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Yoshida M, Suwa T, Shimada S, Shiotsuki K, Shigeta K, Nakamura H, Takada K, Kishida Y, Ito S, Imai K, Hotta K, Ono H, Sugino T. Desmin immunostaining is effective for improving interobserver variability in the depth assessment of the submucosal invasion of colorectal cancers. Hum Pathol 2023; 141:149-157. [PMID: 37633534 DOI: 10.1016/j.humpath.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
Tumor depth evaluation is essential for pathological tumor staging because it affects clinical management as an independent risk factor for lymph node metastasis in colorectal cancers. However, poor interobserver variability of invasion depth has been reported. This study aimed to clarify the effectiveness of desmin immunostaining in the histological diagnosis of colorectal cancer. Overall, 63 sets of slides of colorectal cancer stained with hematoxylin and eosin (H&E) and desmin were prepared and independently reviewed by four examiners. After reviewing the desmin-stained slides, the interobserver variability of H&E slides alone was significantly improved for all examiners. For the assessment of Tis vs. T1, the sensitivity and accuracy were significantly improved for all examiners by combining H&E and desmin immunostaining. For the diagnosis of T1b vs. Tis or T1a, specificity and accuracy were significantly improved by adding desmin immunostaining. Ancillary desmin staining to assess submucosal invasion in colorectal cancers significantly improved interobserver agreement, led to efficient screening of T1 cancers, and reduced excessive T1b diagnoses. The combination of desmin immunostaining and H&E staining is highly recommended for diagnosing invasive colorectal cancer.
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Affiliation(s)
- Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan.
| | - Tetsuya Suwa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan
| | - Seitaro Shimada
- 3rd Department of Internal Medicine, University of Toyama, Toyama, 930-0194 Japan
| | - Kazuo Shiotsuki
- Department of Gastroenterology Kitakyushu Municipal Medical Center, Fukuoka, 802-8561 Japan
| | - Kohei Shigeta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan; 3rd Department of Internal Medicine, University of Toyama, Toyama, 930-0194 Japan
| | - Haruka Nakamura
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan
| | - Yoshihiro Kishida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan
| | - Takashi Sugino
- Department of Pathology, Shizuoka Cancer Center, Shizuoka, 411-8777 Japan
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Bai J, Liu K, Gao L, Zhao X, Zhu S, Han Y, Liu Z. Computer-aided diagnosis in predicting the invasion depth of early colorectal cancer: a systematic review and meta-analysis of diagnostic test accuracy. Surg Endosc 2023; 37:6627-6639. [PMID: 37430125 DOI: 10.1007/s00464-023-10223-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Endoscopic resection (ER) is widely applied to treat early colorectal cancer (CRC). Predicting the invasion depth of early CRC is critical in determining treatment strategies. The use of computer-aided diagnosis (CAD) algorithms could theoretically make accurate and objective predictions regarding the suitability of lesions for ER indication based on invasion depth. This study aimed to assess diagnostic test accuracy of CAD algorithms in predicting the invasion depth of early CRC and to compare the performance between the CAD algorithms and endoscopists. METHODS Multiple databases were searched until June 30, 2022 for studies that evaluated the diagnostic performance of CAD algorithms for invasion depth of CRC. Meta-analysis of diagnostic test accuracy using a bivariate mixed-effects model was performed. RESULTS Ten studies consisting of 13 arms (13,918 images from 1472 lesions) were included. Due to significant heterogeneity, studies were stratified into Japan/Korea-based or China-based studies. For the former, the area under the curve (AUC), sensitivity, and specificity of the CAD algorithms were 0.89 (95% CI 0.86-0.91), 62% (95% CI 50-72%), and 96% (95% CI 93-98%), respectively. For the latter, AUC, sensitivity, and specificity were 0.94 (95% CI 0.92-0.96), 88% (95% CI 78-94%), and 88% (95% CI 80-93%), respectively. The performance of the CAD algorithms in Japan/Korea-based studies was not significantly different from that of all endoscopists (0.88 vs. 0.91, P = 0.10) but was inferior to that of expert endoscopists (0.88 vs. 0.92, P = 0.03). The performance of the CAD algorithms in China-based studies was better than that of all endoscopists (0.94 vs. 0.90, P = 0.01). CONCLUSION The CAD algorithms showed comparable accuracy for prediction of invasion depth of early CRC compared to all endoscopists, which was still lower than expert endoscopists in diagnostic accuracy; more improvements should be achieved before it can be extensively applied to clinical practice.
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Affiliation(s)
- Jiawei Bai
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
- School of Medicine, Yan'an University, Yan'an, China
| | - Kai Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Li Gao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xin Zhao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Shaohua Zhu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Ying Han
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Zhiguo Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
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Wang B, Feng Y, Song J, Ma J, Liang Y, Li M, Wang X, Cheng CE, Shi R. Analysis of white-light imaging-based features predictive for determination of lesion depths of superficial flat esophageal squamous cell carcinoma: a retrospective multicenter study from China. Eur J Med Res 2023; 28:187. [PMID: 37291613 DOI: 10.1186/s40001-023-01153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/03/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVES Endoscopic diagnosis of invasion depth of superficial esophageal squamous cell carcinoma (SESCC) by white-light imaging (WLI) modality remains difficult. This study aims to clarify WLI-based features which are predictive for invasion depth of SESCC. METHODS A two-phase study was performed by enrolling 1288 patients with 1396 SESCC lesions. Endoscopic appearances, clinical characteristics and post-operative pathological outcomes were collected and reviewed. The association between lesion features and invasion depth were analyzed. A predictive nomogram was constructed for prediction of invasion depth. RESULTS Among 1396 lesions in derivation and validation cohort, 1139 (81.6%), 194 (13.9%) and 63 (4.5%) lesions were diagnosed as lesions confined into the intraepithelium or the lamina propria mucosa (T1a-EP/LPM), lesions invading the muscularis mucosa (T1a-MM) or superficial submucosa (T1b-SM1) and tumor with moderate invasion into the submucosa or deeper submucosal invasion (≥ T1b-SM2), respectively. Lesion length > 2 cm (p < 0.001), wider circumferential extension (p < 0.001, 0.002 and 0.048 for > 3/4, 1/2-3/4 and 1/4-1/2 circumferential extension, respectively), surface unevenness (p < 0.001 for both type 0-IIa/0-IIc lesions and mixed type lesions), spontaneous bleeding (p < 0.001), granularity (p < 0.001) and nodules (p < 0.001) were identified as significant factors predictive for lesion depth. A nomogram based on these factors was constructed and the values of area under the Receiver Operating Characteristics curve were 0.89 and 0.90 in the internal and external patient cohort. CONCLUSIONS Our study provides six WLI-based morphological features predicting for lesion depth of SESCC. Our findings will make endoscopic evaluation of invasion depth for SESCC more convenient by assessing these profiles.
