title: Factors predictive of inaccurate determination of horizontal extent of intestinal-type early gastric cancers during endoscopic submucosal dissection: a retrospective analysis.
abstract: BACKGROUND
  Certain tumor characteristics may pose challenges when endoscopically determining the horizontal extent of early gastric cancers (EGC). In the present study, clinicopathological features related to inaccurate endoscopic evaluation of horizontal extent of intestinal-type EGC were analyzed.
  
  
  METHODS
  We analyzed 431 lesions with intestinal-type EGC treated by endoscopic submucosal dissection (ESD) at our hospital. We focused on whether pretreatment demarcation was accurate by comparing positional relationships between marking dots and tumor edges in resected specimens, and factors related to inaccurate evaluation were analyzed. Gender, age, tumor size, location, circumference, depth, ulceration, macroscopic type, presence of a flat (0-IIb) component, predominant histological type, mixture of diffuse-type adenocarcinoma, mixed histology, and use of magnification endoscopy with narrow band imaging were analyzed. Reasons for inaccurate evaluation were also investigated by re-examining endoscopic images and prepared histological slides.
  
  
  RESULTS
  Rate of inaccurate evaluation of horizontal extent was 7.4% (32/431 lesions). Multivariate analysis revealed the following significant independent variables contributing to inaccurate endoscopic evaluation: presence of a flat component, large size, and predominant histological findings of moderately differentiated adenocarcinoma. Re-examination of prepared histological slides of inaccurately evaluated cases revealed a marginal flat spreading area in 28 of the 32 lesions (87.5%). In 14 of the 32 lesions (43.8%), tumor margins were composed of moderately differentiated adenocarcinoma.
  
  
  CONCLUSIONS
  For lesions with a flat component, large lesions, and moderately differentiated adenocarcinoma, determination of the horizontal extent can be challenging in EGC indicated for ESD, even with the best available endoscopic tools.
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Itsuko
authors.initials: I
authors.lastname: Asada-Hirayama
authors.forename: Shinya
authors.initials: S
authors.lastname: Kodashima
authors.forename: Osamu
authors.initials: O
authors.lastname: Goto
authors.forename: Nobutake
authors.initials: N
authors.lastname: Yamamichi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.forename: Keiko
authors.initials: K
authors.lastname: Niimi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mochizuki
authors.forename: Maki
authors.initials: M
authors.lastname: Konno-Shimizu
authors.forename: Rie
authors.initials: R
authors.lastname: Mikami-Matsuda
authors.forename: Chihiro
authors.initials: C
authors.lastname: Minatsuki
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Matsusaka
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ushiku
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D002454:Cell Differentiation; D003951:Diagnostic Errors; D004210:Dissection / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D018365:Neoplasm, Residual / Q000473:pathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: early gastric cancer (EGC); endoscopic submucosal dissection (ESD); horizontal extent; inaccurate demarcation; marking dots