Endoscopic Diagnosis and Clinical Pathology of Early Upper ...
| [Abstract] Early diagnosis of upper gastrointestinal tumor mostly rely on endoscopy at present. There are conventional endoscopy, chromoendoscopy, magnifying endoscopy, ultrasonic endoscopy. Electron stain endoscopy is a newly used technique with the combining of chromoendoscopy and magnifying endoscopy, more precisely evaluates the extent and character of lesions,or even measures invasion depth. Therapy of the early upper gastrointestinal carcinoma still relies on surgery. But as the developing and maturing of endoscope mucosal resection(EMR), more and more early upper gastrointestinal carcinoma patients chose endoscopic therapy. The most important factor of upper gastrointestinal cancer survival rate are invasion depth and lymphoid node metastasis. Precise detecting invasion depth and lymphoid node metastasis is a key basis of patients'therapy option.Based on above,this study gathered up 55 early esophageal carcinoma from january 2000 to june 2006 and 24 early gastric cancer from december 2004 to december 2006 that detected by endoscopy and comfirmed by post-operation biopsy in our hospital, analyzed their endoscope character and pathology. Discuss endoscopic diagnostic value and clinical pathological character of the early upper gastrointestinal cancer. We also performed conventional endoscopy,narrow band imaging system(NBI), magnifying endoscopy,and some of them chromoendoscopy and ultrasonic endoscope to 215 clinic patients of our hospital from October 2006 to January 2007,for the purpose of approaching NBI acting in early upper gastrointestinal cancer diagnosis.There are three parts in this study,that is:1、Endoscopy and clinical pathology of early esophageal cancerObjective: Statistically analyze the result of 55 patients'preoperative endoscopy and postoperative biopsy. Discuss the relation between early esophageal cancer endoscopic character and it's invasion depth.Materials and methods: We collected 55 early esophageal carcinoma that detected by preoperative Endoscopy and comfirmed by post-operation biopsy in our hospital from january 2000 to june 2006,of which were 37 male , 18 female with ages ranged from 37 to 77, mean 57.9. 18 of them were performed preoperative ultrasonic endoscopy.and we analyzed the relation between it's endoscopy character and invasion depth as well as lymphoid node metastasis.Result: Surface diffusion auxotype,intracavitary auxotype (height<5mm)、bilateral auxotype (height < 2mm)、inner wall auxotype(depth < 0.5mm) imply intramucosal carcinoma. intracavitary auxotype(height≥5mm), bilateral auxotype(height≥2mm) ,inner wall auxotype(depth≥0.5mm) and mixing auxotype imply submucosal carcinoma.. There are reverse relationship between histological differentiation and invasion depth of the tumor . Only one was mucosal carcinoma among 4 lymph node metastas and 2 lymphovascular invaded,The other were submucosal carcinoma, All carcinoma in situ wasn't metastasis. By compared preoperative endoscopic ultrasonography performed to 18 patients with postoperative,16 of them are completely accurate. The accuracy is 88.9%.Conclusion: Endoscopic character of th early esophageal cancer was related closely to invasion depth . Detection of endoscope auxotype can help detect it's invasion depth. Endoscopic ultrasonography has important meaning in diagnosing cancer invasion depth. More serious malignant tumor suggests sites of deeper invasion.Deeper invasion cues to more lymphonode metastasis.2、Endoscopic diagnosis and pathology of early gastric cancer.Objective: Discuss the diagnosis method of early gastric cancer to reduce its missing diagnosis.Methods: Collected 24 early gastric cancers detected by preoperative endoscopy and comfirmed by post-operation biopsy in our hospital from december 2004 to december 2006,16 are male and 8 female.aged between 30 to 74, average 53.5.Analyzed their endoscopy charactors and clinical pathological data.Result: 17 of the tumor were located in arcus minor ventriculi, 70.8%.8 were submucosa cancer and 16 were intramembrane.Only one lymphonode( 1/28) were metastasis in a totally number of 529 were found. TypeⅠwere found in 2 patients, typeⅡa were found in a patient, typeⅡb were found in 6 patients, typeⅡc were found in 11 patients, typeⅢwere found in 4 patients. 2 patients are well-differentiated adencarcinoma. 8 patients are moderately differentiated adencarcinoma, 13 are poorly differentiated adenocarcinoma. 