The acetic acid + indigocarmine method in the delineation of gastric cancer.
OBJECTIVE
For the purpose of precise preoperative diagnosis that ensures complete endoscopic resection, it is important to accurately determine the lateral spread of gastric cancer lesions. The acetic acid + indigocarmine (AI) method used by us has been found to meet this need. This paper reports its usefulness in the determination of lateral spread of gastric cancer before endoscopic submucosal dissection (ESD).


METHODS
The present study was conducted in 114 patients who were operated on for an early-stage gastric cancer, after determining the lateral spread of cancerous lesions by the AI method, between September 2005 and December 2006. The negative lateral stump reaction rate obtained in ESD was conducted in areas delineated by the AI method. The borderline clarification rate obtained by the AI method and the indigocarmine (I) method were compared between the lesions with and without clear borders under observation with the naked eye.


RESULTS
The lateral stump after ESD conducted using the AI method was histologically negative in 111 of the 114 patients (97%). The lesion spread was clarified by the AI method in 103 patients (90%): 55 (95%) and 48 (86%) patients with and without clear macroscopic lesion borders, respectively. Compared to the I method, the AI method clarified the lesion spread in a significantly higher percentage of patients with macroscopically unclear lesion borders (P = 0.015).


CONCLUSIONS
The present study stresses that the AI method should be used to conduct ESD more safely and accurately in patients with well or moderately differentiated adenocarcinoma.
Department of Gastroenterology, Toranomon Hospital, Toranomon, Tokyo, Japan. t-iizuka@toranomon.gr.jp
Toshiro
T
Iizuka
Daisuke
D
Kikuchi
Syu
S
Hoteya
Naohisa
N
Yahagi
D019342:Acetic Acid; D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002454:Cell Differentiation; D004396:Coloring Agents; D004210:Dissection; D019160:Endosonography; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011300:Preoperative Care; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
D004396:Coloring Agents; D007203:Indigo Carmine; D019342:Acetic Acid