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Affiliation(s)
- Bin Wang
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
- Department of Gastroenterology, the Affiliated Changshu Hospital of Nantong University, Changshu No.2 People's Hospital, 18 Taishan Road, Suzhou, 215500, China
| | - Yadong Feng
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of Gastroenterology, the Affiliated Changshu Hospital of Nantong University, Changshu No.2 People's Hospital, 18 Taishan Road, Suzhou, 215500, China.
| | - Jie Song
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Jifeng Ma
- Department of Gastroenterology, Maanshan 17th Metallurgy Hospital, 828 West Hunan Road, Maanshan, 243011, China
| | - Yan Liang
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Mengjie Li
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Xiaofen Wang
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Cui-E Cheng
- Department of Gastroenterology, the Affiliated Changshu Hospital of Nantong University, Changshu No.2 People's Hospital, 18 Taishan Road, Suzhou, 215500, China.
| | - Ruihua Shi
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of Gastroenterology, the Affiliated Changshu Hospital of Nantong University, Changshu No.2 People's Hospital, 18 Taishan Road, Suzhou, 215500, China.
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Li H, Hu H, Geng P, Guo P, Zhu Y, Zeng L, Liu J, Hu X. The effect of short-term training about depth predicting score on the diagnostic ability of invasion depth for differentiated early gastric Cancer among non-expert endoscopists. BMC Med Educ 2023; 23:347. [PMID: 37198569 DOI: 10.1186/s12909-023-04230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/03/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND The depth-predicting score (DPS) was proposed based on conventional white-light imaging (C-WLI) endoscopic features of early gastric cancer (EGC) to determine the invasion depth of the neoplasm. However, the effect of DPS on training endoscopists remains unclear. Therefore, we aimed to investigate the effect of short-term DPS training on improving the diagnostic ability of EGC invasion depth and compare the training effect among non-expert endoscopists at different levels. METHODS In the training session, the definitions and scoring rules of DPS were instructed, and classic C-WLI endoscopic example graphics were exhibited to the participants. Another C-WLI endoscopic images of 88 cases of histologically proven differentiated EGC were selected as an independent test dataset for evaluating the training effect. Each participant was tested, and the diagnostic accuracy rate of invasion depth was calculated differently one week before the training and after the completion of training. RESULTS A total of 16 participants were enrolled and completed the training. Participants were divided into a trainee group and a junior endoscopist group according to the total number of C-WLI endoscopies performed. The total number of C-WLI endoscopies performed showed a significant difference between the trainee group and junior endoscopist group (350 vs. 2500, P = 0.001). No significant difference between the trainee group and junior endoscopist group was observed for pre-training accuracy. The overall diagnostic accuracy of invasion depth was improved significantly after completing DPS training compared with before (68.75 ± 5.71% vs. 61.58 ± 9.61%, P = 0.009). In the subgroup analysis, the post-training accuracy was higher than the pre-training accuracy, but significant improvement was observed only in the trainee group (61.65 ± 7.33% vs. 68.32 ± 5.71%, P = 0.034). In addition, no significant difference in post-training accuracy between the two groups was observed. CONCLUSION Short-term DPS training can improve the diagnostic ability of the invasion depth of EGC and homogenize the diagnostic ability of non-expert endoscopists at different levels. The depth-predicting score was convenient and effective for endoscopist training.
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Affiliation(s)
- Hui Li
- Digestive Department, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, Anhui Province, 230601, China
| | - Hui Hu
- Digestive Department, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, Anhui Province, 230601, China
| | - Ping Geng
- Digestive Department, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, Anhui Province, 230601, China
| | - Panhui Guo
- Digestive Department, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, Anhui Province, 230601, China
| | - Yuanrong Zhu
- Digestive Department, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, Anhui Province, 230601, China
| | - Lulu Zeng
- Digestive Department, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, Anhui Province, 230601, China
| | - Jun Liu
- Department of Pathophysiology, School of Basic Medical College, Anhui Medical University, Hefei, Anhui Province, 230032, China.
- Functional experiment center, School of Basic Medical College, Anhui Medical University, Hefei, Anhui Province, 230032, China.
| | - Xiangpeng Hu
- Digestive Department, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, Anhui Province, 230601, China.
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Goto A, Kubota N, Nishikawa J, Ogawa R, Hamabe K, Hashimoto S, Ogihara H, Hamamoto Y, Yanai H, Miura O, Takami T. Cooperation between artificial intelligence and endoscopists for diagnosing invasion depth of early gastric cancer. Gastric Cancer 2023; 26:116-122. [PMID: 36040575 PMCID: PMC9813068 DOI: 10.1007/s10120-022-01330-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS The diagnostic ability of endoscopists to determine invasion depth of early gastric cancer is not favorable. We designed an artificial intelligence (AI) classifier for differentiating intramucosal and submucosal gastric cancers and examined it to establish a diagnostic method based on cooperation between AI and endoscopists. PATIENTS AND METHODS We prepared 500 training images using cases of mainly depressed-type early gastric cancer from 250 intramucosal cancers and 250 submucosal cancers. We also prepared 200 test images each of 100 cancers from another institution. We designed an AI classifier to differentiate between intramucosal and submucosal cancers by deep learning. We examined the performance of the AI classifier and the majority vote of the endoscopists as high confidence and low confidence diagnostic probability, respectively, and cooperatively combined them to establish a diagnostic method providing high accuracy. RESULTS Internal evaluation of the training images showed that accuracy, sensitivity, specificity, and F1 measure by the AI classifier were 77%, 76%, 78%, and 0.768, and those of the majority vote of the endoscopists were 72.6%, 53.6%, 91.6%, and 0.662, respectively. A diagnostic method based on cooperation between AI and the endoscopists showed that the respective values were 78.0%, 76.0%, 80.0%, and 0.776 for the test images. The value of F1 measure was especially higher than those by AI or the endoscopists alone. CONCLUSIONS Cooperation between AI and endoscopists improved the diagnostic ability to determine invasion depth of early gastric cancer.
