Usefulness of Magnifying Endoscopic Observation of Surface Micro-structure, in Order to Diagnose the Extent of IIb Type Early Gastric Cancer by Using Crystal-violet Staining Yoshiro Tamegai 1 , Keiko Kudo 1 , Takashi Koike 1 , Dai Yoshizawa 1 , Katsuya Higami 1 , Kiyoaki Ito 1 , Koji Yano 1 , Masatoshi Imamura 1 , Naohiko Masaki 1 , Masashi Mizogami 1 , Kei Matsueda 1 , Tsuyoshi Ishida 2 1Department of Gastroenterology, Kohnodai Hospital, International Medical Center of Japan, Ichikawa, Japan 2Department of Pathology, Kohnodai Hospital, International Medical Center of Japan, Ichikawa, Japan Keyword: 早期胃癌 , 0IIb型早期胃癌 , 微細表面構造 , 拡大内視鏡 , クリスタルバイオレット染色 pp.71-84
Published Date 2010/1/25
DOI https://doi.org/10.11477/mf.1403101836
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 Introduction : An accurate diagnosis of the tumor extent is very important in order to complete endoscopic submucosal dissection(ESD)successfully. We report the usefulness of magnifying endoscopic examination to perform accurate diagnosis of the tumor margin. Objects and Methods : The objects were 237 lesions of gastric tumor of in 226 patients(175 male,51 female, average : 72.4 years old), which were resected by the ESD procedure. Among these cases, we encountered 6 cases of early cancer accompanied with 0IIb component. In this study, we evaluated the usefulness of magnifying endoscopic examination(Crystal-violet staining)of the surface micro-structure to diagnose the extent of the tumor. The surface micro-structures of gastric tumor were divided into three types(TP : Tubular pattern with irregular micro-structure,PP : Papillary pattern with irregular micro-structure,DP : Destructive pattern), based on magnifying endoscopic finding and its stereomicroscopic view of the resected specimen. TP is a tubular or round shaped pit and PP is a papillary or villous shaped configuration. On the other hand,DP shows marked destruction of pit or surface structure. Results : In magnifying endoscopic examination of surface-microstructure,29 lesions(90.6%)of adenoma and 142 lesions(81.6%)of intra-mucosal cancer showed type TP significantly(p<0.001). Type DP was significantly observed in 19 lesions(61.3%)of submucosally invasive cancer. According to histological evaluation of the resected specimens, the magnifying endoscopic group revealed a significantly high rate of tumor negative in the lateral margin compared with the conventional group. On the other hand, magnifying endoscopy revealed composite findings of TP-S,TP-L(H), and PP in all cases accompanied with IIb component(0IIb : 4,0IIa+IIb : 1,0IIc+IIb : 1). Because of these findings, we were able to perform accurate diagnosis of the extent of cancer spread. Conclusions : Magnifying endoscopic observation(Crystal-violet staining)of surface micro-structure is thought to be very useful in the diagnosis of the tumor extent, especially in 0IIb type early gastric cancers.

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