[684] Method of Measurement of Invasion Depth and Scoring System To Predict LN Metastasis in Submucosal EGC

Joo Yeun Kim, Nari Shin, Gregory Y Lauwers, Do Youn Park. Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea; Massachusetts General Hospital and Harvard Medical School, Boston

Background: It is important to determine further surgical intervention after EMR/ESD, due to wider use of endoscopic resection as first treatment of EGC and controversies among investigators about the validity of known criteria. We have evaluated the risk factors of LN meta and validated methods of sm invasion depth in smEGCs and suggest new prediction scoring systems to indicate further surgery after EMR/ESD.
Design: We have reviewed 169 smEGCs and analyzed the risk factors affecting LN meta and made prediction score. Also we investigated patterns of mm visualized desmin immunostain and different methods of sm invasion measurement and suggestive most reliable method of sml invasion depth of measurement to predict LN meta of smEGCs.
Results: There are 15.9% (27/169) of LN meta in smEGC. Increased sm extent, depth of invasion, lymphovascular invasion and infiltrative growth pattern were associated with LN meta.

Predictive factors of lymph node metastasis in 169 sm EGCs
 BOR (95% CI)P
Lymphovascular tumor emboli (present vs absent)2.1288.396 (3.252-21.679)<0.0001
Submucosal invasion width (≥0.75cm vs <0.75cm)1.0832.954 (1.041-8.381)0.042
Note: B, coefficient; OR, odds ratio; CI, confidence interval. The independent factors for lymph node metastasis were analyzed by binary logistic regression analysis (backward, stepwise).

We have made predict score H=(2.128 x lymphovascular tumor emboli)+(1.083 x sm invasion width ≥0.75cm)+0.507xsm invasion depth≥1000um+(0.515x infiltrative growth pattern). H score yielded an area under the ROC curve of 0.809 in predicting LN meta of smEGC. Depth of invasion was higher in LN meta group than LN negative group by alternative method of measurement (distance from the lowest point of the imaginary line of mm), but statistically not significant by classic method (distance from the lowest point of the mm) (p=0.128), especially in discontinuous type of mm. The area under the ROC curve of alternative method was 0.652 compared to classic method.

Relationship between LN metastasis with depth of invasion in 169 smEGC
 LN metastasis(absent)LN metastasis(present)p value
Depth of invasion (imaginary)1608.55±83.272142.59±205.100.012
Depth of invasion (imaginary)1335.10±92.081684.25±198.600.128

Conclusions: we recommend that the use of prediction scoring system and alternative method of measurement of sml invasion depth can help decision making further surgical intervention after ESD in smEGCs.
Category: Gastrointestinal

Tuesday, March 20, 2012 1:00 PM

Poster Session IV # 55, Tuesday Afternoon


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