title: Correlation of lifting versus non-lifting and microscopic depth of invasion in early colorectal cancer.
abstract: BACKGROUND
  The non-lifting sign is considered a contraindication to endoscopic resection. Our objective was to investigate whether lifting or nonlifting of a lesion is determined by the volume of normal submucosal tissue.
  
  
  METHODS
  We measured the thickness of the submucosa and examined the relation between submucosal invasion and lesion elevation induced by submucosal injection in 60 patients with colorectal cancer with evidence of submucosal invasion. Extent of tumor elevation was classified into two groups: A, lifting; B, non-lifting. Submucosal invasion was classified as sm1, sm2, or sm3. The distance between the carcinoma and the line of resection and that between the carcinoma and the muscularis propria were measured.
  
  
  RESULTS
  Of 31 sm1 lesions, 29 (93.5%) were group A. All 6 sm3 lesions were group B. All lesions in group A had a value for the distance between carcinoma and muscularis propria of more than 1000 microm. Group B lesions with sm3 invasion had distances of only 105 to 750 microm.
  
  
  CONCLUSIONS
  Lesions classified as sm3 do not elevate in response to submucosal injection, and lesions that become elevated on injection can be resected endoscopically because they are sm1 or sm2 and have a thickness of normal submucosa of more than 1000 microm.
authors.affiliation: First Department of Internal Medicine, Hirosaki University School of Medicine, Zaifu-Cho, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Ishiguro
authors.forename: Y
authors.initials: Y
authors.lastname: Uno
authors.forename: Y
authors.initials: Y
authors.lastname: Ishiguro
authors.forename: A
authors.initials: A
authors.lastname: Munakata
authors.forename: T
authors.initials: T
authors.lastname: Morita
mesh_terms: D018256:Adenomatous Polyps / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D001707:Biopsy, Needle; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D010340:Pathology, Surgical / Q000379:methods; D012016:Reference Values; D012680:Sensitivity and Specificity; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D012965:Sodium Chloride