Diagnosis of Extent of Invasion in Early Stomach Cancer in the Age of Endoscopic Submucosal Dissection(ESD)─Evaluation of Precise Radiography Examinations for Endoscopic Diagnosis Takashi Nagahama 1 , Yasuhiro Takaki 1 , Shinichiro Maki 1 , Masao Takeichi 1 , Kenshi Yao 1 , Toshiyuki Matsui 1 , Hiroshi Tanabe 2 , Nobuaki Nishimata 2 , Akinori Iwashita 2 1Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan 2Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan Keyword: 早期胃癌 , 浸潤範囲診断 , X線診断 , flat panel detector , ESD pp.637-649
Published Date 2009/4/24
DOI https://doi.org/10.11477/mf.1403101635
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 The significance of a precise radiographic examination before performing endoscopic submucosal dissection(ESD)lies in diagnosis of the extent of invasion, diagnosis of depth of invasion, estimation of ulcer(UL)depth, and picking up other synchronous multiple lesions as well. When diagnosing extent of invasion, it is especially useful for determining the overall picture and measuring tumor diameter in large lesions that represent areas where observation is difficult endoscopically and in superficial spreading types. It also enables the positional relationship between the lesion and the suture line in residual stomach cancer to be determined objectively. In addition, we consider it to be essential for choosing additional surgical procedures for lesions that as a result of the radiographic examination are outside the indications. On the other hand, radiographic examinations are useful for determining extent in IIb-like lesions and associated IIb lesions that have histopathological factors that make the invasion boundary indistinct endoscopically, and it sometimes serves as an indicator when performing marking. Actually, it is necessary to make a diagnosis based on faint shadow plaques, minute differences in shape between non-cancerous mucosa and cancerous mucosa, and minor barium adherence abnormalities, and technology that acquires better quality images and training in image interpretation are needed. In order to reflect the radiographic diagnosis, in the marking, it takes work to contrast the two after endoscopy and the radiographic examination and to confirm the validity of endoscopic diagnosis of the extent of invasion while taking the tissue architecture into consideration. More accurate and efficient diagnosis of extent of invasion will become possible by narrowing down problem points than by blind magnified endoscopic examinations and 4-point biopsy.

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