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[À§¾ÏÀÇ ±íÀÌ. Depth of invasion of gastric cancer (ħÀ± ±íÀÌ. ½É´Þµµ)] - ðû

½É´Þµµ(ä¢Ó¹Óø)´Â ÀϺ»½Ä Ç¥ÇöÀ̹ǷΠ°¡±ÞÀû 'ħÀ± ±íÀÌ'¶ó´Â Ç¥ÇöÀ» »ç¿ëÇϽñ⠹ٶø´Ï´Ù.

1. Á¶±âÀ§¾Ï°ú ÁøÇ༺À§¾ÏÀÇ ±¸ºÐ

2. Á¶±âÀ§¾Ï Áß Á¡¸·¾Ï°ú Á¡¸·ÇϾÏÀÇ ±¸ºÐ

3. Á¡¸·¾Ï°ú Á¡¸·ÇÏ¾Ï ±¸ºÐÀ» À§ÇÑ tip

4. EGC IIa+IIc´Â »ý°¢º¸´Ù ±í½À´Ï´Ù.

5. EGC-like AGC Áõ·Ê ¸ðÀ½

6. º¸¸¸ 1Çü ÁøÇ༺ À§¾Ï°ú EGC type IÀÇ ±¸ºÐ

7. Cases

8. FAQs

9. References


1. Á¶±âÀ§¾Ï°ú ÁøÇ༺À§¾ÏÀÇ ±¸ºÐ

À§¾ÏÀÇ ±íÀÌ¿¡ ´ëÇÑ ³»½Ã°æ Æò°¡ÀÇ Á¤È®¼º¿¡ ´ëÇÑ ³í¹®Àº °´°üÀûÀ̱⠾î·Æ½À´Ï´Ù. °üÂûÀÚ°£ Â÷ÀÌ°¡ Å©±â ¶§¹®ÀÔ´Ï´Ù. ÀϺ»°ú ¿ì¸®³ª¶óÀÇ °á°úµµ Á¦¹ý ´Ù¸¨´Ï´Ù. ¿ì¸®´Â ¿ì¸® ½ÇÁ¤¿¡ ¸Â´Â µ¥ÀÌŸ¸¦ Âü°íÇÏ¿© ȯÀÚÁø·á¿¡ ÀÀ¿ëÇÏ´Â °ÍÀÌ ÁÁÀ» °ÍÀÔ´Ï´Ù. 2011³â ¼­¿ï´ëÇб³º´¿ø¿¡¼­ À§¾Ï ±íÀÌ Æò°¡ÀÇ Á¤È®¼º¿¡ ´ëÇÑ ³í¹®À» ³½ ¹Ù Àִµ¥ ¿ì¸® Çö½ÇÀ» Àß º¸¿©ÁÖ´Â ÁÁÀº Âü°íÀÚ·á¶ó°í »ý°¢ÇÕ´Ï´Ù (ÃÖÁ¤¹Î. GIE 2011).

Á¶±âÀ§¾Ï¿¡¼­ ÁøÇ༺À§¾ÏÀ¸·Î º¯ÇÏ´Â ±â°£Àº ¿¬±¸Çϱ⠾î·Æ½À´Ï´Ù. ÀϺ»ÀÇ ÇÑ ¿¬±¸¿¡¼­´Â 44°³¿ùÀ» Á¦½ÃÇÑ ¹Ù ÀÖ½À´Ï´Ù (Tsukuma H. Stomach Intestine 2008:43:1777-83). °°Àº ¿¬±¸¿¡¼­ 5³â ÈÄ 64.7%, 10³â ÈÄ 95% ÀÌ»óÀÌ ÁøÇ༺À§¾ÏÀ¸·Î ¹ßÀüÇÑ´Ù°í ÇÕ´Ï´Ù.

2010³â »ï¼º¼­¿ïº´¿ø ¿Ü°úÀÇ ºÐ¼®(Shin SH. J Surg Oncol 2010)¿¡ µû¸£¸é, ³»½Ã°æ¿¡¼­ Á¶±âÀ§¾ÏÀ¸·Î ÃßÁ¤ÇÏ¿´´ø 1,611¸í Áß 120¸í(7.4%)ÀÌ ÁøÇ༺À§¾ÏÀ̾ú½À´Ï´Ù. ³»½Ã°æÄ¡·á¸¦ ÇÏ¿´´ø Á¶±âÀ§¾ÏÀÌ Æ÷ÇԵǾú´õ¶ó¸é ¾à°£ ´õ ÁÁ¾ÒÀ» °ÍÀÔ´Ï´Ù. ³»½Ã°æ¿¡¼­ ÁøÇ༺ À§¾ÏÀ¸·Î ÃßÁ¤ÇÏ¿´´ø 1,299¸í Áß 132¸í(10.2%)Àº Á¶±âÀ§¾ÏÀ̾ú½À´Ï´Ù. ÀϹÝÀûÀ¸·Î ³»½Ã°æ¿¡¼­ Á¶±âÀ§¾ÏÀ¸·Î »ý°¢ÇÑ À§¾ÏÀÇ 5%´Â ÁøÇ༺ À§¾Ï, ³»½Ã°æ¿¡¼­ ÁøÇ༺À§¾ÏÀ¸·Î »ý°¢ÇÑ À§¾ÏÀÇ 10%´Â Á¶±âÀ§¾ÏÀ¸·Î »ý°¢Çϱ⠹ٶø´Ï´Ù.

2011³â ¼­¿ï´ëº´¿ø ³í¹® (ÃÖÁ¤¹Î. GIE)¿¡¼­ ³»½Ã°æÀ¸·Î Á¶±âÀ§¾ÏÀ¸·Î ÃßÁ¤µÈ 2,105¸í Áß 2.9%ÀÎ 60¸íÀº ½ÇÁ¦·Î´Â ÁøÇ༺À§¾ÏÀ̾ú½À´Ï´Ù. ÀÌ Á¤µµÀÇ Á¤È®µµ´Â ¸Å¿ì ¿ì¼öÇÑ °ÍÀÔ´Ï´Ù.

