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[ ð з. Classification of early gastric cancers] -

1. In vivo, real time, endoscopic classification

2. Big picture.

3. Simple is useful. ܼ ϴ.

4. IIa + IIc or IIc +IIa issue

5. Folds

6. Folds for EGC classification. ð Ⱥз fold  ݿ ΰ?

7.

8. ܱ ð ȿ ª

9. з survey (2012)

10. References


1. In vivo, real time, endoscopic classification

з 'Ϻ Ͽȸ з'Դϴ. 50⵵ зԴϴ (1962 Ϻȭ⳻ðȸ, 1963 ϺϿȸ). ֱ ǵ Բ Paris classification äõǾ ǥ ǥԴϴ. 'Ϻ Ͽȸ з' Ͽ ã ϴ. ڼ ( Ϻ 𸣱 ã ϰ ִ ֽϴ). ׳ 뿡 밭 зϰ ִ Դϴ. '밭'̶ ʽÿ. ô մϴ.

ϰ ִ з ð Ұ߿ gross classificationԴϴ. Ȥ з ϱ⵵ ϴµ, ̴ Դϴ. ð ȼҰ real time з Դϴ. In vivo, real time, endoscopic classification ܰ ġ ħ ū ϱ Դϴ.

ðз о߿ Ϻ ޾Ƶ ȲԴϴ. 2003 ǥǰ 2005 Paris з ٷ װԴϴ (Endoscopy 2005;37:570-8). ġ ô մϴ. Ϻ̳ 츮 ð 忡 Ǵ з͵ ణ ٸϴ. 밭 ص ϴ.

PPT PDF 0.4 M

Paris з ̷ο ī


2. Big picture.

ð з ð ٶ Ұ Դϴ. Ȯ볻ð, NBI, ҳð  ̴ ̼ ȭ зϴ ƴմϴ. ϰ ٶ Ư¡ ֽϴ.

̷ Ҹ Ѹ Ͽ ڼ ϸ ð з ϴ. Ҿ, Ȯ, ׳ Խ ߰ зϴ ٰ մϴ. ƴ ϰų ESD ġ ϴ ҳ Ȯ밡 մϴ. ׷ з ƴմϴ.


3. Simple is useful. ܼ ϴ.

ڼ ƴմϴ. ֱ Դϴ. ġ ̳ » ܼ з ϴ. elevated flat or depressed ѷ մϴ.

ġ ڼ ϸ mixed typeó Դϴ. ſ ܵ IIc ű ̿Ͽ ڼ ϸ ణ ԸǾų κ ֱ Դϴ. ̸ ݿϸ ׻ IIa + IIc + IIb ۿ ϴ.

з 밭 5 group ڴ Դϴ. ̿ ش ʴ mixed type ˴ϴ. IIa + IIc ´ ӻ Ư¡ ֽϴ. ׷ IIc + III + IIa + IIb ӻ Ư¡ ϱ?

̷ ұ? ӻ 뼺 ִ ϱ?

ܰ Ͽ (Ȯ볻ð, ҳð, NBI ) ڼ ϰ ϴ. ׷ з ܼϰ մϴ. ð з ϴ 밭 зϰ δ ڽϴ. mixed type зǴ ʸ ̴ ǿ̶ մϴ.


4. IIa + IIc or IIc +IIa issue

в Ʒ ð з  Ͻʴϱ?

IIa + IIc Ȥ IIc +IIa ׸ ܼ ʽϴ. IIc ޵ κ Ը ̰ ֺ ϱ ϴ. ׷ Paris з(Powerpoint PDF, 0.4 M) IIa + IIc Ը ϴ. Depressed relatively depressed̴. ׸ ֽϴ. ׷ٰ ̸ ݿϿ зü踦 ʰ ֽϴ. з ܼϰ ϰ ʿϸ ̸ DZ Դϴ.

Paris з(Powerpoint PDF, 0.4 M) Ʒ depressed relatively depressed Ͽϴ. ð濡 Ȯ ?

Depressed relatively depressed  򰥸 Axon absolutely depressed relatively depressed ̸ ణ Ͽϴ. 󸶳 ϴ.


5. Fold

Fold ƽϴ. Fold ⸦ ˴ϴ. ⸦ ణ ְ 鼭 ֺ ȭ ɽ ϴ ϴ.

