Stomach and Intestine(Tokyo) Volume 49, Issue 7 (June 2014)

Magnifying Endoscopic Diagnosis for Submucosal Invading Colorectal Cancer Hiro-o Yamano 1 , Hiro-o Matsushita 1 , Kenjiro Yoshikawa 1 , Eiji Harada 1 , Ryo Takagi 1 , Michiko Nakaoka 1 , Yoshihito Tanaka 1 , Ryogo Himori 1 , Yuko Yoshida 1 , Yasushi Imai 1 , Kentaro Sato 1 1Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan Keyword: 大腸T1(SM)癌 , pit pattern診断 , VI型亜分類 , SM深達度 , 組織分化度 pp.1015-1023
Published Date 2014/6/25
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 Since ESD(endoscopic submucosal dissection)for colorectal tumors has become eligible for health insurance coverage, endoscopic treatment for neoplastic lesions of the colon is being readily performed. On the other hand, a question has been raised regarding the importance of preoperative diagnosis in determining the advantages and disadvantages of treatment. Colorectal magnifying endoscopic diagnosis generally involves performing diagnosing invasion depth on the basis of VI slightly and highly irregular lesions in accordance with classification of Hakone Consensus. However, in the present study we didn't use Hakone's classification, because of we wanted to investigate extent of histodifferentiation and vascular invasion with out invasion depth. We established the original and temporary type VI sub-classification which was divided provisionally into 3 subtypes from the difference between stainability, irregularity and density of orifice of glands, and compared pT1 invasion depth, extent of histodifferentiation, and the vascular invasion. As a result, in all pT1 cancers, lesions that indicated VI 1/3 and VI 2/3 type of the temporary classification corresponded to pT1a cancer And in the same subtypes of lesions, the rate of pT1a cancer was higher in flat and depressed lesions than protruded lesions. Moreover, with regard to the extent of histodifferentiation, lesions up to VI 1/3 were well differentiated adenocarcinoma(tub1), and as irregularity increased, we found that the extent of histodifferentiation decreased, whereas vascular invasion gradually increased. This was observed more in case of protruded lesions than superficial flat and depressed lesions. Based on these results, we believe that it is important to practice endoscopic treatment for accurate pathological diagnosis and to handle resected specimens appropriately.

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49巻7号 (2014年6月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院