2013³â °Ç±¹´ë ³í¹® (Clin Endosc)¿¡¼­ Á¶±âÀ§¾ÏÀ¸·Î ÃßÁ¤µÈ 207¸í Áß 6.8%ÀÎ 14¸íÀº ½ÇÁ¦·Î´Â ÁøÇ༺ À§¾ÏÀ̾ú½À´Ï´Ù. Proximal part¿¡ EGC-like AGC°¡ ¸¹¾Ò½À´Ï´Ù.

AGC-like EGCs predominate in the distal part of the stomach, while EGC-like AGCs predominate in the proximal part. When evaluating the depth of a gastric cancer, care should be taken not to underestimate measurements in proximal gastric cancers since they tend to be poorly-differentiated adenocarcinomas, in Lauren¡¯s diffuse type, and invade deeper than their endoscopic appearance might suggest.

2015³â ÇѾç´ëº´¿ø ³í¹®¿¡¼­ ³»½Ã°æ¿¡¼­ Á¶±âÀ§¾ÏÀ¸·Î ÆÇ´ÜÇÏ¿´´ø 367¸í Áß 40¸í(11 %)ÀÌ ÁøÇ༺À§¾ÏÀ̾ú½À´Ï´Ù (Lee JH. Surg Endosc 2015 - Epub).

PM cancer´Â Á¶±âÀ§¾Ï°ú ÁøÇ༺ À§¾ÏÀÇ Áß°£Àû ¼º°ÝÀ» °¡Áö°í ÀÖ½À´Ï´Ù. Á¦°¡ Àü°øÀÇ ½ÃÀý¿¡ ºÐ¼®ÇÑ ÀڷḦ ±º´ë ±â°£µ¿¾È ÃâÆÇÇÑ ³í¹®ÀÌ PM cancer¿¡ ´ëÇÑ °ÍÀ̾ú½À´Ï´Ù.

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2. Á¶±âÀ§¾Ï Áß Á¡¸·¾Ï°ú Á¡¸·ÇϾÏÀÇ ±¸ºÐ

Á¶±âÀ§¾Ï ±íÀÌ(depth of invasion) Æò°¡ÀÇ Áß¿äÇÑ ¿ä¼Ò Áß Çϳª´Â fold º¯È­ÀÔ´Ï´Ù. Fold´Â À§³»¿¡ °ø±â¸¦ ¾î´À Á¤µµ »°À» ¶§ Àß °üÂûµË´Ï´Ù. °ø±â¸¦ ¾à°£¾¿ ³Ö°í »©¸é¼­ º´¼Ò ÁÖº¯ Á¡¸·ÀÇ º¯È­¸¦ Á¶½É½º·´°Ô °üÂûÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù.

Á¶±âÀ§¾Ï fold¿¡ ´ëÇÑ (°£´ÜÇÏÁö¸¸ ±×¸® Á¤È®ÇÏÁö ¾ÊÀº) ´ë¿øÄ¢Àº ´ÙÀ½°ú °°½À´Ï´Ù. Á¡¸·¾Ï¿¡¼­´Â abrupt cutting, rapid tapering (= rat-tailing, Áã ²¿¸®Ã³·³ »ý°å´Ù´Â ÀǹÌ), Á¡¸·ÇϾϿ¡¼­´Â fusion, clubbingÀÌ, °íÀ¯±Ù¾Ï(PM cancer)¿¡¼­´Â dam-formationÀÌ °üÂûµË´Ï´Ù. Fold º¯È­´Â À§¾Ï ±íÀÌ ¿¹ÃøÀÇ Áß½ÉÀÌÁö¸¸ fold¿¡ µû¸¥ ±íÀÌ Áø´ÜÀÌ ²À ¿ÇÀº °ÍÀº ¾Æ´Õ´Ï´Ù. ±íÀÌ ¿¹ÃøÀº ¿¹¼úÀÔ´Ï´Ù. EGC·Î ÃßÁ¤Çߴµ¥ AGC·Î ³ª¿À´Â °æ¿ì´Â ¾à 5-10%ÀÔ´Ï´Ù. AGC·Î ÃßÁ¤Çߴµ¥ EGC·Î ³ª¿À´Â °æ¿ìµµ ¾à 5-10%ÀÔ´Ï´Ù. (´ëÇѼÒÈ­±â³»½Ã°æÇÐȸÁö 2007;35:297-303)

À̹ø Áõ·Ê´Â (1) ÇÔ¸ôºÎ°¡ ºñ±³Àû ±í°í, (2) fold fusion ¼Ò°ßÀÌ ¿©·µ °üÂûµÇ°í, (3) Á¶Á÷ÇüÀÌ signet ring cell carcinomaÀ̾úÀ¸¹Ç·Î ´«À¸·Î º¸±âº¸´Ù ´Ù¼Ò ±íÀ» ¼ö ÀÖÀ» ¿©Áö°¡ ¸¹¾Ò´ø °æ¿ìÀÔ´Ï´Ù. ºñ·Ï ³»½Ã°æ¿¡¼­ EGC III (r/o submucosal cancer)¶ó´Â impressionÀ» ºÙÀÏ ¼ö ¹Û¿¡ ¾øÁö¸¸... ¾à°£ ±í´Ù°í ³ª¿ÔÁö¸¸ ³î¶ö ÇÊ¿ä´Â ¾øÀ» °Í °°½À´Ï´Ù.

¼­¿ï´ë ³í¹® (ÃÖÁ¤¹Î. GIE)¿¡¼­ Á¡¸·¾ÏÀ¸·Î ÃßÁ¤µÈ 1,276¸í Áß 1,026¸í(82.0%)´Â Á¡¸·¾ÏÀ̾ú°í, Á¡¸·ÇϾÏÀ¸·Î ÃßÁ¤µÈ 829¸í Áß 596¸í (71.9%)´Â Á¡¸·ÇϾÏÀ̾ú½À´Ï´Ù.

