Significance of Macroscopic Classification of Laterally Spreading Tumors in Determining Endoscopic Treatment Strategy Yutaka Saito 1 , Taku Sakamoto 1 , Shusei Fukunaga 1 , Takaya Aoki 1 , Yosuke Otake 1 , Takeshi Nakajima 1 , Takahisa Matsuda 1 , Minori Matsumoto 1 , Eriko So 1,2 , Hirokazu Taniguchi 2 , Ryoji Kushima 2 1Endoscopy Division, National Cancer Center Hospital, Tokyo 2Pathology of Clinical Laboratory Division, National Cancer Center Hospital, Tokyo Keyword: 計画的分割切除術(EPMR) , ESD , LST-G , LST-NG , 多中心性浸潤 pp.1001-1010
Published Date 2010/5/25
DOI https://doi.org/10.11477/mf.1403101958
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 We previously reported that granular type laterally spreading tumors(LST-Gs)can be treated by EPMR(endoscopic piecemeal mucosal resection)because of a lower submucosal(sm)invasion rate with most SM invasions that do occur found under a large nodule.

 In contrast, non-granular type laterally spreading tumors(LST-NGs)>20mm should be resected en bloc using ESD(endoscopic submucosal dissection)because of a higher sm invasion rate and difficulty in predicting the area of sm invasion. There is no consensus, however, on the appropriate treatment strategy for LST-Gs at the present time.

 We recently encountered two cases of invasive recurrence after EPMR of LST-Gs histologically determined to be intramucosal cancers. As a result, we have reevaluated the sm invasion rate and sm invasion area using en-bloc LST-G specimens and reconsidered our previous treatment strategy for LST-Gs.

 The sm invasion rate for LST-Gs>30mm was 16% with 25% for multifocal invasion outside of a large nodule or depression which was difficult to diagnose even using magnification colonoscopy. Based on these latest findings, LST-Gs with a large nodule>30mm are also good candidates for ESD.

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