Histopathological Evaluation of Stomach Material Resected in the Treatment of Early Gastric Cancer by Endoscopic Mucosal Resection (EMR):Broadening the Histological Criteria for Prediction of Curability by EMR Yasuro Ninomiya 1 , Akio Yanagisawa 1 , Sho Ishihara 2 , Hisanobu Tomimatsu 1,3 , Noriko Yamamoto 1,3 1Department of Pathology, Cancer Institute 2Department of Surgery, Cancer Institute Hospital 3Hiratsuka Gastrointestinal Hospital Keyword: 内視鏡的粘膜切除(EMR) , 切除標本 , 外科手術 , 癌遺残 pp.1619-1626
Published Date 1998/11/25
DOI https://doi.org/10.11477/mf.1403103870
  • Abstract
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 In order to examine the possibility of broadening the histological criteria for diagnosing as cured patients who have undergone endoscopic mucosal resection (EMR), we studied 22 cases subjected to surgery after EMR due to cancer-positive cut margin (s) in the mucosa, cancer positive end cuts from the resected material, or submucosal, or submucosal invasion (sm). All histological examinations were performed on EMR materials sectioned at 2 mm-intervals.

 Criteria for Classification as Cured.

 For differentiated mucosal gastric cancer treated by EMR, the center of the lesion must be captured with only one cancer-positive cut-end in the EMR material (all cases of this type in the present study had at least one positive cut end). The 2 cases which met these criteria had no residual cancer in their operated material. When the lesion apparently extended the EMR material with more than 2 cancer-positive cut ends, residua cancer was observed without exception in the operated material (there were no cases of exactly 2 cancer positive cut-ends).

 For differentiated type adenocarcinomas with sm-invasion, predictive criteria for curability and the avoidance of lymph node metastases include sm-invasion limited to 200~300 μm from the mucosal muscle (sml) without any cancer-positive cut ends.

 However, when it comes to undifferentiated type adenocarcinomas, all patients subjected to surgery after EMR had residual cancer in the operated materials. One patient appeared macroscopically to have been cured by EMR, but, histologically, cancer-positive cut ends were observed in the EMR material. In general, it is difficult macroscopically determine the areas and invasion-depths of undifferentiated type adenocarcinomas. Accordingly, unless complete resection is assured, cases with undifferentiated type adenocarcinomas should always be followed by additional surgery.

 For differentiated type adenocarcinomas with and without sm-invasion, the current study suggests the possibility of broadening histological criteria for diagnosing as cured patients who have undergone EMR. For undifferentiated type adenocarcinomas, this possibility is not indicated.

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