¼­¿ï´ë ³í¹®¿¡¼­´Â Á¶±âÀ§¾Ï ħÀ±±íÀÌ ¿¹ÃøÀÇ ±âÁØÀÌ µÇ´Â ¿©·¯ ¼Ò°ßÀÇ Àǹ̰¡ ºÐ¼®µÇ¾î ÀÖ½À´Ï´Ù. ³Ê¹« º¹ÀâÇÏ¿© ±× Àǹ̸¦ Á¤È®±â ¾Ë±â´Â ¾î·Æ½À´Ï´Ù. ±×·¯³ª °£´ÜÈ÷ »ý°¢Çϸé ÀÌ°ÍÀÔ´Ï´Ù. "¾î´À ÇÑ ¼Ò°ßÀ¸·Î Á¡¸·¾Ï°ú Á¡¸·ÇϾÏÀ» ±¸ºÐÇÒ ¼ö ¾ø´Ù."

¼­¿ï´ë ³í¹®¿¡¼­ Á¦°¡ Èï¹Ì·Ó°Ô º» °ÍÀº ´Üº¯·® ºÐ¼®°ú ´Ùº¯·® ºÐ¼®ÀÇ Â÷ÀÌÀÔ´Ï´Ù. ¾Æ·¡ Ç¥¿¡¼­ ÁÂÃøÀÌ ´Üº¯·® ºÐ¼®ÀÌ°í ¿ìÃøÀÌ ´Ùº¯·® ºÐ¼®ÀÔ´Ï´Ù. ´Üº¯·® ºÐ¼®¿¡¼­ undifferentiate-type histology´Â differentiated-type histology¿¡ ºñÇÏ¿© ħÀ±±íÀÌ ¿¹Ãø Á¤È®µµ°¡ ¶³¾îÁý´Ï´Ù (OR=0.804, p=0.046). ´Ùº¯·® ºÐ¼®¿¡¼­´Â p °ª 0.889 (OR=0983)·Î Â÷ÀÌ°¡ ¾ø¾ú½À´Ï´Ù. ¹«¾ù¶§¹®¿¡ ´Üº¯·®¿¡¼­ÀÇ Àǹ̰¡ ´Ùº¯·®¿¡¼­´Â »ç¶óÁ³´ÂÁö Àú·Î¼­´Â ¾Ë µµ¸®°¡ ¾ø½À´Ï´Ù.


3. Á¡¸·¾Ï°ú Á¡¸·ÇÏ¾Ï ±¸ºÐÀ» À§ÇÑ tip

Clin Endosc 2015³â 6¿ùÈ£¿¡ ½Ç¸° Ãæ³²´ë ¹®Èñ¼® ±³¼öÀÇ Á¾¼³(Improving the Endoscopic Detection Rate...)¿¡¼­ Èï¹Ì·Î¿î »çÁøÀ» ¿Å±é´Ï´Ù (À§¾Ï 294).

¹®±³¼ö´ÔÀº ÀÌ·¸°Ô ¾²¼Ì½À´Ï´Ù. "Remarkable elevation of the tumor is seen with a converging fold. This findings fulfill the criteria for massive submucosal invasion by tumor." ÀÏÀü¿¡ differentiated-type EGCÀÇ depth-predicting score¸¦ ¼Ò°³ÇÑ ¹Ù ÀÖ½À´Ï´Ù (Abe. Gastric Cancer 2011). ÀÌ ³í¹®ÀÇ °á·ÐÀº ¾Æ·¡¿Í °°¾Ò½À´Ï´Ù.

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.

ÀϺ» ÀúÀÚ°¡ ¸»ÇÑ margin elevation°ú ¹®Èñ¼® ±³¼ö´ÔÀÇ ¸»¾¸Àº ¾à°£ ´Ù¸£±â´Â ÇÕ´Ï´Ù. ¿©ÇÏÆ° ÇÔ¸ôÇü º´¼Ò¿¡¼­ °ø±â¸¦ ¾à°£ »©°í °üÂûÇÏ¿´À» ¶§ ÀüüÀûÀ¸·Î À¶±âµÈ º´¼Ò´Â massive submucosal invasionÀ» ½Ã»çÇÏ´Â ¼Ò°ßÀÔ´Ï´Ù. ´ëÀå¾Ï¿¡¼­´Â ÀÌ·¯ÇÑ Æ¯Â¡ÀÌ º¸´Ù ÇöÀúÈ÷ °üÂûµË´Ï´Ù.


Á¡¸·ÇϾÏÀ¸·Î ÃßÁ¤Çߴµ¥ ÀÇ¿Ü·Î Á¡¸·¾ÏÀÌ ³ª¿Ô½À´Ï´Ù. ½É´Þµµ´Â ¾î·Æ½À´Ï´Ù.


Stomach, Subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at mid body and posterior wall
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : mixed
5. Size : 3.8x2.4 cm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 1.5 cm, distal 11.7 cm
8. Lymph node metastasis : no metastasis in 22 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1a N0


Á¶Á÷°Ë»ç¿¡¼­ poorly differentiated·Î ³ª¿À´Â °æ¿ì´Â À°¾È¼Ò°ßº¸´Ù ´Ù¼Ò ±íÀº °æ¿ì°¡ ¸¹½À´Ï´Ù. ¿ì¸®°¡ ħÀ± ±íÀ̸¦ ³íÇÏ´Â °ÍÀº ºÐÈ­ Á¶Á÷Çü À§¾Ï¿¡ ÇØ´çÇÑ´Ù°í ÀÌÇØÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.


Stomach, radical subtotal gastrectomy: Advanced gastric carcinoma
1. Location : middle third, Center at body and anterior wall
2. Gross type : Borrmann type 2
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.5x2.2 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma, safety margin: proximal 3.4 cm, distal 7.0 cm
8. Lymph node metastasis : no metastasis in 32 regional lymph nodes (pN0) (0/32: "1", 0/1; "3", 0/11; "4", 0/4; "5", 0/0; "6", 0/5; "7", 0/5; "9", 0/0; "8a", 0/1; "11p", 0/3; "12a", 0/2; "4sb", 0/0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT2 N0
ñÉ: EGC-like AGC·Î ºÎ¸£´Â °ÍÀÌ Å¸´çÇÑ Áõ·ÊÀÔ´Ï´Ù.


