The Usefulness of the Endoscopic Findings for Predicting Depth of Invasion in Early Gastric Cancer

Baek, Yang Hyun; Yoo, Hyun Seung; Yoon, Hyun Ah; Kim, Ja Won; Koo, Jeong Mo; Kim, Young Hoon; Cho, Su Hyun; Kim, Seul Ki; Jang, Jin Seok; Lee, Jong Hun; Roh, Myung Hwan; Choi, Seok Reyol

Abstract

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) has been used as a treatment for early gastric cancer (EGC). This study was performed to evaluate the usefulness of the endoscopic findings for diagnosing the depth of invasion in EGC patients.
METHODS
We retrospectively analyzed the endoscopic findings of 558 EGC patients who were diagnosed after gastrectomy, EMR or ESD at Dong-A University Hospital between 2000 and 2006, and we divided them into two groups (the mucosa group versus the submucosa group). Nine factors were assessed (Type I or IIa: surface color, surface irregularity, the Yamada type and pitting on the apex; Type IIb: surface color, surface irregularity and marginal definiteness: Type IIc or III: ulcer base irregularity, shape of the converging folds, center of the converging folds and marginal elevation). The tumor size and histologic type were assessed for all the EGCs.
RESULTS
Ulcer base irregularity (p=0.005), marginal elevation (p=0.001), and the shape of the converging folds (p=0.018) showed significant correlation with the depth of invasion in type IIc or III EGCs. Tumor size ( <2 cm) showed a significant correlation with mucosal invasion for all the EGCs.
CONCLUSIONS
These results support the usefulness of the endoscopic findings for making the therapeutic decision for performing EMR or ESD through predicting the depth of invasion of EGCs.