Fold ִ ָ 츦  ϴ ޴ 찡 ϴ. ̷ϴ. Ǵε ̴ fold ǹ̸ οϴ ڽϴ. Indigo carmine Ҹ Ѹ ϰ Ǵ ͵ ϴ ڽϱ? ð ܿ Ģ ҳ Ȯ Ǵ fold ֱ ҳ Ȯ Ǵ fold Ͽ , з, ðġ Ǵ ϴ ٶմϴ.

fold ( ħ) ˾ ƹ鼭 ٰ ϴ. ׷ Ͽ Ҷ ϴ desmoplastic reaction Ͽ fold ֽϴٴ. fold Ģ ϴ. Ͽ abrupt cutting, rapid tapering (= rat-tailing, ó ٴ ǹ), ϾϿ fusion, clubbing, پ(PM cancer) dam-formation ˴ϴ. Fold ȭ ɴ޵ ߽ fold ɴ޵ ƴ϶ մϴ. ɴ޵ ̱ Դϴ.

Ʒ (Ѽȭ⳻ðȸ 2007;35:297-303) Ͻñ ٶϴ.

ȭ ϰ ̺ȭ fold Ұ ̰ ִٰ մϴ.


[2013-4-27. ֵ ǰ. K ]

"ɴ޵ " ־ ߿ ߿ ϳ ġ մϴ. Antrum ִ II M > SM invasion ɼ , cardia ִ II SM > M invasion ɼ ϴ. 츮 ˰ ִ " Ұ߿ ɴ޵ " ο ִ Ͽ ַ Ǹ, Ӿ ü (Ư ) ܰ ɴ޵ ؾ Ѵٴ Դϴ.


6. Folds for EGC classification. ð Ⱥз fold  ݿ ΰ?

з fold κп consensus ϴ. Clubbing̳ fusion fold elevation DZ Դϴ. ̸ ״ ݿϸ Ը κ Բ Ǵ ۿ . EGC IIc+IIa ߵǴ Դϴ. Fold Ͽ ȭ̸, fold ü ϼ ͵ ƴϸ, fold 絵 ⸦ ְ Ϳ , Ⱥз fold κ ʴ ٰ մϴ.

Ը ҿ fold ׳ EGC IIc зսô.

Fold ׳ EGC IIc з ϰ ͽϴ.


7.

ð ˻翡 ˾ , ߿ 缺 ˾ Ǽ ˾ Դϴ. Ǽ˾ ָ ˾ ٴڿ ų abrupt cutting (=interruption), rat-tailing (=rapid tapering), clubbing, fusion, dam-formation Դϴ.

Ǽ˾ ٸ Ұ edge margin ִµ, ˾纯 ѷ , ֺ ұĢ , κ , overriding, ұ ҽ Դϴ. Ǽ ˾ ٴ ұĢ ź ̴ 쵵 ֽϴ. ˾系 tumor island ߿ ҰԴϴ.

tumor island

缺 ˾ ٴ smoothϸ ˾ 谡 Ȯϰ ޵ Ǽ ûϴ Ұ ϴ. 缺 ˾ ָ ˾ ٴڿ ְ ˾ ū 쿡 DZ⵵ մϴ.

point ұϰ δ 缺 ˾ Ǽ˾ Ϻϰ ϱ ƽϴ. ˻ follow-up. Ȯ մϴ.


8. ܱ ð ȿ ª

PDF 0.8 M


9. з survey (2012)

ð 22п 18 ðз ̸ Ͽϴ. ð ڽ ð з Ͻʽÿ. ׸ 츮 ٸ  Ͽ ñ ٶϴ. ֽϴ.

IIc: 16, Mixed: 5 (IIc+IIb ), IIb: 1

I: 15, Mixed: 7 (I+IIa)

IIc: 10, Mixed : 9 (III+IIc ), III: 3

IIa: 16, Mixed: 2 (IIa + IIc), I: 4

I: 16, Mixed: 2 (I+IIa), IIa: 4

Mixed: 18 (IIa+IIc ), IIa : 4

IIb: 19, IIc: 2, IIa: 1

Mixed: 13(IIc + IIa), IIc: 8, III: 1

IIb: 15, Mixed: 4 (IIc+ IIb ), IIc: 3

IIa: 9, IIb: 8, Mixed: 3 (IIb + I or II a), IIc : 2

IIc: 17, Mixed: 3 (II c + IIa or IIb), IIb: 1, IIa: 1

III: 18, Mixed: 4 (IIa + III)

I: 22

III: 11, Mixed: 9 (IIc + III), IIc: 2

IIa: 12, I: 8, Mixed: 2 (III + IIc)

III: 17, Mixed: 2 (III + IIa), IIc: 2, ȿ: 1

Mixed: 12 (IIa + IIc), IIa: 7, IIc: 2, ȿ: 1

Mixed: 11 (IIc + III), IIc: 7, III: 3, ȿ: 1


[References]

1) EndoTODAY atlas

2) [2013-4-17 Ѽȭ⳻ðȸ ڷ] ð з ü

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