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[Negative biopsy after referral for biopsy-proven gastric cancer. ¾ÏÀ¸·Î ÀǷڵǾúÀ¸³ª Á¶Á÷°Ë»ç À½¼ºÀÎ °æ¿ì (¼ÒÀ§ invisible cancer)] - ðû

¾Ï Àǽɺ´¼Ò Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀº °æ¿ì¿Í Á¶Á÷°Ë»ç¿¡¼­ Çѹø ¾ÏÀ¸·Î ³ª¿Ô´Âµ¥ Àç°Ë¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê´Â °æ¿ì (¼ÒÀ§ invisible cancer)´Â ÀüÇô ´Ù¸¥ »óȲÀÔ´Ï´Ù. º» ÆäÀÌÁö¿¡¼­´Â ù¹ø° °æ¿ì¸¦ ´Ù·ì´Ï´Ù.

1. Introductory case

2. ³í¹®À¸·Î ¹ßÇ¥ÇÑ early personal experience - Gut Liver 2016

3. ȯÀÚ¿¡°Ô ¾î¶»°Ô ¼³¸íÇÒ °ÍÀΰ¡?

4. ESD¸¦ À§ÇØ ÀÇ·ÚµÈ È¯ÀÚ¿¡¼­ Àç°ËÀ» ÇÒ °ÍÀΰ¡?

5. FAQ

6. References


1. Introductory case

ÀÇ·Ú ÈÄ Ã¹ °Ë»ç¿¡¼­ ¾ÏÀÌ È®ÀεÇÁö ¾Ê¾ÒÀ¸³ª Àç°Ë¿¡¼­ È®ÀεǾú°í Ä¡·á ÈÄ ÃÖÁ¾ÀûÀ¸·Î´Â 2.1 cm Á¡¸·¾ÏÀ̾ú½À´Ï´Ù.

ÀÌó·³ ¿ÜºÎ¿¡¼­ ¾ÏÀÌ ³ª¿Í ÀǷڵǾú´Âµ¥ Àç°Ë¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀ¸¸é ȯÀÚ³ª ÀÇ»ç ¸ðµÎ ³­°¨ÇØÁý´Ï´Ù. Ä¡·á¹æħÀ» Á¤Çϱ⠾î·Æ±â ¶§¹®ÀÔ´Ï´Ù. Á¦°¡ ³»½Ã°æÀ» ¹è¿ï ¶§¿¡´Â Çѹø ¾ÏÀÌ ³ª¿À°í Àç°Ë¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀº °æ¿ì ¼ö¼úÀ» ±ÇÇÏ´Â ¿¹°¡ ¸¹¾Ò½À´Ï´Ù. ±×·±µ¥ ¿äÁòÀº Àç°ËÀ» ÅëÇÏ¿© È®ÀÎÇÑ ÈÄ Ä¡·á¹æ¹ýÀ» ´Ù½Ã °í¹ÎÇÏ´Â °ÍÀÌ º¸ÅëÀÔ´Ï´Ù. ÀÛ°í ±Ë¾çÇüÀÌ ¾Æ´Ï°í °æ°è°¡ ¸íÈ®ÇÏ´Ù¸é Áø´Ü ¹× Ä¡·á¸¦ À§ÇÑ ESD¸¦ ½ÃÇàÇÒ ¼öµµ ÀÖ½À´Ï´Ù. ±×·¸Áö ¾Ê´Ù¸é Áï½Ã Àç°ËÀ» ÇÏ°í, ±×·¡µµ ¾È ³ª¿À¸é short-term ÃßÀû°üÂûÀ» ÇØ¾ß ÇÕ´Ï´Ù.

¾à°£ ´Ù¸¥ À̾߱âÁö¸¸, ¿À·¡ Àü µ¶ÀÏ ³í¹®¿¡¼­´Â random biopsy¿¡¼­ ³ª¿Â invisible gastric carcinoma¿¡ ´ëÇÑ photodynamic therapy¸¦ ÇÏ¿´´Ù´Â Èï¹Ì·Î¿î À̾߱Ⱑ ÀÖ¾ú½À´Ï´Ù. ¾îµòÁö ¸ð¸£´Âµ¥ ¾î¶»°Ô local therapy¸¦ Àû¿ëÇÑ´Ù´Â ¸»ÀÎÁö ÀÌÇØÇϱâ´Â ¾î·Æ½À´Ï´Ù.


2. ³í¹®À¸·Î ¹ßÇ¥ÇÑ early personal experience

ÀÌ ÁÖÁ¦(negative biopsy after referral for biopsy-proven gastric cancer)¿¡ °ü·ÃµÈ ¹®ÇåÀº °ÅÀÇ ¾ø½À´Ï´Ù. ¾ÏÀε¥ Á¶Á÷°Ë»ç Àç°Ë¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀ¸¸é ½Ç¼ö·Î »ý°¢ÇÏ°í °¨Ã߱⠱ޱÞÇÏ´Ï ³í¹®À¸·Î ³ª¿Ã ¼ö ¾ø´Â °ÍÀÌ°ÚÁö¿ä. ¾Æ¸¶ Á¦°¡ ¹ßÇ¥ÇÑ ÀÚ·á(Tae CH. Gut Liver 2016)°¡ °ÅÀÇ À¯ÀÏÇÑ referenceÀÏ °ÍÀÔ´Ï´Ù.