1 patient is signet-ring cell carcinoma.Conclusion: Early gastric cancer is poor in specific clinical manifestation. The focus of the EGC is in arcus minor ventriculi. And typeⅡc ,mucosa cancer,poorly differentiated adenocarcinoma are mostly in them. Early gastric cancer has a relatively lower lymphonode metastasis rate than advanced gastric cancer.3、The preliminary application of narrow band imaging in diagnosis of upper gastrointestinal cancer and precancerous lesion.Objective: Discuss the value of applying narrow band imaging in diagnosis of upper gastrointestinal cancer and precancerous lesion. To improve accuracy of endoscopy diagnosis.Methods: We performed conventional endoscopy, narrow band imaging(NBI), magnifying endoscopy,and some of them chromoendoscopy or endoscopic ultrasonography to 215 clinical patients of our hospital from October 2006 to January 2007. Following pathology as diagnostic criteria.Result: Magnifying endoscopy can detect intra-epithelial papillary capillary loops of esophagus. The esophagus mucosa looks light blue with NBI. Using magnifying endoscopy with NBI (MENBI) we can clearly observe intraepithelial and deep layer blood vessel of esophagus. We categorized IPCL into 4 types as below: IPCL-TypeI: Commonly in upper esophagus. IPCL-TypeII:Commonly in middle esophagus. IPCL-TypeIII:Commonly in lower esophagus or inflammation lesion. IPCL-TypeIV: commonly in esophageal carcinoma or epithelium dysplasia.There are 4 subtype of this type: IPCL-TypeIV-1: Commonly in dysplasia and m1 cancer. IPCL-TypeIV-2:Commonly in m2 cancer. IPCL-TypeIV-3: Commonly in m3、sm1 cancer. IPCL-TypeIV-4: Commonly in sm2 and below cancer.Lesions in gastral cavity can be esay observed with conventional endoscopy, While it was diffcult with NBI because its brightness was poor if no magnifying .Pit pattern of gastric mucosa can be revealed with magnifying endoscopy(ME) , And it can be displayed more clearly and stereoscopical with MENBI than ME. Observate on normal gastric mucosa with MENBI, regular small-round pit openings patterns in the fundus small oval shape patterns in the corpus, and,Rod or Strip patterns in the antrum. In the central part of mild atrophic areas gastric pits were found to be decreased in quantity , stereoscopical and color;Mucosa with intestinal metaplasia showed round or oval shape pit pattern, lucency around the gastric pits. Mucosa of dysplasia showed different size and shape pits, in which expansion blood vessels were seen. Mucosa of early carcinoma showed: 1. different size and irregular shape in pit pattern, 2. and disappearing with pit pattern , existing twist and irregular tumor vessels;3. the architecture of pit pattern is distorted. and internal of it was thicker diameters.Conclusion Search the lesions of esophagus mucosa with NBI is easier than conventional endoscopy , MENBI may demonstrate the character , extent and invasion depth of the early esophagus cancer. NBI is not fit to search for lesion in stomach. MENBI may evaluate the character and extent of gastric mucosal atrophy , intestinal metaplasia , dysplasia and early gastric cancer.Summary: The study investigated the early upper gastrointestinal carcinoma patients, analyzed their common clinical data, endoscope character and pathology. Discuss endoscopy diagnostic value and clinical pathology character of the early upper gastrointestinal cancer. We also performed narrow band imaging (NBI) system to clinic patients to discuss its value in diagnosis of early upper gastrointestinal cancer and. precancerous lesion. The results were: 1 .Endoscope character of th early esophageal cancer was related closely to invasion depth . Detection of endoscope auxotype can help detect it's invasion depth. Endoscopic ultrasonography has important meaning in diagnosing cancer invasion depth. More serious malignant tumor suggests sites of deeper invasion.Deeper invasion cues to more lymphonode metastasis.2 Early gastric cancer is poor in specific clinical manifestation.They mostly happened in arcus minor ventriculi. And typeⅡc ,mucosa cancer,poorly differentiated adenocarcinoma are mostly in them. Early gastric cancer has a relatively lower lymphonode metastasis rate than advanced gastric cancer.3 Search the lesions of esophagus mucosa with NBI is easier than ordinary endoscopy , MENBI may demonstrate the character , extent and invasion depth of the early esophagus cancer. NBI. It is not fit to search for lesion in stomach with NBI. MENBI may evaluate the character and extent of gastric mucosal atrophy , intestinal metaplasia , dysplasia and early gastric cancer. Title: Endoscopic Diagnosis and Clinical Pathology of Early Upper Gastrointestinal Carcinoma Category: Cancer Letters Filename: Endoscopic Diagnosis and Clinical Pathology of Early Upper Gastrointestinal Carcinoma.pdf Pages: 164 Price: US$50.00 Buy This Paper: Download: Donated for this research subject: FAVORITE: ADD TO FAVORITE Contact: E-Mail:bizdg@126.com TEL:1-888-774-999A How to get this paper's electronic documents? 1, Click the "Buy Now" button to complete the online payment 2, Download the paper's electronic document from the successful payment return page/Or the system will send this paper's electronic document to your E-Mail within 24 hours Version:zh-cn Perhaps You will be interested in these papers
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