Studies On The Endoscopic Diagnosis Of The Quality And The Invasive Depth Of Early Gastric Cancer

BackgroundIn recent years,with the maturity of endoscopic mucosal dissection,the treatment effect of ESD was similar to that of traditional surgery in patients with early gastric cancer.Accurate diagnosis of the quality and the invasive depth were the keys to determine the treatment modality and effect.The pathological result of biopsy was regarded as the golden standard of the quality diagnosis.But there is an obvious inconsistency between the pathological result of biopsy and postoperation.At present,most of the lesions were observed by ordinary white light endoscopy and endoscopic ultrasonography(EUS).However,the two methods had greater subjectivity,which leaded to larger difference in judgment results.In recent years,foreign scholars had established a depth-prediction score system(DPS),which could be used to judge whether there was deep infiltration of submucosa.However,the scoring system had not been used widely,and there were few domestic studies.Obejectives1.To analyse the difference and influencing factors between preoperative biopsy and postoperative pathology in gastric intraepithelial neoplasia.2.To analyse the influence factors of early gastric cancer infiltration depth,and to explore the value of DPS criteria to judge the infiltration depth of early gastric cancer.Methods1.56 lesions of gastric intraepithelial neoplasia(GIEN)diagnosed by preoperative biopsy were collected.There were 32 cases of low grade intraepithelial neoplasia(LGIN)and 24 cases of high grade intraepithelial neoplasia(HGIN).They were all treated by ESD or surgical operation.The difference rate of biopsy pathology and postoperative pathology and influencing factors were analysed.2.The clinical data and gastroscope images of 38 patients with early gastric cancer who were diagnosed by ESD or surgical operation were collected from November 2010-September 2016.The clinical data included gender,age,tumor size,location,endoscopic morphology,degree of differentiation,the presence of merger ulcer,the presence of vascular tumor emboli,the presence of edge uplift,the presence of significant redness and the presence of surface was not whole,and analysed the influence factors of early gastric cancer infiltration depth.6 seniority doctors with at least 5 years working experience in endoscopic operation were selected.They were divided randomly into group S(scoring group)and group C(control group),each group of three people.They judged the depth of infiltration by comparing endoscopic images.We compared whether there were differences between the determination results of the two groups,understood use value of DPS ratings,and analysed the effect of using DPS ratings misjudged cases.Results1.The total difference rate between preoperative and postoperative pathology was 62.5%(35/56).The difference rate of LGIN was 46.9%(15/32).The postoperative pathological upgrading was 15.6%(5/32)and the degradation was 31.3%(10/32).The diagnostic consistency of HGIN was 16.7%(4/24)and the difference rate was 83.3%(20/24).The postoperative pathological upgrading of HGIN was 70.8%(17/24)and the degradation was 12.5%(3/24).The lesions located in the upper and middle part of the stomach,type I and type III of the general form and lesions combined with ulcer were related to preoperative and postoperative pathological differences(P < 0.05).Lesions size,apparent redness on the surface of lesions and surface roughness of lesions were not correlated with the differences(P>0.05).2.Lesion mergered ulcer and edge uplift associated with deep submucosal infiltration(P < 0.05),while there were no significantly difference(P > 0.05)between the submucosal shallow submucosal infiltrating carcinoma and infiltrating carcinoma in gender,age,tumor location,tumor size,endoscopic morphology credits,organizational credit,vascular tumor emboli,redness and surface was not whole.Accuracy of judgment of the subgroups in scoring group were more accurate than those in the control group.Eight patients were misjudged by DPS scoring system,which including 7 cases of excessive diagnosis and 1 case of insufficient diagnosis.The rate of miscarriage was higher in the lower part of the stomach and undifferentiated carcinoma.Conclusion1.The reliability of preoperative biopsy suggesting GIEN was low.There was possibility of canceration in GIEN.The rate of histopathological upgrading after HGIN was higher than that of LGIN.The lesions located in the upper 1/3 and middle 1/3 of stomach,the general form of type I and type III and the ulceration were easy to be upgraded after the operation.2.The influence factors of the deep infiltration of early gastric cancer mucosa were the combination of ulcer and the uplift of the lesion.DPS could improve the accuracy of infiltration depth judgment of early gastric cancer.