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Size discrepancy between endoscopic size and pathologic size is not negligible in endoscopic resection for early gastric cancer

Authors
 Choong Nam Shim  ;  Mi Kyung Song  ;  Dae Ryong Kang  ;  Hyun Soo Chung  ;  Jun Chul Park  ;  Hyuk Lee  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.28(7) : 2199-2207, 2014 
Journal Title
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 
ISSN
 0930-2794 
Issue Date
2014
MeSH
Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Aged ; Biopsy ; Cohort Studies ; Female ; Gastric Mucosa/pathology ; Gastroscopy* ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/surgery*
Keywords
Early gastric cancer ; Size ; Discrepancy ; Endoscopic resection
Abstract
BACKGROUND: Accurate tumor size measurement is critical for selecting proper candidates for endoscopic resection (ER) of early gastric cancer (EGC). However, size discrepancy between endoscopic size and pathologic size often occurs during ER for EGC. OBJECTIVE: The purposes of this study were to investigate the clinicopathological characteristics related to size discrepancy and the clinical implications of size discrepancies in terms of therapeutic outcomes. METHODS: Between April 2006 and June 2013, a total of 820 patients with 826 EGCs underwent ER. Enrolled lesions were categorized into the following three groups based on size discrepancy between endoscopic size and pathologic size: well-estimated (N = 308), underestimated (N = 215), or overestimated (N = 303) lesions. The well-estimated group was defined as lesions with a ratio of endoscopic size to pathologic size from 0.7 to 1.3. RESULTS: The overall median size discrepancy was 5.0 mm (interquartile range 2.0-9.0). Size, location, macroscopic type, primary tumor stage, and histology differed significantly between the three groups. Larger size [odds ratio (OR) 5.07, 95 % confidence interval (CI) 3.38-7.59, p < 0.001], flat/depressed type (OR 1.71, 95% CI 1.15-2.55, p = 0.008), and undifferentiated histology (OR 2.24, 95% CI 1.31-3.83, p = 0.003) were independent risk factors for endoscopic size underestimation in multivariate analysis. Smaller size (OR 10.95, 95% CI 4.64-25.87, p < 0.001) was the only independent predictor for endoscopic overestimation of size. Significantly lower complete resection and curative resection rates were detected in the underestimated group compared with the well-estimated group, while the complete resection rate in the overestimated group tended to be higher than in the well-estimated group. There was no significant difference of curative resection rate between the overestimated and the well-estimated groups. CONCLUSIONS: Larger size, flat/depressed type, and undifferentiated histology of EGC carry a significant risk for endoscopic underestimation of lesion size, which results in the lower rates of complete and curative resections for EGC. Further studies to reduce size discrepancy are warranted.
Full Text
http://link.springer.com/article/10.1007%2Fs00464-014-3453-6
DOI
10.1007/s00464-014-3453-6
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Dae Ryong(강대용)
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Song, Mi Kyung(송미경)
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Shim, Choong Nam(심충남)
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hyuk(이혁)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99344
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