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Accuracy of endoscopic size measurements of early gastric signet ring cell carcinoma

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Abstract

Background and aims

Indications for endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) are expanding, but signet ring cell carcinoma (SRC) is still unclear because of its unclear boundaries. The purpose of this study was to compare pathologic size and endoscopic size in SRC-type EGC and to find risk factors associated with tumor size underestimation.

Methods

Medical records of 137 patients diagnosed with SRC-type EGC between January 2009 and December 2016 at our tertiary hospital were reviewed. According to pathologic and endoscopic tumor sizes, they were classified into correct estimation, underestimation, and overestimation groups, and risk factors related to underestimation were analyzed.

Results

Among 137 patients with SRC-type EGC, 77 patients (56.2%) had undergone correct estimation, 43 patients (31.4%) had undergone underestimation, and 17 patients (12.4%) had undergone overestimation. Mean pathologic size (SD) was 20.1 (13.8) mm and mean endoscopic size (SD) was 17.9 (10.1) mm, the correlation coefficients were 0.919 (p < 0.001) , and there was no significant difference between the two groups. Multivariate analysis showed that tumor size more than 20 mm (OR 3.419; 95% CI 1.271–9.194; p = 0.015) and atrophy (OR 6.011; 95% CI 2.311–15.633; p = 0.001) were risk factors for tumor size underestimation.

Conclusion

There was no significant difference in pathologic and endoscopic size in SRC-type EGC. Therefore, ESD may be considered as a therapeutic option if the size of the tumor is less than 20 mm and atrophy is not present in the surrounding mucosa.

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Authors and Affiliations

  1. Department of Internal Medicine, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea

    Ju Seok Kim, Sun Hyung Kang, Hee Seok Moon, Eaum Seok Lee, Seok Hyun Kim, Jae Kyu Sung, Byung Seok Lee & Hyun Yong Jeong

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  1. Ju Seok Kim
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Correspondence to Sun Hyung Kang.

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Disclosures

JS Kim, SH Kang, HS Moon, ES Lee, SH Kim, JK Sung, BS Lee and HY Jeong have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was approved by the Institutional Review Board of Chungnam National University Hospital (2017-01-004).

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Kim, J.S., Kang, S.H., Moon, H.S. et al. Accuracy of endoscopic size measurements of early gastric signet ring cell carcinoma. Surg Endosc 35, 2324–2331 (2021). https://doi.org/10.1007/s00464-020-07646-w

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  • DOI: https://doi.org/10.1007/s00464-020-07646-w

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