ÀÌ °æ¿ì´Â Á¶Á÷°Ë»ç¿¡¼­ moderatele differentiated·Î ³ª¿Ô´Âµ¥ º´¼ÒÀÇ °æ°è°¡ ¸Å¿ì ¸ðÈ£ÇÏ¿´Áö¸¸ ¿©ÇÏÆ° »ó´çÈ÷ ³ÐÀº °ÍÀ¸·Î ÃßÁ¤ÇÏ¿´½À´Ï´Ù. ¼ö¼ú ÈÄ º´¸®°ú¿¡¼­µµ Å©±â¸¦ ´Ù¼Ò ¾Ö¸ÅÇÏ°Ô ½á Áּ̽À´Ï´Ù.^^ ½É´Þµµ´Â SM3¿´°í ¸²ÇÁÀý ÀüÀÌ´Â ¾ø¾ú½À´Ï´Ù.


Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at antrum and circle
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : encircling x 6.0 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 5.0 cm, distal 1.0 cm
8. Lymph node metastasis : no metastasis in 29 regional lymph nodes (pN0) (0/29 : "3,5", 0/9; "4,6", 0/8; "1", 0/1; "5", 0/1; "6", 0/4; "7", 0/2; "9", 0/1; "8a", 0/0; "11p", 0/2; "12a", 0/1; "4sb", 0/0)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 8th edition: pT1b N0
ñÉ: ù ³»½Ã°æ °Ë»ç´Â ±¸Çü Pentax ³»½Ã°æÀ̾ú°í ÀÇ·Ú ÈÄ Àç°ËÀº Olympus 260H ¿´½À´Ï´Ù. Àΰ£ À§ÀÇ Á¤»ó »ö±òÀº ¹«¾ùÀϱî¿ä? ù ³»½Ã°æÀÇ »öÁ¶¿Í µÎ¹ø° ³»½Ã°æÀÇ »öÁ¶ Áß°£ ¾îµð°¡ °¡Àå ÀÚ¿¬½º·¯¿î ³»½Ã°æ »çÁø ¾Æ´Ò±î »ý°¢µÇ¾ú½À´Ï´Ù. Pentax´Â toneÀÌ ³·Àº °æÇâÀÌ ÀÖ¾î °Ë»ç°¡ Â÷ºÐÇÏ°Ô ÁøÇàµÇÁö¸¸ ¼±¸íÇÏÁö ¾Ê´Ù°í ÀÌ´À³¢½Ã´Â ºÐµéÀÌ ¸¹½À´Ï´Ù. Olympus´Â toneÀÌ ³ô¾Æ °Ë»çÀÚ¸¦ ÈïºÐ½ÃÅ°Áö¸¸ ¼±¸íÇÏ°Ô º¸ÀÎ´Ù°í ´À³¢½Ã´Â ºÐµéÀÌ ¸¹½À´Ï´Ù. »ç½Ç »öÁ¶´Â ¼±¸íµµ¿Í´Â ¾Æ¹« »ó°üÀÌ ¾øÁö¸¸ ´À³¦ÀÌ ±×·¸´Ù´Â °ÍÀÔ´Ï´Ù. °°Àº ¸ðµ¨ÀÌ¶óµµ »öÁ¶°¡ Á¶±Ý¾¿ ´Ù¸£°í, ¿À·¡ »ç¿ëÇÏ¸é »öÁ¶°¡ ´Ù¼Ò ³·¾ÆÁöÁö¸¸... ÀüüÀûÀÎ Áø´ÜÀ²¿¡´Â º°´Ù´Â ¿µÇâÀ» ÁÖÁö ¾Ê´Â °Í °°½À´Ï´Ù. ÃëÇâ°ú ½À°ü Á¤µµÀÏ °Í °°½À´Ï´Ù.


4. EGC IIa+IIc´Â »ý°¢º¸´Ù ±í½À´Ï´Ù.

IIa+IIc Çü Á¶±âÀ§¾ÏÀº ±íÀÌ°¡ Á¡¸·ÇÏÃþÀÎ °æ¿ì°¡ ¸¹½À´Ï´Ù. ±×·¯³ª ¸ðµÎ ´Ù ±×·± °Íµµ ¾Æ´Ï±â ¶§¹®¿¡ óÀ½ºÎÅÍ ¼ö¼úÀ» ±ÇÇϱ⵵ ¾î·Æ½À´Ï´Ù. EUS¸¦ Çصµ º° µµ¿òÀÌ ¾È µÇ°í......

ESD ÈÄ ¼ö¼ú
Early gastric carcinoma
1. Location : proximal antrum, postero-greater curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 16 mm (2) vertical diameter, 14 mm
6. Depth of invasion : invades submucosa, (depth of sm invasion : 650 §­) (pT1b)
7. Resection margin : free from carcinoma(N), safety margin : distal 11 mm, proximal 12 mm, anterior 10 mm, posterior 12 mm, deep 200§­ (sm only)
8. Lymphatic invasion : present (++)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent


ESD ÈÄ ¼ö¼ú
Stomach, endoscopic submucosal dissection:
Early gastric carcinoma
1. Location : angle, lesser curvature
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, well differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 16 mm (2) vertical diameter, 10 mm
6. Depth of invasion : invades submucosa, (depth of sm invasion : 1700 §­) (pT1b)
7. Resection margin : involved deep resection margin by carcinoma, safety margin : distal 13 mm, proximal 13 mm, anterior 8 mm, posterior 18 mm, deep 0 mm (sm only)
8. Lymphatic invasion : present (++)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent


óÀ½ºÎÅÍ ¼ö¼ú
Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at body and lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 1.5x1.3 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 2.8 cm, distal 8.3 cm
8. Lymph node metastasis : no metastasis in 20 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1b N0


