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.
|B||OR (95% CI)||P|
|Lymphovascular tumor emboli (present vs absent)||2.128||8.396 (3.252-21.679)||<0.0001|
|Submucosal invasion width (≥0.75cm vs <0.75cm)||1.083||2.954 (1.041-8.381)||0.042|
|LN metastasis(absent)||LN metastasis(present)||p value|
|Depth of invasion (imaginary)||1608.55±83.27||2142.59±205.10||0.012|
|Depth of invasion (imaginary)||1335.10±92.08||1684.25±198.60||0.128|