Endoscopic Diagnosis of Tumor Depth of Adenocarcinoma at the Esophagogastric Junction Ichiro Oda 1 , Chika Kusano 1 , Seiichiro Abe 1 , Ryuta Takenaka 1 , Ikuo Aoyama 1 , Tetsu Kinjyo 1 , Kazuhiro Tada 1 , Hajime Takisawa 1 , Satoru Nonaka 1 , Tetsuro Hirashima 1 , Shinsuke Kiriyama 1 , Shigetaka Yoshinaga 1 , Hirokazu Taniguchi 2 , Tadakazu Shimoda 2 , Takuji Gotoda 1 1Endoscopy Division, National Cancer Center Hospital, Tokyo 2Pathology of Clinical Laboratory Division National Cancer Center Hospital, Tokyo Keyword: 食道胃接合部腺癌 , Barrett食道癌 , 深達度診断 , 内視鏡診断 pp.1155-1162
Published Date 2009/6/25
DOI https://doi.org/10.11477/mf.1403101707
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 Accurate endoscopic diagnosis of tumor depth for gastrointestinal cancer is essential for making a proper decision on treatment strategy. Although correlation of macroscopic type with tumor depth for gastric cancer has been reported, there have been only a few reports comparing the differential endoscopic diagnosis between mucosal(M)and submucosal(SM)adenocarcinoma located at the esophagogastric junction(EGJ). We analyzed the relationship between macroscopic type and tumor depth for such EGJ cancer. We reviewed 73 EGJ adenocarcinomas(M/SM=33/40 ; differentiated/undifferentiated type=70/3)in 73 consecutive patients treated endoscopically and/or surgically between 2000 and 2008. Median age was 64 years(range, 37-85)and male/female ratio was 62/11. EGJ adenocarcinoma was defined as a “junctional carcinoma(type II)” according to the Siewert classification. Endoscopic macroscopic type was classified based on the Paris classification and divided into polypoid(0-I)and non-polypoid(0-IIa, 0-IIb, 0-IIc and 0-III)types. Polypoid types were subdivided into sessile and pedunculated types. Mixed type was diagnosed when a lesion was composed of two distinct macroscopic types. We found 0-I in 14, 0-IIa in eight, 0-IIc in 31, 0-IIa+IIc in 17 and 0-IIc+IIa in three patients. In 0-I, SM invasion was significantly more frequent for the sessile type than the pedunculated type(92%, 11/12 vs. 0%, 0/2 ; p<0.05). In the non-polypoid type, SM invasion was significantly more frequent for the mixed type than the total of 0-IIa and 0-IIc(85%, 17/20 vs. 31%, 12/39 ; p<0.01). SM lesions(24.5±7.7mm)were significantly larger than M lesions(14.5±7.5mm, p<0.01). In conclusion, determination of endoscopic macroscopic type is valuable in accurately diagnosing tumor depth for EGJ adenocarcinoma.

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