title: Depth-predicting score for differentiated early gastric cancer.
abstract: BACKGROUND
  Intramucosal and minute submucosal (M-SM1; < 500 μm in depth) differentiated gastric cancers, which have a negligible risk of lymph node metastasis, are the targets for endoscopic resection. However, there have been few reports about the endoscopic distinction between these cancers and cancers with deeper submucosal invasion (SM2; ≥ 500 μm in depth). The aim of this retrospective study was to analyze the differences in the endoscopic features between M-SM1 and SM2 cancers, and to develop a simple scoring model to predict the depth of these early gastric cancers.
  
  
  METHODS
  We analyzed 853 differentiated early gastric cancers treated endoscopically or surgically as a derivation group. Endoscopic images were reviewed to determine the relationship between depth of invasion and the following endoscopic features: tumor location, macroscopic type, tumor size, and endoscopic findings (remarkable redness, uneven surface, margin elevation, ulceration, and enlarged folds). Secondly, we created a depth-predicting model based on the obtained data and applied the model to 211 validation samples.
  
  
  RESULTS
  On logistic regression analysis, tumor size more than 30 mm, remarkable redness, uneven surface, and margin elevation were significantly associated with deeper submucosal cancers. A depth-predicting score was created by assigning 2 points for margin elevation and tumor size more than 30 mm, and 1 point for each of the other endoscopic features. When validation lesions of 3 points or more were diagnosed as deeper submucosal cancers, the sensitivity, specificity, and accuracy as evaluated by three endoscopists were 29.7-45.9, 93.1-93.7, and 82.5-84.8%, respectively.
  
  
  CONCLUSIONS
  The depth-predicting score could be useful in the decisions on treatment strategy for differentiated M-SM1 early gastric cancers.
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Abe
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.forename: Taichi
authors.initials: T
authors.lastname: Shimazu
authors.forename: Tetsu
authors.initials: T
authors.lastname: Kinjo
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tada
authors.forename: Taku
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Chika
authors.initials: C
authors.lastname: Kusano
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
mesh_terms: D002454:Cell Differentiation; D055088:Early Detection of Cancer; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D009092:Mucous Membrane / Q000473:pathology; D009361:Neoplasm Invasiveness / Q000175:diagnosis*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology*