this report is to elucidate the precision with which submucosal(SM)1 carcinoma with convergence of the mucosal folds, can be diagnosed using conventional radiologic indicators for diagnosis. Subjects : The subjects were 31 lesions of depressed gastric cancer(mainly of the differentiated type)with convergence of the mucosal folds. Forty-five lesions of mucosal(M)carcinoma with convergence of the mucosal folds and 29 lesions of SM2 carcinoma served as controls. Methods : (1)The accuracy of preoperative X-ray was investigated for estimating the depth of depressed M carcinoma and SM1 carcinoma lesions with convergence of the mucosal folds. (2)The frequency of finding a positive X-ray indicator of deep SM infiltration in the cases of depressed early gastric cancer with convergence of the mucosal folds(the radiological positivity rate)and the frequency with which the observed radiological findings could be confirmed by histopathological examination as being causally related to the cancer infiltration(the accuracy rate)were determined, and then investigated comparatively according to the depth of invasion. Results : (1)Forty(89%)of the 45 pM lesions showed cM, SM1, and 20(65%)of the 31 pSM1 lesions showed cM, SM1. The assessment of factors giving rise to errors in the diagnosis revealed that both pM and pSM1 carcinomas were overdiagnosed in cases with ulcer formation(Ul)-III and IV, with a reduced accuracy of diagnosis. (2)The radiologic positivity rate was higher for SM1 lesions than for M carcinoma lesions, but the difference was not statistically significant difference(22.6% vs. 8.9% ; p=ns). The diagnostic accuracy rate of the findings was 0% for SM1 carcinoma lesions and 0% for M carcinoma lesions, the difference not being significant. The diagnostic accuracy rate of the radiologic findings in SM2 or deeper carcinoma lesions was 84%(21/25 lesions), which was significantly(p<0.01)higher than that for the SM1 and M carcinoma lesions. Conclusions : All of the above-described observations indicate that it is difficult to make a diagnosis of pSM1 carcinoma lesions with convergence of mucosal folds from conventional radiologic indicators for the diagnosis of SM carcinomas showing deep infiltration. It was, therefore, concluded that improvements in imaging and diagnostic techniques are needed, particularly for lesions with vertical distance of infiltration of 500~800μm and those classified as Ul-III and IV.

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42巻1号 (2007年1月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院