title: Lymph node metastasis from intestinal-type early gastric cancer: experience in a single institution and reassessment of the extended criteria for endoscopic submucosal dissection.
abstract: BACKGROUND
  Given the increasing use of endoscopic resection as a therapeutic modality for cases of early gastric cancer (EGC), it is very important to define strict criteria for the use of endoscopic mucosal resection and endoscopic submucosal dissection. To date, the criteria are almost entirely based on Japanese literature evaluating the risk of lymph node (LN) metastasis in patients with EGC.
  
  
  OBJECTIVE
  To analyze our own experience with the factors affecting LN metastasis and to reappraise the extended criteria for endoscopic submucosal dissection.
  
  
  METHODS
  Retrospective, single-center study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  This study involved 478 patients who underwent gastrectomy with LN dissection (n = 270, mucosal [m] EGC; n = 208, submucosal [sm] EGC).
  
  
  METHODS
  Gastrectomy with LN dissection.
  
  
  METHODS
  LN metastasis.
  
  
  RESULTS
  Overall, 12.6% (60/478) of patients with EGCs presented with LN metastasis (mEGC, 3.0% [8/270], smEGC, 25.0% [52/208]). Increased size, macroscopic type (elevated), depth of invasion, and lymphovascular invasion were associated with LN metastasis. In 270 cases of mEGC, there was no relationship between clinicopathologic features and LN metastasis. In the smEGC group, size, depth of invasion, and lymphovascular emboli were associated with an increased risk of LN metastasis. Significantly, LN metastasis was noted in EGCs falling within established extended endoscopic submucosal dissection criteria, that is, intestinal-type mucosal cancer of any size without ulcer and no lymphovascular emboli (2/146 [1.4%]) or < or =3 cm with no lymphovascular emboli and irrespective of the presence of ulceration (2/126 [1.6%]) or intestinal-type submucosal cancer (sm1, <500 microm) without lymphovascular invasion and measuring < or =3 cm in size (3/20 [15.0%]).
  
  
  CONCLUSIONS
  Retrospective review of a single-center study.
  
  
  CONCLUSIONS
  We recommend that more centers survey their experiences of LN metastasis in cases of EGC to refine the criteria for endoscopic submucosal dissection as a therapeutic modality of intestinal-type EGC.
authors.affiliation: Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Seo-Gu, Busan, Korea.
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Kang
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kim
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Jeon
authors.forename: Soo-Han
authors.initials: SH
authors.lastname: Lee
authors.forename: Nari
authors.initials: N
authors.lastname: Shin
authors.forename: Sue-Hye
authors.initials: SH
authors.lastname: Chae
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.forename: Geum Am
authors.initials: GA
authors.lastname: Song
authors.forename: Dong-Heon
authors.initials: DH
authors.lastname: Kim
authors.forename: Amitabh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Do Youn
authors.initials: DY
authors.lastname: Park
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000231:Adenocarcinoma, Papillary / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018279:Carcinoma, Signet Ring Cell / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D004210:Dissection / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*