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Classification of superficial neoplastic lesion : stomach 소 화 기 내 과 황보 영
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Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case
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‘‘superficial’’ endoscopic appearance suggests that the depth of penetration is not more than into the submucosa there is no infiltration of the muscularis propria Type 0
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Incidence of Esophageal Adenocarcinoma Esophageal AdenoCA Melanoma Prostate cancer Breast, Lung, Colon NCI 2006
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Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case
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Terminology and Definitions Metaplasia transformation of an epithelium to another type of epithelium with distinct morphology and function Intestinal metaplasia 3 type type I (Complete): absorptive cells with a well- defined brush border, some goblet cells type II and III (Incomplete) :columnar intermediate cells and goblet cells that secrete sialomucin (type II) or sulfomucin (type III)
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In the distal esophagus, metaplasia 3 types cardiac or junctional-type glands : mucus-secreting cells oxyntic-type epithelium, parietal and chief cells are present intestinal type epithelium ‘‘specialized intestinal metaplasia.’’
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Adenoma or Dysplasia? Noninvasive neoplastic lesion of the columnar epithelium Adenoma: protruding (polypoid) Dysplasia: flat or depressed (non-polypoid) Vienna consensus classification : adenoma and dysplasia are both replaced by ‘‘intraepithelial neoplasia.’’ p-TNM : p-Tis, p-T1m, p-T1sm
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Low vs High
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Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case
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Type 0 neoplastic lesions
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0-I vs 0-II
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0-II
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0-III Barrettt’s esophagus
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Cutoff Limit StomachColon
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Squamous cell neoplasia in the esophagus
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Endoscopic Stage Morphology depth of invasion Type 0-I lesion diameter : predictive criterion Submucosal invasion increases with the diameter Type 0-II lesions morphologic subtypes Invasion of the submucosa more frequent in depressed lesions (IIc) Morphologic stage + EUS High predictive value
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Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case
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Distribution of category in Japan
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Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case
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Baseline Characteristics 나이 60.2(24-84) 성별 (M/F) 69/27 최대직경 ( cm) 3.49 (0.18~8.5) 부위 Antrum : 60 Body: 36 Cardia: 0 LN 전이 6/96 (6.2%) 분화도 Well : 30 Moderate : 29 Poorly : 37 심달도 M : 50 Sm1: 27 Sm2: 5 Sm3: 14
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n% 0-I7.2% 0-I5 0-I + IIa2 0-IIa,b38.5% 0-IIa7 0-IIa + IIb3 0-IIb25 0-IIb + IIa2 0-IIc46.8% 0-IIc20 0-IIc + IIa1 0-IIc + IIb3 0-IIb + IIc21 0-III7.2% 0-IIc + III5 0-III2 Total96
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N ◦ total N ◦ mN ◦ sm% sm 0-I86% 0-I51480% 0-I + IIa202100% 0-IIa,b32% 0-IIa75229% 0-IIa + IIb31267% 0-IIb2519624% 0-IIb + IIa202100% 0-IIc47% 0-IIc2012840% 0-IIc + IIa101100% 0-IIc + IIb32133% 0-IIb + IIc2191257% 0-III85% 0-IIc + III51480% 0-III202100% Total96504648%
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심달도에 따른 LN 전이 M n/N(%) 0/50(0) Sm1 n/N(%) 1/27(3.7) Sm2 + Sm3 n/N(%) 5/19(26.3)
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Stomach-nodal invasion Size in mmN<500µ n/N (%) >500µ n/N (%) <10160/15 (0)0/1 (0) 10~20430/38 (0)1/5 (20) 21~30191/11 (9)3/8 (38) >30180/13 (0)1/5 (20) Total961/77 (1.2)5/19 (26.3)
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Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case
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0-I MSM3
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0-I + IIa SM2
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0-IIa MM
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0-IIb MM
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0-IIc SM3
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0-IIa + IIb SM3
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0-IIb + IIa SM2
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0-III SM1
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0-IIc + IIa SM1
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0-IIc + IIb MSM3
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0-IIb +IIc SM1M
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0-IIc + III MSM1
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감사합니다
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