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Affiliation(s)
- Atsushi Goto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Minami-kogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan.
| | - Naoto Kubota
- Department of Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Jun Nishikawa
- Department of Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Ryo Ogawa
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Minami-kogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan
| | - Koichi Hamabe
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Minami-kogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan
| | - Shinichi Hashimoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Minami-kogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroyuki Ogihara
- National Institute of Technology, Tokuyama College, Shunan, Yamaguchi, Japan
| | - Yoshihiko Hamamoto
- Division of Electrical, Electronic and Information Engineering, Yamaguchi University Graduate School of Sciences and Technology for Innovation, Ube, Yamaguchi, Japan
| | - Hideo Yanai
- Department of Clinical Research, National Hospital Organization Kanmon Medical Center, Shimonoseki, Yamaguchi, Japan
| | - Osamu Miura
- Department of Surgery, Hofu Institute of Gastroenterology, Hofu, Yamaguchi, Japan
| | - Taro Takami
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Minami-kogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan
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Schleiss-Andreassen JL, Kristensen E, Frøding LP, Stæhr E, Høgdall C, Christiansen AP, Høgdall E, Schnack TH. Assessment of recurrence rate and risk factors of relapse in stage in IA vulvar carcinoma. Gynecol Oncol 2021; 164:543-549. [PMID: 34973843 DOI: 10.1016/j.ygyno.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate recurrence rates and risk factors of relapse in stage IA vulvar squamous cell carcinoma (VSCC) patients. MATERIAL AND METHODS Population-based prospectively collected data on stage IA VSCC was retrieved through the Danish Gynecological Cancer Database (DGCD) during 2011-2017. A central pathology review was performed on tumors from women with recurrent disease. RESULTS 62 women diagnosed and treated for stage IA VSCC were identified. Nine (14.5%) of the included cases relapsed within the observation period. The recurrences were in the vulva, groins or both in 5 (8.1%), 3 (4.8%) and 1 (1.6%) of the women, respectively. At central pathology review, including all recurrent cases (n = 9), 5 out of 21 reviewed patients were upstaged to stage IB due to depth of invasion >1 mm and two were downstaged to Carcinoma in situ. Two of the upstaged women developed an isolated groin recurrence and one an isolated vulvar relapse. After exclusion of the seven cases the overall recurrence rate decreased to 10.9% (n = 6). Among these cases (n = 55) resection margin <8 mm and tumor size were associated with cancer recurrence. CONCLUSION Pathological assessment of stage IA VSCC (depth of invasion ≤1 mm) may be difficult. This may result in under-staging, which impact the choice of treatment and possibly the prognosis. This suggests a need for further clarification of the FIGO measurement and may require a more radical approach when it comes to treatment and groin exploration in stage IA VSCC. Resection margins <8 mm and tumor size were associated with relapse of the disease.
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Affiliation(s)
| | - Elisabeth Kristensen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Estrid Stæhr
- Department of Pathology, Skejby, University of Aarhus, Aarhus, Denmark
| | - Claus Høgdall
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Estrid Høgdall
- Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Tine Henrichsen Schnack
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Gynecology, Odense University Hospital, Odense, Denmark.
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Kawasaki K, Torisu T, Nagahata T, Esaki M, Kurahara K, Eizuka M, Tanaka Y, Fujiwara M, Kawatoko S, Oshiro Y, Yamada S, Ikegami K, Fujioka S, Fuyuno Y, Matsuno Y, Umeno J, Moriyama T, Kitazono T, Sugai T, Matsumoto T. Role of barium enema examination for the diagnosis of submucosal invasion depth in T1 colorectal cancers. Cancer Imaging 2021; 21:66. [PMID: 34876222 PMCID: PMC8650542 DOI: 10.1186/s40644-021-00437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The indication for endoscopic resection for submucosally invasive colorectal cancer (T1-CRC) depends on the preoperative diagnosis of invasion depth. The aim of this investigation was to evaluate the association between barium enema examination (BE) profile views and depth of submucosal (SM) invasion in CRCs. METHODS We reviewed the radiographic and endoscopic findings of 145 T1-CRCs diagnosed from 2008 to 2019. We measured the widths of horizontal and vertical rigidity under a BE profile view corresponding to CRC and compared the values with SM invasion depth. Horizontal rigidity was defined as the horizontal length and vertical rigidity as the vertical width of the barium defect corresponding to each target lesion. The most appropriate cut-off values for predicting SM invasion ≥1.8 mm were calculated by receiver operating characteristic curve analysis. RESULTS Values of horizontal rigidity (r = 0.626, P < 0.05) and vertical rigidity (r = 0.482, P < 0.05) correlated significantly with SM invasion depth. The most appropriate cut-off values for the prediction of SM invasion depth ≥ 1.8 mm were 4.5 mm for horizontal rigidity, with an accuracy of 80.7%; and 0.7 mm for vertical rigidity, with an accuracy of 77.9%. The prevalence of lympho-vascular invasion was significantly different when those cut-off values were applied (43.2% vs. 17.5% for horizontal rigidity, P < 0.005). CONCLUSIONS In T1-CRC, values of horizontal and vertical rigidities under a BE profile view were correlated with SM invasion depth. While the accuracy of the rigidities for the prediction of SM invasion depth ≥ 1.8 mm was not high, horizontal rigidity may be predictive of lympho-vascular invasion, thus aiding in therapeutic decision-making.
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Affiliation(s)
- Keisuke Kawasaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan. .,Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, 028-3695, Japan.
