Endoscopic And Pathologic Analysis Of Early Gastric Cancer

Objective To analyze the endoscopic and pathologic features of early gastriccancer so as to improve the detection rate. Method Datas of267patients whounderwent gastrectomy or endoscopic submucosal dissection and confirmed as earlygastric cancer by histopathology were retrospectively analyzed from2008to2011.Result The detection rate of early gastric caner in our hospital was13.7%during2008to2011.The distribution of lesions was gastric antrum，gastric corpus,gastricangle,cardia,gastric stump and pylorus respectively. Most of the lesions were singleones,multiple cancer accounted for only1.9%.TypeIIc and typeIII lesions accountedfor47.3%and24.4%respectively. Histologically,62.6%of the lesions were tubularadenocarcinomas. Rate of differentiated early gastric cancer was65.9%, with34.1%of undifferentiated early gastric cancer. The constituent ratio of type I，type IIc andtype III lesions in submucosal cancer was respectively higher than in intramucosalcancer while type IIa, type IIb,type IIa+IIc and type IIa+IIb lesons in intramucosalcancer higher than in submucosal cancer. Lymph node metastasis rate of early gastriccancer in our group was12.7%. Lymph node metastasis rate of submucosal cancerwas significantly higher than intramucosal cancer(17.8%VS7.14%, P <0.05),inundifferentiated cancer higher than in differentiated type (21.3%VS7.7%to P<0.05) as well as lesions with vascular invasion higher than without vascularinvasion (50%VS10.4%, P <0.05).Besides,lymph node metastasis rate ofdifferentiated submucosal cancer was significantly higher than differentiatedintramucosal cancer (15.9%vs0%, P <0.05)and no significant difference existedbetween undifferentiated intramucosal cancer and undifferentiated submucosal canceron the aspect of lymph node metastasis rate (21.3%vs21.3%, P>0.05).Conclusion Early gastric cancer frequently appeared in male,with peak ageof50-69years old.Gastric antrum and corpus were the most common sites.The mainmacroscopical types were typeIIc and type III. The most frequent histologic aspectwas the tubular one and differentiated cancer was more common than undifferentiated cancer. For early gastric cancer,there were differences in the constituent ratio ofmacrosopical types between intramucosal cancer and submucosal cancer.Depth ofinvation,degree of differentiation and lymphovascular invasion showed significantcorrelation with lymph node metastasis. Differentiated intramucosal cancer had nolymph node metastasis. Undifferentiated cancer could had lymph node metastasiseven when just invading the superficial layer while differentiated cancer with lymphnode metastasis invaded the submucosal layer more often.Clinical diagnosis of earlygastric cancer is difficult to some extent, endoscopy combined with biopsy is themost commonly used and effective diagnostic method. Enhancing and improvingendoscopic recognition capabilities and thus achieving accurate biopsy for pathologicexamination is the key point to improve the detection rate of early gastric cancer.