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Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based on Pathology Section Interval.
J Gastric Cancer. 2020 Jun; 20(2):165-175.JG

Abstract

Purpose

The guidelines for pathological evaluation of early gastric cancer (EGC) recommend wider section intervals for surgical specimens (5-7 mm) than those for endoscopically resected specimens (2-3 mm). Studies in surgically resected EGC specimens showed not negligible lymph node metastasis risks in EGCs meeting the expanded criteria for endoscopic submucosal dissection (ESD).

Materials and Methods

This retrospective study included 401 EGC lesions with an endoscopic size of ≤ 30 mm detected in 386 patients. Pathological specimens obtained by ESD or surgery were cut into 2-mm section intervals for reference. Submucosal or lymphovascular invasion (LVI) was evaluated arbitrarily in 4- or 6-mm section intervals. McNemar's tests compared the differences between submucosal and LVI.

Results

Submucosal invasion was detected in 29.2% (117/401) and LVI in 9.5% (38/401) at 2-mm interval. The submucosal invasion detection rates in 4-mm intervals decreased to 88.0% or 90.6% (both P<0.001), while the LVI detection rates decreased to 86.8% or 57.9% (P=0.025 and P<0.001, respectively). In 6-mm intervals, the submucosal and LVI detection rates decreased further to 72.7-80.3% (P<0.001 for all three sets) and 55.3-63.2% (P<0.001 for all three sets), respectively. Among 150 out-of-indication cases at 2-mm interval, 4-10 (2.7%-6.7%) at 4-mm intervals, and 10-17 (6.7%-11.3%) at 6-mm intervals were misclassified as lesions meeting the curative resection criteria due to the underestimation of submucosal or LVI.

Conclusions

After ESD, the 2-mm wide section interval was suitable for the pathological evaluation of focal submucosal or LVI. Thus, if an EGC lesion meets the expanded criteria for the ESD specimen pathological evaluation, it could be safely followed up.

Authors+Show Affiliations

Center for Gastric Cancer, National Cancer Center, Goyang, Korea.Center for Gastric Cancer, National Cancer Center, Goyang, Korea.Center for Gastric Cancer, National Cancer Center, Goyang, Korea.Center for Gastric Cancer, National Cancer Center, Goyang, Korea.Center for Gastric Cancer, National Cancer Center, Goyang, Korea.Center for Gastric Cancer, National Cancer Center, Goyang, Korea.Center for Gastric Cancer, National Cancer Center, Goyang, Korea.Center for Gastric Cancer, National Cancer Center, Goyang, Korea.Center for Gastric Cancer, National Cancer Center, Goyang, Korea.Center for Gastric Cancer, National Cancer Center, Goyang, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32596000

Citation

Kim, Young-Il, et al. "Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based On Pathology Section Interval." Journal of Gastric Cancer, vol. 20, no. 2, 2020, pp. 165-175.
Kim YI, Kook MC, Choi JE, et al. Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based on Pathology Section Interval. J Gastric Cancer. 2020;20(2):165-175.
Kim, Y. I., Kook, M. C., Choi, J. E., Lee, J. Y., Kim, C. G., Eom, B. W., Yoon, H. M., Ryu, K. W., Kim, Y. W., & Choi, I. J. (2020). Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based on Pathology Section Interval. Journal of Gastric Cancer, 20(2), 165-175. https://doi.org/10.5230/jgc.2020.20.e14
Kim YI, et al. Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based On Pathology Section Interval. J Gastric Cancer. 2020;20(2):165-175. PubMed PMID: 32596000.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based on Pathology Section Interval. AU - Kim,Young-Il, AU - Kook,Myeong-Cherl, AU - Choi,Jee Eun, AU - Lee,Jong Yeul, AU - Kim,Chan Gyoo, AU - Eom,Bang Wool, AU - Yoon,Hong Man, AU - Ryu,Keun Won, AU - Kim,Young-Woo, AU - Choi,Il Ju, Y1 - 2020/04/06/ PY - 2019/12/30/received PY - 2020/03/14/revised PY - 2020/03/19/accepted PY - 2020/6/30/entrez KW - Endoscopic submucosal dissection KW - Lymphovascular invasion KW - Stomach neoplasm KW - Submucosal invasion SP - 165 EP - 175 JF - Journal of gastric cancer JO - J Gastric Cancer VL - 20 IS - 2 N2 - Purpose: The guidelines for pathological evaluation of early gastric cancer (EGC) recommend wider section intervals for surgical specimens (5-7 mm) than those for endoscopically resected specimens (2-3 mm). Studies in surgically resected EGC specimens showed not negligible lymph node metastasis risks in EGCs meeting the expanded criteria for endoscopic submucosal dissection (ESD). Materials and Methods: This retrospective study included 401 EGC lesions with an endoscopic size of ≤ 30 mm detected in 386 patients. Pathological specimens obtained by ESD or surgery were cut into 2-mm section intervals for reference. Submucosal or lymphovascular invasion (LVI) was evaluated arbitrarily in 4- or 6-mm section intervals. McNemar's tests compared the differences between submucosal and LVI. Results: Submucosal invasion was detected in 29.2% (117/401) and LVI in 9.5% (38/401) at 2-mm interval. The submucosal invasion detection rates in 4-mm intervals decreased to 88.0% or 90.6% (both P<0.001), while the LVI detection rates decreased to 86.8% or 57.9% (P=0.025 and P<0.001, respectively). In 6-mm intervals, the submucosal and LVI detection rates decreased further to 72.7-80.3% (P<0.001 for all three sets) and 55.3-63.2% (P<0.001 for all three sets), respectively. Among 150 out-of-indication cases at 2-mm interval, 4-10 (2.7%-6.7%) at 4-mm intervals, and 10-17 (6.7%-11.3%) at 6-mm intervals were misclassified as lesions meeting the curative resection criteria due to the underestimation of submucosal or LVI. Conclusions: After ESD, the 2-mm wide section interval was suitable for the pathological evaluation of focal submucosal or LVI. Thus, if an EGC lesion meets the expanded criteria for the ESD specimen pathological evaluation, it could be safely followed up. SN - 2093-582X UR - https://www.unboundmedicine.com/medline/citation/32596000/Evaluation_of_Submucosal_or_Lymphovascular_Invasion_Detection_Rates_in_Early_Gastric_Cancer_Based_on_Pathology_Section_Interval L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32596000/ DB - PRIME DP - Unbound Medicine ER -
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