Magnified Endoscopic Findings of Early Gastric Cancers Mixed with Well and Poorly Differentiated Type Tsuneo Oyama 1 , Akiko Takahashi 1 , Akihisa Tomori 1 , Tomoaki Shinohara 1 , Takaaki Kishino 1 , Shinichiro Takeda 1 , Toshiyuki Wakatsuki 1 , Toshiyuki Kubo 1 , Tatsuo Morinushi 1 , Takahiro Yamada 1 1Department of Gastroenterology, Saku Central Hospital, Saku, Japan Keyword: 組織混在 , 早期胃癌 , NBI拡大内視鏡 , 組織型診断 pp.1619-1628
Published Date 2013/10/25
DOI https://doi.org/10.11477/mf.1403113971
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 One hundred eighty-two gastric adenocarcinomas from 172 patients treated by ESD from January to December, 2012 were enrolled in this study. The gross type was classified into 0-I, IIa, IIb and IIc, and the numbers were 9, 66, 8, and 99, respectively. The histology was classified into tub1, tub2, pap, por, sig and muc. When the cancer had only tub1, tub2, or pap component, it was classified as pure differentiated type. And, when the cancer had tub1 and pap component, it was classified as mixed type. And, when the cancer had a poorly differentiated component, it was classified as poorly mixed type.

 Two of 9 0-I cancers were classified as poorly mixed type. Both of them had pap component. And remaining 7 cancers were pure well-differentiated type.

 Eighteen of 67 0-IIa cancers were classified as mixed type, and 4 of them were poorly mixed type. The frequency of poorly mixed type was higher when the size became 30mm or more.

 One of 7 0-IIb was mixed type. But, there were no poorly mixed types.

 On the other hand, 42 of 99 0-IIc cancers were mixed type, and 17 cancers had por component. The frequency of poorly mixed type has increased with the size. And, the ratio of poorly mixed type increased to 50%, when the size became 30mm or more.

 Magnified endoscopy is a useful device for the diagnosis of the histology. For example, when uncertain surface or non-network vascular pattern was observed, the cancer could be diagnosed as poorly differentiated type. However, the disadvantage of magnified endoscopy is the narrow observation field and contact bleeding. Detailed observation from the edge to the edge by a magnified endoscopy is impossible, because the width of the visual field is only 3mm. Therefore, a combination of white light endoscopy and NBI magnified endoscopy is necessary.

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