| Part1Endoscopic features and outcomes of the biopsy-based diagnosis of gastric Low-Grade Intraepithelial Neoplasia.Objective:To elucidate the endoscopic features and outcomes of the biopsy-based diagnosis of Gastric Low-Grade Intraepithelial Neoplasia.Methods:1. We reviewed the clinical data of219patients that diagnosed as LGIN based on the biopsy specimen between January2009and December2011from the Second Affiliated Hospital of Zhejiang University School of Medicine, and retrospectively analyzed the relationship between the endoscopic appearance and pathologic outcomes.2. We reviewed the clinical data of82patients that initially diagnosed as LGIN based on the biopsy specimen who underwent the Endoscopic Resection between January2009and December2014, and retrospectively analyzed the factors related to the discreapancy between the biopsy pathology and the final pathology.Results:1.Among the219lesions initially diagnosed as LGIN underwent endoscopic resection or with follow-up,176(80.4%) lesions finally disappeared or re-biopsy pathology showed Non-IN,27(12.3%) lesions remained the diagnosis of LGIN after endoscopic resection,3cases(1.4%) showed upgraded diagnosis as HGIN after endoscopic resection,5cases(2.3%) diagnosed as adenocarcinoma after endoscopic resection or operation. The outcomes of lesions with different morphology:4/16(25%)of the ulcerative lesions finally diagnosed as adenocarcinoma,31/65(47.7%) of the single protruding lesions, the pathologic outcomes were LGIN,33/35(94.3%) of the rough erosive lesions,51/52(98.1%) of the multiple protruding lesions and50/51(98%) of the indefinite lesions, finally disappeared or pathology showed Non-IN.All the4adenocarcinoma lesions diagnosed during follow-up are ulcerative lesions.2.Among the82lesions that initially diagnosed as LGIN which underwent the endoscopic resection treatment,28.1%with the final pathotholy upgraded to HGIN or adenocarcinoma,3.7%downgraded to Non-IN,68.3%maintained the diagnosis of LGIN. Compared the Upgrade Group of the final pathology with the Concordant Group, it showed that the lesion maximum diameter, lesion color, with ulcer or not had significant difference(P<0.05), multivariate analysis showed lesion size larger than25mm, mucosal redness are significant independent factors suggesting upgrade diagnosis. Conclusion:1. Among the lesions initially diagnosed as LGIN of the first group,80.3%finally disappeared or were pathologically downgraded,3.7%were pathologically upgraded,16%maintained.6.2%of the single protruding lesions and25%of the ulcerative lesions were pathologically upgraded,It suggested these lesions shoud be carefully followed up or endoscopically resected in necessity.2.Among the definite lesion initially diagnosed as LGIN of the second group,28.1%upgraded to HGIN or adenocarcinoma,3.7%downgraded,68.3%maintained. If the lesion size is larger than25mm, with mucosal redness, these may suggest upgrade diagnosis, diagnostic endoscopic resection may be adequate treatment for accurate diagnosis. Part2Clinicopathological and endoscopic characteristics of small and minute gastric cancers.Objective:To elucidate the clinicopathological and endoscopic characteristics of small and minute gastric cancers.Methods:We retrospectively reviewed the clinicopathological and endoscopic data of61patients from our hospital that diagnosed as small or minute gastric cancer based on post-operation pathology between January2009and December2014(40cases of small gastric cancer,21cases of minute gastric cancer), and analyzed the clinicopathological and endoscopic characteristics of small and minute gastric cancers.Results:1. The small and minute gastric cancer accounted for2.7%of gastric cancers, and accounted for10.2%of early gastric cancer.4.9%(3cases) of them accompanied with minute stromal tumor.2. The most common histological type of small gastric cancer was well/moderate differentiated adenocarcinoma, accounting for77.5%(31/40).All the small gastric cancers were early gastric cancers.The submucosal infiltration rate was12.5%(5/40). Lymph node metastasis occurred in1case.The most common endoscopic morphology were IIc (45%) and IIa+IIc (35%),accompanied with moth-eatern appearance,85%(34/40) accompanied with mucosal redness,25%(10/40) accompanied with mucosal ulcer,22.5%(9/40)accompanied with spontaneous bleeding.3. The most common histological type of minute gastric cancer was well/moderate differentiated adenocarcinoma, accounting for85.7%(18/21).All the minute gastric cancers were early gastric cancers.The submucosal infiltration rate was9.5%(2/21).The smallest submucosal infiltrating carcinoma is2mm in diameter.No case occured with Lymph node metastasis. The most common endoscopic morphology were IIc (52.4%) and IIa+IIc (33.3%), accompanied with moth-eatern appearance,76.2%(16/21) accompanied with mucosal redness,19%(4/21) accompanied with mucosal ulcer,28.6%(6/21)accompanied with spontaneous bleeding.4.7cases(11.5%) of small and minute gastric cancer occurred with submucosal infiltration,4out of7located at the cardiac part. Submucosal infiltration was difficult to predict by endoscopic appearance.Conclusion:1. The endoscopic appearance of small and minute gastric cancer mainly were shallow depression or slightly protruding lesion with shallow depression, accompanied with mucosal redness.2. The predominant histology type of small and minute gastric cancers were well/moderate differentiated adenocarcinoma, and with lesions becoming larger, the diversity of histology increased.3. Submucosal infiltration rate was11.5%in all small and minute gastric cancers.3.7%(1case) of small gastric cancer had lymph node metastasis, No lymph node metastasis occurred in minute gastric cancers. These suggested closely post-operation follow-up of small and minute gastric cancers underwent endoscopic submucosal dissection. |
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