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Takahisa Nagahata
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Koichi Kurahara
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, 790-8524, Japan
| | - Makoto Eizuka
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, 028-3695, Japan.,Department of Diagnostic Pathology, Iwate Medical University, Yahaba, 790-8524, Japan
| | - Yoshihito Tanaka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, 790-8524, Japan
| | - Minako Fujiwara
- Department of Pathology, National Hospital Organization Kyushu Medical Center, Fukuoka, 810-8563, Japan.,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-0054, Japan
| | - Shinichiro Kawatoko
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan.,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-0054, Japan
| | - Yumi Oshiro
- Department of Pathology, Matsuyama Red Cross Hospital, Matsuyama, 790-8524, Japan
| | - Shun Yamada
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, 028-3695, Japan
| | - Koji Ikegami
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, 790-8524, Japan
| | - Shin Fujioka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Yuta Fuyuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Yuichi Matsuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Tomohiko Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, 790-8524, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, 028-3695, Japan
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Gotoda T, Hori K, Nakagawa M, Kobayashi S, Toyokawa T, Ishiyama S, Imagawa A, Abe M, Kono Y, Kanzaki H, Iwamuro M, Kawano S, Kawahara Y, Okada H. A prospective multicenter study of the magnifying endoscopic evaluation of the invasion depth of superficial esophageal cancers. Surg Endosc 2021. [PMID: 34322721 DOI: 10.1007/s00464-021-08666-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment strategies for superficial esophageal squamous cell carcinoma (SESCC) are determined mainly on the basis of the invasion depth. The Japan Esophageal Society (JES) developed a simplified magnifying endoscopic classification for estimating the invasion depth of SESCC. We aimed to evaluate its accuracy. METHODS We prospectively applied the JES classification for estimating the invasion depth of SESCC to 204 consecutive lesions from 6 hospitals in Japan between April 2016 and October 2018. We analyzed the accuracy of the endoscopic diagnosis by adding the following two categories to the JES classification: ≥ 7 mm lesion in B2 vessels (defined as B2 ≥ 7 mm) and B2 vessels with inflammation (defined as B2i). RESULTS After applying the exclusion criteria, 201 lesions remained in the analysis. The diagnostic value of type B1, B2, B3 vessels were as follows: sensitivity, 93.9%, 68.0%, 25.0%; specificity, 81.1%, 89.2%, 99.4%; positive predictive value (PPV), 95.6%, 47.2%, 75.0%; negative predictive value (NPV), 75.0%, 95.1%, 95.4%; and accuracy, 91.5%, 86.5%, 95.0%, respectively. A retrospective analysis showed that the diagnostic accuracy was higher in type B2 vessels (86.5% to 92.0%). An avascular area (AVA) was found in 55 (27%) of the 201 lesions, which tended to be associated with a deeper pathological diagnosis of each Type B vessel. In an additional analysis, B2 ≥ 7 mm and B2i improved the diagnostic accuracy of type B2 vessels from 86.5% to 92.0%. CONCLUSIONS The JES classification is useful for estimating the invasion depth of SESCC. The diagnostic accuracy for type B2 vessels was low, which may be improved by using B2 ≥ 7 mm and B2i.
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Abstract
Recently, studies in many medical fields have reported that image analysis based on artificial intelligence (AI) can be used to analyze structures or features that are difficult to identify with human eyes. To diagnose early gastric cancer, related efforts such as narrow-band imaging technology are on-going. However, diagnosis is often difficult. Therefore, a diagnostic method based on AI for endoscopic imaging was developed and its effectiveness was confirmed in many studies. The gastric cancer diagnostic program based on AI showed relatively high diagnostic accuracy and could differentially diagnose non-neoplastic lesions including benign gastric ulcers and dysplasia. An AI system has also been developed that helps to predict the invasion depth of gastric cancer through endoscopic images and observe the stomach during endoscopy without blind spots. Therefore, if AI is used in the field of endoscopy, it is expected to aid in the diagnosis of gastric neoplasms and determine the application of endoscopic therapy by predicting the invasion depth.
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Affiliation(s)
- Ji Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Kangwon Do, South Korea
| | - Seung-Joo Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Kangwon Do, South Korea
| | - Sung Chul Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Kangwon Do, South Korea
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Kawasaki K, Nakamura S, Eizuka M, Tanaka Y, Kumei T, Yanai S, Toya Y, Urushikubo J, Torisu T, Moriyama T, Umeno J, Sugai T, Matsumoto T. Is barium enema examination negligible for the management of colorectal cancer? Comparison with conventional colonoscopy and magnifying colonoscopy. Jpn J Radiol 2021; 39:1159-1167. [PMID: 34164768 DOI: 10.1007/s11604-021-01157-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/12/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this investigation was to evaluate the clinical value of barium enema (BE) examination for the management of colorectal epithelial neoplasms. METHODS We reviewed the colonoscopy records at our institution from 2014 to 2019 and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms evaluated by BE, conventional colonoscopy, magnifying narrow-band imaging colonoscopy (M-NBI), and magnifying chromoendoscopy (MCE). The yield of each modality for the diagnosis of massively submucosal invasive (mSM) colorectal cancer was evaluated by a receiver-operating characteristic analysis including the area under the curve (AUC). RESULTS We analyzed the records of 105 patients (17 adenomas, 53 high-grade dysplasias (HGDs), and 35 cancers). Smooth surface, irregularity in depression, and eccentric deformity on the profile view with BE were observed more frequently in mSM cancers than adenomas/HGDs/slightly submucosal invasive cancers (p < 0.01). The AUC of BE was 0.8355, the value of which was not different from the other three modalities (conventional colonoscopy 0.7678; M-NBI 0.7835; MCE 0.8376). Although the specificity, PPV, and accuracy of BE were lower than those of M-NBI and MCE, the sensitivity and NPV of BE were the highest among the four types of examinations. CONCLUSION BE is still available and may serve as a supplementary modality for the diagnosis of mSM cancers.
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Affiliation(s)
- Keisuke Kawasaki
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Makoto Eizuka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Yoshihito Tanaka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Tomo Kumei
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Shunichi Yanai
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Jun Urushikubo
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiko Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
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Li W, He F, Liu P, Duan H, Ni Y, Wang S, Lin L, Yin Z, Chen X, Yin L, Wang L, Liu Y, Luan Z, Chen C. Uterine corpus invasion in cervical cancer: a multicenter retrospective case-control study. Arch Gynecol Obstet 2021; 303:777-85. [PMID: 33544202 DOI: 10.1007/s00404-021-05968-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/12/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the accuracy of uterine corpus invasion (UCI) diagnosis in patients with cervical cancer and identity risk factors for UCI and depth of invasion. METHODS Clinical data of patients with cervical cancer who underwent hysterectomy between 2004 and 2016 were retrospectively reviewed. UCI was assessed on uterine pathology. Independent risk factors for UCI and depth of invasion were identified using binary and ordinal logistic regression models, respectively. RESULTS A total of 2,212 patients with cervical cancer from 11 medical institutions in China were included in this study. Of these, 497 patients had cervical cancer and UCI, and 1,715 patients had cervical cancer and no UCI, according to the original pathology reports. Retrospective review of the original pathology reports revealed a missed diagnosis of UCI in 54 (10.5%) patients and a misdiagnosis in 36 (2.1%) patients. Therefore, 515 patients with cervical cancer and UCI (160 patients with endometrial invasion, 176 patients with myometrial invasion < 50%, and 179 patients with myometrial invasion ≥ 50%), and 1697 patients with cervical cancer without UCI were included in the analysis. Older age, advanced stage, tumor size, adenocarcinoma, parametrial involvement, resection margin involvement, and lymph node metastasis were independent risk factors for UCI. These risk factors, except resection margin involvement, were independently associated with depth of UCI. CONCLUSIONS UCI may be missed or misdiagnosed in patients with cervical cancer on postoperative pathological examination. Older age, advanced stage, tumor size, adenocarcinoma, parametrial involvement, resection margin involvement, and lymph node metastasis were independent risk factors for UCI and depth of UCI, with the exception of resection margin involvement.