ÀüÁ¤ºÎ ¼Ò¸¸ mid-antrum transverse fold¿¡ À§¾ÏÀÌ ³õ¿©ÀÖÀ¸¸é ½É´Þµµ ¿¹ÃøÀÌ Á¦¹ý ¾î·Æ½À´Ï´Ù. IIc¶ó°í ÇØ¾ß ÇÒÁö IIa+IIc¶ó°í ºÒ·¯¾ß ÇÒÁöµµ ¾Ö¸ÅÇÕ´Ï´Ù. Àú´Â ÁÖº¯ À¶±âºÎ°¡ Á¶±Ý ÇöÀúÇÏ´Ù°í º¸°í IIa+IIc¿¡ ÁØÇÏ¿© ÆÇ´ÜÇÏ¿´½À´Ï´Ù. º´¸®°ú¿¡¼­´Â IIc·Î º¸¾Ò½À´Ï´Ù. ³»½Ã°æ Ä¡·á Çϱâ´Â ½¬¿î À§Ä¡À̹ǷΠÁ¶±Ý Àû±ØÀûÀ¸·Î ½ÃµµÇØ º¸±âµµ Çϴµ¥, ÀÌ È¯ÀÚ¿¡¼­´Â ÇÔ¸ôºÎÀ§°¡ ¶Ñ·ÇÇÏ°í tumor island±îÁö ÀÖ´Â °ÍÀÌ ¿µ ¸¶À½¿¡ °É·Á ¹Ù·Î ¼ö¼úÀ» º¸³Â½À´Ï´Ù. SM3·Î ³ª¿Ô½À´Ï´Ù. ÈÞ~~~


5. EGC-like AGC Áõ·Ê ¸ðÀ½


À§Ã¼»óºÎ Èĺ®ÀÇ ÀÛÀº depressed lesionÀÌ ¹ß°ßµÇ¾ú°í ³»½Ã°æÀÇ´Â ´ç¿¬È÷ EGC·Î »ý°¢ÇÏ¿´Áö¸¸ º´¸®°á°ú°¡ ÀÇ¿Ü·Î ¾Æ·¡¿Í °°ÀÌ ³ª¿Ô½À´Ï´Ù.

Advanced gastric carcinoma
- Gross type : Borrmann type (unclassifiable) (mimicking EGC type IIc)
- Histologic type : tubular adenocarcinoma, poorly differentiated
- Size : 3.2x2.1x0.2 cm
- Depth of invasion : extension to proper muscle (pT2a)

´Ù½Ã ºÁµµ ¿ª½Ã EGC¶ó°í ºÎ¸¦ ¼ö ¹Û¿¡ ¾ø´Â º´¼Ò¿´½À´Ï´Ù. ¾Æ¹«¸® ÁÖÀÇÇصµ EGC¿Í AGC¸¦ ³ª´©´Â Á¤È®µµ´Â 80-90%ÀüÈÄÀÔ´Ï´Ù. ¹°·Ð ¾ÆÁÖ definiteÇÑ EGC°¡ ÀÖ°í ¹Ý¹ÚÇÒ ¼ö ¾ø´Â AGCµµ ÀÖ½À´Ï´Ù. ±×·¯³ª ¸¹Àº °æ¿ì ¿ì¸®ÀÇ ¿¹»óÀÌ Æ²¸³´Ï´Ù. ±×´ÙÁö ³î¶ö ÀÏÀº ¾Æ´Õ´Ï´Ù.

ÀÌ È¯ÀÚ¿¡¼­ Èï¹Ì·Î¿î °ÍÀº º´¸®°ú¿¡¼­ Barrett esophagus°¡ ÀÖ´Ù°í ¿¬¶ôÀ» ÇØ ÁØ Á¡ÀÔ´Ï´Ù. »çÁøÀ» reviewÇغ¸´Ï ultrashort segment Barrett esophagus°¡ ÀÖ´Ù°í ¸»ÇÒ ¼ö ÀÖ´Â ±×·± ¸ð¾çÀ̾ú½À´Ï´Ù. ±×·±µ¥ °õ°õÈ÷ »ý°¢Çغ¾½Ã´Ù. ÀÌ Á¤µµÀÇ ¹Ì¼¼ÇÑ º¯È­´Â ³Ê¹«³ª ¸¹Áö ¾Ê½À´Ï±î? ¿À´Ã ³»½Ã°æÇÑ È¯ÀÚ Áß¿¡µµ ÀÌ·± ºñ½ÁÇÑ ¸ð¾çÀ» º¸ÀÎ »ç¶÷ÀÌ ¿©·¯ºÐ ÀÖ¾ú´ø °Í °°Áö ¾Ê½À´Ï±î? ÀÌ È¯ÀÚÀÇ °æ¿ì¿¡´Â À§¾ÏÀ¸·Î ÀÎÇÏ¿© ¼ö¼úÀ» ÇÏ¿´±â ¶§¹®¿¡ ÇϺνĵµÀÇ Á¶Á÷ÀÇ ¾çÀÌ ¸¹¾Æ¼­ BarrettÀ̶ó°í º´¸®ÇÐÀû Áø´ÜÀ» ÇÒ ¼ö ÀÖ¾ú´ø ¿¹ÀÔ´Ï´Ù. ±×·¯³ª forcep biopsy·Î´Â ¾î¸² ¾øÁö¿ä. ´ëºÎºÐ Áø´ÜµÇÁö ¾Ê½À´Ï´Ù. Ȥ½Ã ÀÌ·± ªÀº ¹Ù·¿½Äµµ(Àú´Â ultra ultra ultra-short Barrett esophagus¶ó°í ºÎ¸¨´Ï´Ù)°¡ ÀÖ´Â °æ¿ì ÀÓ»óÀû ÀÇÀÇ´Â ¾ó¸¶³ª µÉ±î¿ä? ¿ª½Ã 1 cmÀÌÇÏÀÇ ¸Å¿ì ªÀº ESEM (endoscopically suspected esophageal metaplasia)´Â ¿ì¼± ¹«½ÃÇÏ´Â °ÍÀÌ Çö½ÇÀûÀÏ °Í °°½À´Ï´Ù. 1 cmÀÌÇÏÀÇ ESEM¿¡ °ü½ÉÀ» °¡Áö´À´Ï Â÷¶ó¸® Á¶±âÀ§¾ÏÀ» ã±â À§ÇÏ¿© À§¸¦ Á» ´õ ¸é¹ÐÈ÷ °üÂûÇÒ °ÍÀ» ±ÇÇÏ°í ½Í½À´Ï´Ù.



