Clinicopathological Differences between Endoscopic Ulcer Scar (+) Early Gastric Cancers and Pathological Ulcer Scar (+) Early Gastric Cancers Junko Fujisaki 1 , Yorimasa Yamamoto 1 , Noriko Yamamoto 2 , Tomohiro Shimizu 1 , Natsuko Yoshizawa 1 , Yusuke Horiuchi 1 , Yasumasa Matsuo 1 , Hirotaka Ishikawa 1 , Takanori Suganuma 1 , Masami Omae 1 , Toshiaki Hirasawa 1 , Tomoko Yokoyama 3 , Akiyoshi Ishiyama 1 , Tomohiro Tsuchida 1 , Masahiro Igarashi 1 1Department of Gastroenterology, Cancer Institute Hospital of JFCR, Tokyo 2Department of Pathology, Cancer Institute of JFCR, Tokyo 3Department of Internal Medicine, Fuji Film Health Care Center, Minami Ashigara, Japan Keyword: 早期胃癌 , 線維化 , 適応拡大病変 , 内視鏡的UL(+) , 病理学的UL(-) pp.73-81
Published Date 2013/1/25
DOI https://doi.org/10.11477/mf.1403113702
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 In this study, we investigated the clinicopathological differences between gastric cancer patients with endoscopic ulcer scars and pathological ulcer scars. Towards this end, we selected 217 gastric cancer patients who were confirmed histopathologically as having ulcer scars, from among 1,504 patients who had undergone ESD(endoscopic submucosal dissection)at our hospital between 2005 and April 2011. Among the patients with the pathological ulcer scars(+), cases with the depressed type of cancer were many, and the percentage of cases classified, according to the depth of invasion, as SM was higher in comparison to the lesions described in the guidelines. In addition, the rate of curative resection in this group was also lower. For cases of pathological ulcer scars(+)not falling within the description provided in the guidelines, there were neither cases of death from gastric cancer nor cases with recurrence of cancer. There were 11 cases of stage III, of which 4 were followed up, but were not detected to have any recurrence. The accurate endoscopic diagnosis rate of pathological ulcer scars(+)was 92/217(57.6%). Regions of high incidence of inaccurate diagnosis were the greater curvature at the angular incisure and the greater curvature at the gastric antrum. There were 34 patients who were diagnosed as pathological ulcer scar(-)despite being diagnosed as endoscopic ulcer scar(+), and the most frequent region of detection of the false-positive scars was the posterior wall of the M region. In all of these 34 cases, some fibrosis was observed in the submucosa, and the diagnosis of biopsy scar was confirmed by pathological examination.

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