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Liu Y, Zheng H, Xu X, Zhang X, Du P, Liang J, Lu H. The invasion depth measurement of bladder cancer using T2-weighted magnetic resonance imaging. Biomed Eng Online 2020; 19:92. [PMID: 33287834 PMCID: PMC7720543 DOI: 10.1186/s12938-020-00834-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Invasion depth is an important index for staging and clinical treatment strategy of bladder cancer (BCa). The aim of this study was to investigate the feasibility of segmenting the BCa region from bladder wall region on MRI, and quantitatively measuring the invasion depth of the tumor mass in bladder lumen for further clinical decision-making. This retrospective study involved 20 eligible patients with postoperatively pathologically confirmed BCa. It was conducted in the following steps: (1) a total of 1159 features were extracted from each voxel of both the certain cancerous and wall tissues with the T2-weighted (T2W) MRI data; (2) the support vector machine (SVM)-based recursive feature elimination (RFE) method was implemented to first select an optimal feature subset, and then develop the classification model for the precise separation of the cancerous regions; (3) after excluding the cancerous region from the bladder wall, the three-dimensional bladder wall thickness (BWT) was calculated using Laplacian method, and the invasion depth of BCa was eventually defined by the subtraction of the mean BWT excluding the cancerous region and the minimum BWT of the cancerous region. RESULTS The segmented results showed a promising accuracy, with the mean Dice similarity coefficient of 0.921. The "soft boundary" defined by the voxels with the probabilities between 0.1 and 0.9 could demonstrate the overlapped region of cancerous and wall tissues. The invasion depth calculated from proposed segmentation method was compared with that from manual segmentation, with a mean difference of 0.277 mm. CONCLUSION The proposed strategy could accurately segment the BCa region, and, as the first attempt, realize the quantitative measurement of BCa invasion depth.
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Affiliation(s)
- Yang Liu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Haojie Zheng
- School of Life Sciences and Technology, Xidian University, 266 Xinglong Section of Xifeng Road, Xi'an, Shaanxi, 710126, PR China
| | - Xiaopan Xu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Xi Zhang
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Peng Du
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China
| | - Jimin Liang
- School of Life Sciences and Technology, Xidian University, 266 Xinglong Section of Xifeng Road, Xi'an, Shaanxi, 710126, PR China.
| | - Hongbing Lu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, Shaanxi, 710032, PR China.
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Takamaru H, Yoshinaga S, Takisawa H, Oda I, Katai H, Sekine S, Taniguchi K, Saito Y. Endoscopic Ultrasonography Miniature Probe Performance for Depth Diagnosis of Early Gastric Cancer with Suspected Submucosal Invasion. Gut Liver 2020; 14:581-588. [PMID: 31816675 PMCID: PMC7492497 DOI: 10.5009/gnl19243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background/Aims The accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion. Methods From April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis. Results A total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03). Conclusions The depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.
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Affiliation(s)
- Hiroyuki Takamaru
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | | | - Hajime Takisawa
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Oda
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Hitoshi Katai
- Divisions of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Sekine
- Divisions of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yutaka Saito
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
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Kuno T, Yamamura T, Nakamura M, Maeda K, Sawada T, Mizutani Y, Esaki M, Ishikawa T, Furukawa K, Ohno E, Kawashima H, Fujishiro M. A forward-viewing radial-array echoendoscope is useful for diagnosing the depth of colorectal neoplasia invasion. Surg Endosc 2020; 35:4389-4398. [PMID: 32876738 DOI: 10.1007/s00464-020-07936-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/25/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND It is important to accurately diagnose the depth of colorectal neoplasia invasion. We aimed to evaluate the usefulness of a new forward-viewing radial-array echoendoscope (FRE), relative to the pit pattern method. METHODS In this prospective study, the invasion depth of suspected early-stage carcinoma was diagnosed using the pit pattern and FRE methods. The diagnoses were classified as T1a (submucosal invasion distance < 1,000 μm) or shallower and T1b (≥ 1,000 μm) or deeper. Pathological diagnoses were used to compare the diagnostic capabilities of the two methods. RESULTS The final analyses included 110 lesions. The FRE was successfully inserted to the lesion in all cases. There were no significant differences between the two methods regarding the correct prediction rate (79.1% vs. 75.5%, P = 0.57), accuracy (81.3% vs. 79.0%, P = 0.68), specificity (81.3% vs. 70.8%, P = 0.135), positive predictive value (65.0% vs. 60.4%, P = 0.649), negative predictive value (91.0% vs. 98.1%, P = 0.108), or frequency of unevaluable cases (2.7% vs. 4.5%, P = 0.471). The correct prediction rate was calculated by adding the number of unevaluable cases to the denominator of accuracy. Relative to the pit pattern method, the FRE method offered significantly higher sensitivity for predicting T1b or deeper invasion (81.3% vs. 97.0%, P = 0.048). The pit pattern method had significantly poorer accuracy for large lesions (> 36 mm) than for smaller lesions (≤ 36 mm). In contrast, the accuracy of the FRE method did not differ significantly with lesion size. When using the FRE method, no cases were unevaluable because of attenuation. The FRE method provided correct diagnoses in 2 of 3 cases that were unevaluable using the pit pattern method. CONCLUSIONS The pit pattern and FRE methods offered similar diagnostic performance for invasion depth. Furthermore, the FRE method may be used to correctly diagnose cases that are unevaluable using the pit pattern method.
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Affiliation(s)
- Takeshi Kuno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Maeda
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaya Esaki
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
Diagnosis and evaluation of early gastric cancer (EGC) using endoscopic images is significantly important; however, it has some limitations. In several studies, the application of convolutional neural network (CNN) greatly enhanced the effectiveness of endoscopy. To maximize clinical usefulness, it is important to determine the optimal method of applying CNN for each organ and disease. Lesion�-based CNN is a type of deep learning model designed to learn the entire lesion from endoscopic images. This review describes the application of lesion-based CNN technology in diagnosis of EGC.