Stomach, subtotal gastrectomy:
Advanced gastric carcinoma
1. Location : lower third, Center at body and greater curvature
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 3.7x1.4 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma, safety margin: proximal 2.3 cm, distal 9.4 cm
8. Lymph node metastasis : metastasis to 1 out of 37 regional lymph nodes (pN1), (perinodal extension: present) (1/37: "3", 1/11; "4", 0/11; "5", 0/0; "6", 0/0; "7", 0/4; "9", 0/0; "8a", 0/3; "11p", 0/2; "12a", 0/5; "4sb", 0/0; "1", 0/1)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. AJCC stage by 7th edition: pT2 N1

À̹ø Áõ·Ê´Â (1) ÇÔ¸ôºÎ°¡ ºñ±³Àû ±í°í, (2) fold fusion ¼Ò°ßÀÌ ¿©·µ °üÂûµÇ°í, (3) Á¶Á÷ÇüÀÌ signet ring cell carcinomaÀ̾úÀ¸¹Ç·Î ´«À¸·Î º¸±âº¸´Ù ´Ù¼Ò ±íÀ» ¼ö ÀÖÀ» ¿©Áö°¡ ¸¹¾Ò´ø °æ¿ìÀÔ´Ï´Ù. ºñ·Ï ³»½Ã°æ¿¡¼­ EGC III (r/o submucosal cancer)¶ó´Â impressionÀ» ºÙÀÏ ¼ö ¹Û¿¡ ¾øÁö¸¸... ¾à°£ ±í´Ù°í ³ª¿ÔÁö¸¸ ³î¶ö ÇÊ¿ä´Â ¾øÀ» °Í °°½À´Ï´Ù.



Stomach, subtotal gastrectomy:
Advanced gastric carcinoma
1. Location : middle third, Center at body and greater curvature
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.5x2.5 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: proximal 3 cm, distal 11 cm
8. Lymph node metastasis : no metastasis in 70 regional lymph nodes (pN0), (0/70 : "3", 0/31; "4", 0/17; "5", 0/3; "6", 0/5; "7", 0/3; "9", 0/5; "8a", 0/4; "11p", 0/2; "12a", 0/0; "4sb", 0/0; "1", 0/0)
9. Lymphatic invasion : present (+++)
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT3 N0



Stomach, subtotal gastrectomy:
Advanced gastric carcinoma
1. Location : middle third, Center at body and greater curvature
2. Gross type : Borrmann type 2
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.6x2.2 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma, safety margin: proximal 3.8 cm, distal 13.5 cm
8. Lymph node metastasis : no metastasis in 47 regional lymph nodes (pN0) (0/47: "3", 0/14; "4", 0/6; "5", 0/1; "6", 0/9; "7", 0/2; "9", 0/0; "8a", 0/2; "11p", 0/1; "12a", 0/2; "4sb", 0/10; "1", 0/0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT2 N0



1. Location : middle third, center at body and posterior wall
2. Gross type : mimicking EGC type IIc
3. Histologic type : tubular adenocarcinoma, poorly differentiated
4. Histologic type by Lauren : diffuse
5. Size : 5x4x0.5 cm
6. Depth of invasion : extension to subserosa
7. Resection margin: free from carcinoma: safety margin
8. Lymph node metastasis : metastasis to 2 out of 35 regional lymph nodes (pN1)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified



1. Location : middle third, center at body and lesser curvature
2. Gross type : Borrmann type (mimicking EGC type IIc+III)
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 9.5x5.3x0.4 cm
6. Depth of invasion : extension to proper muscle (pT2a)
7. Resection margin: free from carcinoma: safety margin
8. Lymph node metastasis : metastasis to 9 out of 62 regional lymph nodes
9. Lymphatic invasion : present
10.Venous invasion : not identified
11.Perineural invasion : not identified
12.Associated findings : ulceration(ul IV)



Advanced gastric carcinoma
1. Location : lower third, Center at angle and lesser curvature
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.4x2.2 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 31 regional lymph nodes (pN0)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified


Stomach, subtotal gastrectomy: Advanced gastric carcinoma
1. Location : middle third, Center at body and greater curvature
2. Gross type : Borrmann type 2
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 3.6x2.7 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 44 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT2 N0

EGC ¾Æ´Ñ°¡ »ý°¢Çߴµ¥ AGC¿´°í multiple lymph node ÀüÀÌ¿Í bilateral ovary metastasis±îÁö ÀÖ¾ú½À´Ï´Ù.

(2012³â, 50¼¼ ¿©¼º)

Stomach, radical subtotal gastrectomy: Advanced gastric carcinoma
1. Location : middle third, Center at angle and posterior wall
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated >> mucinous adenocarcinoma (mucinous carcinoma portion: 20%)
4. Histologic type by Lauren : mixed
5. Size : 3.3x3.0 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: proximal 3.3 cm, distal 3.8 cm
8. Lymph node metastasis : metastasis to 6 out of 32 regional lymph nodes (pN2) (perinodal extension: present) (6/32: "1", 0/2; "3", 2/2; "4", 2/9; "5", 0/0; "6", 2/5; "7", 0/4; "9", 0/6; "8a", 0/3; "11p", 0/1; "12a", 0/0; "4sb", 0/0)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT3 N2

