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Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based on Pathology Section Interval.

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.

journal_name

J Gastric Cancer

journal_title

Journal of gastric cancer

authors

Kim YI,Kook MC,Choi JE,Lee JY,Kim CG,Eom BW,Yoon HM,Ryu KW,Kim YW,Choi IJ

doi

10.5230/jgc.2020.20.e14

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

165-175

issue

eissn

2093-582X

issn

2093-5641

journal_volume

pub_type

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Evaluation of Submucosal or Lymphovascular Invasion Detection Rates in Early Gastric Cancer Based on Pathology Section Interval.