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Affiliation(s)
- Hong Jin Yoon
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jie-Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Baba A, Ojiri H, Ogane S, Hashimoto K, Inoue T, Takagiwa M, Goto TK. Usefulness of contrast-enhanced CT in the evaluation of depth of invasion in oral tongue squamous cell carcinoma: comparison with MRI. Oral Radiol 2020; 37:86-94. [PMID: 32086730 DOI: 10.1007/s11282-020-00429-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is currently no standardized approach for assessing the depth of invasion (DOI) of oral tongue squamous cell carcinoma via diagnostic imaging. We investigated the usefulness of contrast-enhanced computed tomography (CECT) for estimating the pathological DOI of oral tongue squamous cell carcinoma by evaluating the correlation of pathological DOI with the DOIs on CECT and magnetic resonance imaging (MRI). METHODS We retrospectively reviewed 21 of 139 patients who underwent radical surgery for primary oral tongue squamous cell carcinoma between 2009 and 2018. The 21 cases were evaluable, without dental artifacts on CECT. DOIs on CECT and MRI, and pathological DOI were measured. RESULTS The median pathological DOI was 9 mm, that on CECT was 10.9 mm, that on T2-weighted MRI was 14.2 mm, and that on contrast-enhanced T1-weighted MRI was 13.1 mm. The DOIs on CECT and on MRI were larger than the pathological DOI (p = 0.003 to < 0.001). The absolute value of the difference between pathological DOI and DOI on CECT was smaller than that between pathological DOI and DOI on MRI (p = 0.01 and 0.003). DOIs on CECT and on MRI correlated with pathological DOI (r = 0.74-0.66, all p < 0.001). Spearman's correlation coefficient between DOI on CECT and pathological DOI was greater than that between DOI on MRI and pathological DOI. CONCLUSIONS Compared to the DOI determined on an MRI scan, the DOI determined on a CECT scan correlated with and better approximated pathological DOI. Therefore, CECT can be useful for preoperative staging of patients with oral tongue squamous cell carcinoma.
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Affiliation(s)
- Akira Baba
- Department of Radiology, The Jikei University School of Medicine and University Hospital, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 1058461, Japan. .,Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine and University Hospital, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 1058461, Japan
| | - Satoru Ogane
- Oral Cancer Center, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Kazuhiko Hashimoto
- Department of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Takashi Inoue
- Department of Clinical Pathophysiology, Oral Health Science Center Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Mutsumi Takagiwa
- Laboratory of Mathematics, Tokyo Dental College, 2-9-18, Kansa-Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Tazuko K Goto
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan
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Chao G, Ye F, Li T, Gong W, Zhang S. Estimation of invasion depth of early colorectal cancer using EUS and NBI-ME: a meta-analysis. Tech Coloproctol 2019; 23:821-830. [PMID: 31559545 DOI: 10.1007/s10151-019-02076-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 09/04/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) and narrow band imaging-magnifying endoscopy (NBI-ME) are often used as diagnostic tools to estimate the depth of invasion in early colorectal cancer (CRC). The aim of this study was to compare NBI-ME with EUS in distinguishing between slight submucosal invasion (invasion depth < 1000 μm) and massive submucosal invasion in patients with early CRC, since slight submucosal invasion is currently considered as an indication for endoscopic resection. METHODS For this meta-analysis, relevant studies were identified from PubMed, Embase, Web of Science, Scopus and the Cochrane Library databases between January 1997 and September 2016. Data on the yield of tumors were extracted, pooled, and analyzed by stata12.0 software. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio in differentiating slight submucosal invasion from massive submucosal invasion were calculated for both diagnostic modalities. RESULTS Sixteen studies involving 2197 lesions were included: nine were studies on EUS and 7 were studies on NBI-ME. The pooled sensitivity of EUS was 0.902 (95% CI 0.863-0.930), the specificity was 0.877 (95% CI 0.810-0.922), the positive likelihood ratio was 7.314 (95% CI 4.551-11.755) and the negative likelihood ratio was 0.112 (95% CI 0.076-0.164). The pooled sensitivity and specificity of NBI-ME were 0.981 (95% CI 0.949-0.993) and 0.651 (95% CI 0.600-0.699), respectively, the positive likelihood ratio was 2.815 (95% CI 2.432-3.258) and the negative likelihood ratio was 0.029 (95% CI 0.010-0.080). CONCLUSIONS The sensitivity tended to be higher in ME-NBI than EUS for early CRC with slight submucosal invasion, whereas the specificity was significantly lower in NBI-ME than in EUS.
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Affiliation(s)
- G Chao
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - F Ye
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - T Li
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - W Gong
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - S Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China.
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18
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Wang YL, Yan HL, Wu JC, Gan T, Yang JL, Ma HS. [Accuracy of EUS and ME-NBI for Evaluating the Invasion Depth of Early Esophageal Cancer]. Sichuan Da Xue Xue Bao Yi Xue Ban 2018; 49:840-844. [PMID: 32677389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess the accuracy of endoscopic ultrasound (EUS) and magnifying endoscopy with narrow-band imaging (ME-NBI) in evaluating the invasion depth of early esophageal carcinoma. METHODS Patients who underwent endoscopic resection for early esophageal cancer from March 2013 to October 2017 were enrolled. The EUS and ME-NBI results were compared with the pathology results. RESULTS A total of 392 lesions from 333 patients were assessed, including 83 mild and moderate dysplasia, 72 severe dysplasia, 235 squamous cell carcinoma, and 2 adenosquamous carcinoma. About 308 lesions were given EUS only, 7 had ME-NBI only, 77 underwent both EUS and ME-NBI. EUS resulted in a 43.9% accuracy for the 385 lesions, with poor consistency (Kappa=0.1) with the pathology results. But higher accuracy (68.2%) was found for lesions infiltrating into the submucosa of the lesions, compared with 40.5% for lesions contained within the mucosa (P=0.001). ME-NBI resulted in a 72.6% accuracy for the 84 lesions, with a medium consistency (Kappa=0.4). The accuracy for lesions contained within the mucosa was 91.0%, compared with 16.7% for lesions infilrtrating into the submucosa (P=0.001). EUS and ME-NBI for the 77 lesions demonstrated an accuracy of 42.9% for the EUS and 84.3% for the ME-NBI (P=0.001). CONCLUSIONS ME-NBI has higher accuracy than EUS in evaluating the invasion depth of early esophageal carcinoma.