Ovary and salpinx, bilateral salpingo-oophorectomy : METASTATIC CARCINOMA, clinically from stomach
Location: Bilateral ovaries
Greatest dimension: 5.5 cm (left)
Lymphovascular invasion: PRESENT (focal)
Salpingeal extension: Absent (lymphovascular invasion only; left salpinx)


Á¶Á÷°Ë»ç M/D. ESD ¾ÆÁÖ Àá±ñ °í·ÁÇÏ¿´´Ù°¡ 2cm°¡ ³Ñ°í °æ°è°¡ ºÒºÐ¸íÇÏ¿© ¼ö¼úÀ» º¸³Â´Âµ¥...
Stomach, radical total gastrectomy: Advanced gastric carcinoma
1. Location : upper third, Center at high body and lesser curvature
2. Gross type : Borrmann type unclassifiable (mimicking EGC type IIc)
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 5.1x3.1 cm
6. Depth of invasion : invades serosa (pT4a)
7. Resection margin: free from carcinoma, safety margin: proximal 0.3 cm, distal 16.2 cm
8. Lymph node metastasis : no metastasis in 42 regional lymph nodes (pN0) (0/42: "1", 0/2; "2", 0/3; "5", 0/0; "6", 0/3; "7", 0/5; "9", 0/2; "8a", 0/2; "11p", 0/1; "12a", 0/1; "4sb", 0/0; "8p", 0/1; "lymph node", 0/1; 3,5, 0/9; 4,6, 0/12)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : present
12. AJCC stage by 8th edition: pT4a N0


Á¶Á÷°Ë»ç P/D

W/D³ª M/D¿Í °°Àº ºÐÈ­Á¶Á÷Çü À§¾Ï¿¡¼­´Â ³»½Ã°æ À°¾È¼Ò°ß°ú depth of invasionÀÇ correlationÀÌ ºñ±³Àû ÁÁ½À´Ï´Ù. ±×·¯³ª, P/D³ª SRC°ú °°Àº ¹ÌºÐÈ­Á¶Á÷Çü À§¾Ï¿¡¼­´Â º¸±âº¸´Ù ±íÀº °æ¿ì°¡ ¸¹½À´Ï´Ù.


Stomach, radical total gastrectomy: Advanced gastric carcinoma
1. Location : upper third, Center at body and posterior wall
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 3.7x2.8 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: p 2.7 cm, d 11.7 cm
8. Lymph node metastasis : metastasis to 3 out of 38 regional lymph nodes (pN2) (perinodal extension: present) (3/38: "2", 0/0; "3", 3/10; "4", 0/9; "5", 0/0; "6", 0/4; "7", 0/2; "9", 0/2; "8a", 0/5; "11p", 0/0; "12a", 0/2; "4sb", 0/0; "1", 0/4)
9. Lymphatic invasion : present(+++)
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT3 N2

More cases


6. º¸¸¸ 1Çü ÁøÇ༺ À§¾Ï°ú EGC type IÀÇ ±¸ºÐ

º¸¸¸ 1Çü ÁøÇ༺ À§¾Ï°ú EGC type IÀÇ ±¸ºÐÀº ½±Áö ¾Ê½À´Ï´Ù. °¡Å縯ÀÇ´ë ±èÅÂÈ£ ¼±»ý´ÔÀÇ ³»½Ã°æÇÐȸ ±³À°ÀÚ·á¿¡¼­´Â ¾Æ·¡¿Í °°Àº ¾ð±ÞÀÌ ÀÖ½À´Ï´Ù.

Borrmann type I ÇüÀÇ ÁøÇ༺À§¾Ï°ú EGCa I ÇüÀÇ Á¶±âÀ§¾ÏÀ» ³»½Ã°æ ¼Ò°ß¸¸À¸·Î ¸íÈ®È÷ °¨º°ÇÒ ¼ö´Â ¾øÀ¸³ª, µÐ´öÀ̳ª bridging fold ¿Í °°ÀÌ ÁÖº¯ Á¡¸·ÀÇ º¯È­, °âÀÚ·Î ¾Ð¹ÚÇßÀ» ¶§ ¹Ð¸®Áö ¾Ê´Â ¼Ò°ßÀº Á¡¸·ÇÏÃþ ÀÌ»óÀÇ Ä§À±ÀÌ ÀÖÀ½À» ½Ã»çÇÏ´Â ¼Ò°ßÀÌ´Ù.

º¸¸¸ 1Çü ÁøÇ༺À§¾ÏÀÌ Ä¿Áö¸é¼­ Áß¾Ó¿¡ ÇÔ¸ôºÎ°¡ ¹ß»ýÇÏ¿© º¸¸¸ 2ÇüÀÌ µÇ´Â °æ¿ìµµ ÀÖÀ» °ÍÀÔ´Ï´Ù. °æ¿ì¿¡ µû¶ó¼­´Â ³»½Ã°æÀÇ»ç´Â º¸¸¸ 1ÇüÀ¸·Î, º´¸®ÀÇ»ç´Â º¸¸¸ 2ÇüÀ¸·Î ¼­·Î ´Ù¸£°Ô ºÐ·ùÇϱ⵵ ÇÕ´Ï´Ù.

Áõ·Ê »çÁø(EndoTODAY À§¾Ï 481)À» º¸¸é ¾Æ½Ã°ÚÁö¸¸.... ¾ö¹ÐÇÑ ÀǹÌÀÇ º¸¸¸ 1Çü ÁøÇ༺ À§¾ÏÀº ÈçÇÏÁö ¾Ê½À´Ï´Ù. ³»½Ã°æ¿¡¼­ º¸¸¸ 1Çü ÁøÇ༺ À§¾ÏÀ¸·Î ÃßÁ¤ÇÏ¿´¾îµµ ¸·»ó SM cancer·Î ³ª¿À´Â °æ¿ìµµ ÀûÁö ¾Ê¾Ò½À´Ï´Ù. ±×·¯¸é... 'ȯÀÚ¿¡°Ô´Â ´ÙÇེ·¯¿î ÀÏÀ̱º' Á¤µµ »ý°¢ÇÏ°í ³Ñ¾î°¥ ¼ö ¹Û¿¡ ¾øÀ» °Í °°½À´Ï´Ù. ¿äÄÁµ¥ ´©±¸³ª Ʋ¸± ¼ö ¹Û¿¡ ¾øÀ» °Í °°À¸´Ï ³Ê¹« ½Å°æ¾²Áö ¾ÊÀ¸¼Åµµ ÁÁÀ» °Í °°½À´Ï´Ù.