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Affiliation(s)
- Yi-Lan Wang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hai-Lin Yan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jun-Chao Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tao Gan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin-Lin Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hong-Sheng Ma
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
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Schmitz L, Hessam S, Scholl L, Reitenbach S, Segert MH, Gambichler T, Stockfleth E, Bechara FG. Histological findings after argon plasma coagulation: an ex-vivo study revealing a possible role in superficial ablative treatment of the skin. Arch Dermatol Res 2018; 310:157-163. [PMID: 29350263 DOI: 10.1007/s00403-018-1810-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
Argon plasma coagulation (APC) is an electrosurgical technique which can be used to ablate skin lesions with limited invasion depth into dermal tissue. Hence, APC might be well suited for the removal of epithelial tumours. However, there are no data on the effects of APC on human skin tissue. Thus, the aim of this study was to determine the extent of epidermal and dermal damage after APC of human skin. We performed APC ex-vivo on 91 freshly resected human skin samples, which were obtained after reconstructive surgical closures in actinically damaged areas. Tissue effects were evaluated histologically and compared across different power settings. Using 15, 30, and 45 W, median (interquartile range; IQR) coagulation depths were 110.0 µm (91.7-130.0), 113.3 µm (85.8-135.0), and 130.0 µm (100.0-153.3.0), respectively. Median (IQR) thickness of necrosis zone was 30.0 µm (23.3-40.0) at 15 W, 26.7 µm (20.0-41.6) at 30 W, and 43.3 µm (30.8-57.5) at 45 W. The Kruskal-Wallis test showed significant differences between 15 and 30 W versus 45 W for coagulation depth (P = 0.0414), necrosis zone (P = 0.0017), and necrosis according to overlaying epidermal thickness (P = 0.0467). In summary, APC is a simple and controllable electrosurgical technique to remove epidermal tissue with limited penetration to the dermis. Thus, APC is particularly suited for the ablation of epithelial skin lesions and, therefore, may serve as possible treatment approach for intraepithelial neoplasms such as actinic keratosis.
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Affiliation(s)
- L Schmitz
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - S Hessam
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - L Scholl
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - S Reitenbach
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - M H Segert
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany.
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Tao Z, Yan C, Zhao H, Tsauo J, Zhang X, Qiu B, Zhao Y, Li X. Comparison of endoscopic ultrasonography and magnifying endoscopy for assessment of the invasion depth of shallow gastrointestinal neoplasms: a systematic review and meta-analysis. Surg Endosc 2017; 31:4923-33. [PMID: 28547665 DOI: 10.1007/s00464-017-5596-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/11/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To conduct a meta-analysis to provide accurate evidence regarding the preferred diagnostic method, magnifying endoscopy (ME) or endoscopic ultrasonography (EUS), for assessment of the depth of invasion of the gastrointestinal neoplasms. METHODS PubMed, EMBASE, Ovid Medline, and the Cochrane Library databases were searched for studies published between January 1946 and October 2016, regarding the use of EUS and ME to assess the invasion depth of gastrointestinal cancers. The quality of diagnostic studies was evaluated using the QUADAS2 instrument. The Meta-DiSc software (version 1.4) was used for meta-analysis of the pooled data regarding the diagnostic accuracy of EUS and ME of the invasion depth of gastrointestinal neoplasms. RESULTS Our meta-analysis included the data of 754 patients with gastrointestinal cancers contributed by seven prospective studies. All studies were of high quality (QUADAS2). The receiver operating characteristic (ROC) planes were not observed in shoulder and arm forms for either EUS or ME, with Spearman's correlation coefficients of -0.821 and 0.234 for EUS and ME, respectively. The p values of the diagnostic odds ratio for EUS and ME were 0.0038 and 0.0131, respectively. The sensitivity and specificity of EUS for the diagnosis of the depth of invasion of gastrointestinal cancers were 0.75 (95% CI 0.69-0.81) and 0.84 (95% CI 0.79-0.88), respectively. In comparison, the sensitivity and specificity for ME were 0.74 (95% CI 0.67-0.69) and 0.85 (95% CI 0.80-0.89), respectively. The values of area under the summary ROC (SROC) curves for EUS and ME were 0.8499 and 0.8757, respectively, with a non-significant Z value between EUS and MR (0.296 < 1.96). CONCLUSIONS Both EUS and ME provide a comparable performance for judging the depth of invasion of gastrointestinal neoplasms. However, there is heterogeneity between studies contributed by non-threshold effects.
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Zeng J, Tang ZH, Liu S, Guo SS. Clinicopathological significance of overexpression of interleukin-6 in colorectal cancer. World J Gastroenterol 2017; 23:1780-1786. [PMID: 28348483 PMCID: PMC5352918 DOI: 10.3748/wjg.v23.i10.1780] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/06/2016] [Accepted: 12/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the expression levels of interleukin (IL)-6 in colorectal cancer (CRC) tissues and adjacent non-cancerous tissues, and analyse the correlation of IL-6 expression with the clinicopathological parameters of CRC.
METHODS Fifty CRC tissue specimens and 50 matched adjacent mucosa specimens were collected. The expression of IL-6 in these clinical samples was examined by immunohistochemical staining. The correlation between IL-6 expression and clinicopathological parameters was assessed by statistical analysis.
RESULTS IL-6 expression was significantly elevated in CRC tissues compared with noncancerous tissues (P < 0.001). IL-6 expression was positively correlated with tumour TNM stage (P < 0.001), but a negative correlation was detected between IL-6 expression and tumor histological differentiation in CRC (P < 0.05). Furthermore, IL-6 expression was associated with invasion depth and lymph node metastasis in CRC.
CONCLUSION IL-6 might be a useful marker for predicting a poor prognosis in patients with CRC and might be used as a potential therapeutic target in CRC.
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Oyama T, Inoue H, Arima M, Momma K, Omori T, Ishihara R, Hirasawa D, Takeuchi M, Tomori A, Goda K. Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society. Esophagus 2017; 14:105-12. [PMID: 28386209 DOI: 10.1007/s10388-016-0527-7] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/09/2016] [Indexed: 02/03/2023]
Abstract
Predicting invasion depth of superficial esophageal squamous cell carcinoma is crucial in determining the precise indication for endoscopic resection because the rate of lymph node metastasis increases in proportion to the invasion depth of the carcinoma. Previous studies have shown a close relationship between microvascular patterns observed by Narrow Band Imaging magnifying endoscopy and invasion depth of the superficial carcinoma. Thus, the Japan Esophageal Society (JES) developed a simplified magnifying endoscopic classification for estimating invasion depth of superficial esophageal squamous cell carcinomas. We conducted a prospective study to evaluate the diagnostic values of type B vessels in the pretreatment estimation of invasion depth of superficial esophageal squamous cell carcinomas utilizing JES classification, the criteria of which are based on the degree of irregularity in the microvascular morphology. Type A microvessels corresponded to noncancerous lesions and lack severe irregularity; type B, to cancerous lesions, and exhibit severe irregularity. Type B vessels were subclassified into B1, B2, and B3, diagnostic criteria for T1a-EP or T1a-LPM, T1a-MM or T1b-SM1, and T1b-SM2 tumors, respectively. We enrolled 211 patients with superficial esophageal squamous cell carcinoma. The overall accuracy of type B microvessels in estimating tumor invasion depth was 90.5 %. We propose that the newly developed JES magnifying endoscopic classification is useful in estimating the invasion depth of superficial esophageal squamous cell carcinoma.
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Kouyama Y, Kudo SE, Miyachi H, Ichimasa K, Hisayuki T, Oikawa H, Matsudaira S, Kimura YJ, Misawa M, Mori Y, Kodama K, Kudo T, Hayashi T, Wakamura K, Katagiri A, Hidaka E, Ishida F, Hamatani S. Practical problems of measuring depth of submucosal invasion in T1 colorectal carcinomas. Int J Colorectal Dis 2016; 31:137-46. [PMID: 26428364 PMCID: PMC4701783 DOI: 10.1007/s00384-015-2403-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Submucosal invasion depth (SID) in colorectal carcinoma (CRC) is an important factor in estimating risk of lymph node metastasis, but can be difficult to measure, leading to inadequate or over-extensive treatment. Here, we aimed to clarify the practical aspects of measuring SID in T1 CRC. METHODS We investigated 568 T1 CRCs that were resected surgically at our hospital from April 2001 to December 2013, and relationships between SID and clinicopathological factors, including the means of measurement, lesion morphology, and lymph node metastasis. RESULTS Of these 568 lesions, the SID was ≥1000 μm in 508 lesions. SIDs for lesions measured from the surface layer were all ≥1000 μm. Although lesions with SIDs ≥1000 μm were associated with significantly higher levels of unfavorable histologic types and lymphovascular infiltration than shallower lesions, a depth of ≥1000 μm was not a significant risk factor for lymph node metastasis (LNM) (6.7 vs. 9.8 %; P = 0.64), and no lesions for which the sole pathological factor was SID ≥1000 μm had lymph node metastasis. Protruded lesions showed deeper SIDs than other types. CONCLUSIONS Although we found several problems of measuring SID in this study, we also found, surprisingly, that SID is not a risk factor for lymph node metastasis, and its measurement is not needed to estimate the risk of lymph node metastasis.
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Affiliation(s)
- Yuta Kouyama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Tomokazu Hisayuki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Hiromasa Oikawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Shingo Matsudaira
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Yui J. Kimura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Kenta Kodama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Toyoki Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Takemasa Hayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Atsushi Katagiri
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Eiji Hidaka
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan
| | - Shigeharu Hamatani
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuzuki-ku, Yokohama City, Kanagawa 224-8503 Japan ,Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
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Park CH, Park JC, Chung H, Shin SK, Lee SK, Lee YC. A specific role of endoscopic ultrasonography for therapeutic decision-making in patients with gastric cardia cancer. Surg Endosc 2016; 30:4193-9. [PMID: 26715019 DOI: 10.1007/s00464-015-4728-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The role of endoscopic ultrasonography (EUS) in gastric cardia cancer should be further evaluated because the accuracy of EUS depends on tumor location. We aimed to identify a specific role of EUS for therapeutic decision-making in patients with gastric cardia cancer. METHODS Initial EUS examinations for treatment-naïve gastric cancer that were followed by endoscopic resection or surgery were included in the study. Lesions were classified as cardiac and non-cardiac cancer according to tumor location. The diagnostic performance of EUS in predicting invasion depth was compared between the two groups. RESULTS The overall accuracy of EUS in predicting invasion depth did not differ between the cardiac and non-cardiac cancer groups (44.4 vs. 52.3 %, P = 0.259). The underestimation rate was higher in the cardiac cancer group than in the non-cardiac cancer group (37.0 vs. 18.5 %, P = 0.001). When the depth of invasion was predicted to be deeper than the mucosa (submucosal or deeper) by EUS, the positive predictive value was 82.1 [95 % confidence interval (CI), 66.5-92.5 %] and 62.9 % (95 % CI, 60.5-66.9 %) in the cardiac and non-cardiac cancer groups, respectively (P = 0.015). In multivariable analysis, tumor location in the cardia was found to be an independent factor for the underestimation of invasion depth [odds ratio (95 % CI) = 2.242 (1.156-4.349)]. CONCLUSIONS The underestimation rate in predicting invasion depth was significantly higher for cardiac cancers than for non-cardiac cancers. Therefore, selection of the treatment method for gastric cardia cancer via EUS should be done carefully.
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Tanaka S, Hayashi N, Oka S, Chayama K. Endoscopic assessment of colorectal cancer with superficial or deep submucosal invasion using magnifying colonoscopy. Clin Endosc 2013; 46:138-46. [PMID: 23614123 PMCID: PMC3630307 DOI: 10.5946/ce.2013.46.2.138] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 12/14/2022] Open
Abstract
Among early colorectal carcinoma, endoscopic treatment is generally indicative for cases with intramucosal to submucosal (SM) superficial invasion, because cases with SM deep invasion should be treated surgically due to the risk of lymph node metastasis. It is important, therefore, to distinguish between superficial and deep SM invasion in early colorectal carcinoma prior to treatment. In this review we assessed the clinical usefulness and knack of pit pattern and narrow band imaging (NBI) diagnosis using magnifying observation. VN type pit pattern, type C3 in NBI Hiroshima classification and NBI type 3 in NBI international colorectal endoscopic (NICE) classification are useful predictors of SM deep invasion. In NBI magnifying observation evaluation of both the vascular pattern and surface pattern are important. We have to use pit pattern diagnosis and NBI magnifying diagnosis as the situation demands with the knowledge of both advantage and disadvantage in each diagnostic method.
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Affiliation(s)
- Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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