[Cases]

ÃʽÉÀÚ´Â ÀÌ º´¼Ò¸¦ AGC¶ó°í ºÒ·¶½À´Ï´Ù. ÀüÇüÀûÀÎ EGCÀε¥...
STG: Early gastric carcinoma
1. Location : lower third, Center at antrum and lesser curvature
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 2.8x1.5 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma. safety margin: proximal 12 cm, distal 1.7 cm
8. Lymph node metastasis : no metastasis in 16 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1a N0


[FAQs]

[2015-1-29. ¾Öµ¶ÀÚ Áú¹®]

¾È³çÇϼ¼¿ä, ±³¼ö´Ô. ÃÖ±Ù À§¾Ï Áõ·Ê¿¡¼­ EGC-mimicking AGC, AGC-mimicking EGC µî¿¡ ´ëÇÑ endotoday¸¦ ¹Þ¾Æº¸¸é¼­ ÃÖ±Ù ³»½Ã°æÀû EGC/AGC ±¸ºÐÇÏ´Â ¹æ¹ýÀÌ ¹»±î ¶ÇÇÑ, Àß ±¸ºÐÇÏ·Á¸é ¾î¶»°Ô ÇØ¾ß Çϳª »ý°¢ÀÌ µé¾ú½À´Ï´Ù. ¿Ü·¡¿¡¼­ ¿ÜºÎ º´¿ø ³»½Ã°æ »çÁøÀ» º¸°í AGC·Î ¼³¸íÇߴµ¥, º»¿ø¿¡¼­ ´Ù½Ã ³»½Ã°æÀ» Çß´õ´Ï ´©°¡ ºÁµµ EGC ¿´´ø case¸¦ °æÇèÇÏ¿´½À´Ï´Ù.

¼ÒÈ­±â³»½Ã°æ¾ÆƲ¶ó½º¿¡ ÀûÇô ÀÖ´Â 2910¸íÀÇ ºÐ¼®°ú 91.3%ÀÇ ±¸ºÐ¿¡ ´ëÇؼ­ ³í¹®À» ã¾Æº¸´Ï ¹Ý°©°Ôµµ »ï¼ºº´¿ø¿Ü°ú¿¡¼­ ½èÁö¸¸, ¼±»ý´Ô²²¼­ ÇÔ²² Âü¿©Çß´ø ³í¹®ÀÌ ÀÖ¾ú½À´Ï´Ù. (J Sur Onc, 2010;101:384-388) 2001~2003³â±îÁöÀÇ 2910¸íÀÇ ´ë±Ô¸ð ºÐ¼®À¸·Î ÁÁÀº ±âÁØ(À§Ä¡, Å©±â, ºÐÈ­µµ, Lauren's type, ly+, v+, perineural invasion)À» ¾Ë·ÁÁÖ¼ÌÁö¸¸ ÀÚ¼¼È÷ Àо´Ï, method¿¡¼­ EGC Áø´Ü°ú AGC Áø´Ü¿¡ Â÷À̸¦ µÎ¾ú½À´Ï´Ù.

EGC : ¹Ù·ý ¶Ç´Â ³»½Ã°æ»ó EGC
AGC : ¹Ù·ý°ú ³»½Ã°æ¿¡¼­ ¸ðµÎ AGC

ÀÌ·¸°Ô Â÷À̸¦ µÖ¼­, ½ÇÀº ³»½Ã°æ Àü¹®ÀǸ¦ ÁöÇâÇÏ´Â ÀÔÀå¿¡¼­ barium studyÀÇ ¿µÇâ·ÂÀ» ±¸ºÐÇÏ°í ½Í¾îÁ³½À´Ï´Ù. ÇÏÁö¸¸ ³í¹®»ó¿¡ ³»½Ã°æ¸¸À¸·Î ±¸ºÐÇÏ´Â ÀÔÀåÀ» º¸ÀÌ´Â ¿¬±¸´Â °ÅÀÇ ¾ø°í, ¿äÁòÀº NBI, EUS µîÀÇ ÃֽŠ±â¹ý¿¡ ´ëÇÑ ³í¹®¸¸ °Ë»öµÇ¾ú½À´Ï´Ù. ´Ù½Ã µ¹ÀÌÄѼ­, Ȥ½Ã 2910¸í Áß, ³»½Ã°æ¸¸ ½ÃÇàÇÑ group¿¡¼­ÀÇ Â÷ÀÌ´Â ¾î¶»°Ô ³ª¿Ô´ÂÁö ±Ã±ÝÇؼ­ ±³¼ö´Ô²² ÀÌ·¸°Ô ¸ÞÀÏÀ» º¸³À´Ï´Ù. ¾Æ´Ï¸é ÀÌ·± °ü·ÃµÈ ³í¹®À» ¼ÒÀåÇÏ½Ã°í °è½Å´Ù¸é ¾Ë·ÁÁÖ½Ã¸é °¨»çÇÏ°Ú½À´Ï´Ù.


[References]

1) [2013-4-17 ´ëÇѼÒÈ­±â³»½Ã°æÇÐȸ ±³À°ÀÚ·á] À§¾ÏÀÇ ³»½Ã°æ Áø´Ü ºÐ·ù ü°è

2) Survey on endoscopic classification of EGC (EndoTODAY 2013-5-23)

3) À§¾Ïº´¸® °¡À̵å¶óÀÎ (2023) - ¿ì¸®¸» version

4) AJCC 8th Çؼ³ (±è¼ºÀº)

5) AJCC 8th PPT ÀÎÅÍ³Ý ÀÚ·á

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.