³í¹® ÀÛ¼º °úÁ¤¿¡¼­ »ó´çÇÑ ¾î·Á¿òÀÌ ÀÖ¾ú½À´Ï´Ù. ¸î¸î Àú³Î¿¡ Åõ°íÇßÀ¸³ª ´ëºÎºÐ reject µÇ¾ú±â ¶§¹®ÀÔ´Ï´Ù. ±Ý¹æ reject µÇ´õ±º¿ä. "³ÊÈñ°¡ °Ë»ç¸¦ ¸øÇؼ­ ±×·± °ÍÀÌ´Ù" ÅõÀÇ comment°¡ ¾²ÀÎ reject letter¸¦ ¹ÞÀ¸´Ï ¸¶À½ÀÌ ÆíÄ¡ ¾Ê¾Ò½À´Ï´Ù. Thomas KuhnÀÌ '°úÇÐÇõ¸íÀÇ ±¸Á¶(The Structure of Scientific Revolutions)'¿¡¼­ ¼³¸íÇÑ ¹Ù·Î ±× Æó¼â¼ºÀ» ´À²¼½À´Ï´Ù. Normal science¿¡¼­ ¹þ¾î³­ °á°ú´Â ÀÏ´Ü ¹«½ÃÇÏ´Â °ÍÀÌ ÇаèÀÇ ±âº» ¼ºÇâÀÎ ¸ð¾çÀÔ´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿À´Â °ÍÀÌ normalÀÌ´Ï negative biopsy´Â abnormalÀÌ´Ù... ¹¹ ÀÌ·± °ÍÀÔ´Ï´Ù.

¹°·Ð ÀÎÁ¤ÇÕ´Ï´Ù. À§¾ÏÀÇ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ È®ÀεǸé Á¤»óÀÌ°í, ¾ÏÀÌ È®ÀεÇÁö ¾ÊÀ¸¸é ºñÁ¤»óÀÔ´Ï´Ù. ±×·±µ¥ ´Ã ±×·± °Íµµ ¾Æ´Õ´Ï´Ù. ¿ì¸® ¸ðµÎ °æÇèÀ¸·Î ¾Ë°í ÀÖ½À´Ï´Ù. Fellow ½ÃÀý¿¡ ±³¼ö´ÔÀÇ À§¾Ï ȯÀÚ¸¦ °Ë»çÇÏ¿© Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀ¸¸é ¹«Ã´ °ï¶õÇÑ ÀÏÀÌ ¹ú¾îÁý´Ï´Ù. ¾Æ¸¶ ºÒ·Á°¡¼­ È¥³­ ºÐµµ °è½Ç °ÍÀÔ´Ï´Ù. ºÒÆíÇÑ ÀüÈ­¸¦ ¹ÞÀº ºÐµµ °è½Ç °ÍÀÔ´Ï´Ù. ±×·± °æÇèÀº ¸ðµÎ ºñÁ¤»óÀϱî¿ä? Àú¸¸ À¯³­È÷ ¸ø³­ °ÍÀϱî¿ä? ±³¼ö°¡ Á÷Á¢ °Ë»çÇϸé Ç×»ó ¾ÏÀÌ ³ª¿Ã±î¿ä? °¨Ãß°í ½ÍÀº ºÒÆíÇÑ Áø½ÇÀº ¹«¾ùÀϱî¿ä?

Negative biopsy after referral for biopsy-proven gastric cancer (Gut Liver 2016 - PDF)

BACKGROUND/AIMS: Repeat endoscopy with biopsy is often performed in patients with previously diagnosed gastric cancer to determine further treatment plans. However, biopsy results may differ from the original pathologic report. We reviewed patients who had a negative biopsy after referral for gastric cancer.

METHODS: A total of 116 patients with negative biopsy results after referral for biopsy-proven gastric cancer were enrolled. Outside pathology slides were reviewed. Images of the first and second endoscopic examinations were reviewed. We reviewed the clinical history from referral to the final treatment.

RESULTS: Eighty-eight patients (76%) arrived with information about the lesion from the referring physician. Among 96 patients with available outside slides, the rate of interobserver variation was 24%. Endoscopy was repeated at our institution; 85 patients (73%) were found to have definite lesions, whereas 31 patients (27%) had indeterminate lesions. In the group with definite lesions, 71% of the lesions were depressed in shape. The most common cause of a negative biopsy was mistargeting. In the group with indeterminate lesions, 94% had insufficient information. All patients with adequate follow-up were successfully treated based on the findings in the follow-up endoscopy.

CONCLUSIONS: A negative biopsy after referral for biopsy-proven gastric cancer is mainly caused by mistargeting and insufficient information during the referral.


ÀÚ¼¼ÇÑ ³»¿ëÀº ³í¹®À» Àо½Ã±â ¹Ù¶ø´Ï´Ù. Á¦°¡ °­Á¶ÇÏ°í ½ÍÀº °ÍÀº ÀÌ°ÍÀÔ´Ï´Ù. "¸î ¹ø °Ë»çÇÏ´Ùº¸¸é ´ëºÎºÐ ¾ðÁ¨°¡´Â ¾ÏÀ¸·Î ³ª¿ÀÁö¸¸ ÀüºÎ°¡ ´Ù ¾ÏÀ¸·Î ³ª¿À´Â °ÍÀº ¾Æ´Ï´Ù."

³ª»Û °á°ú´Â µü ÇѸíÀ̾ú½À´Ï´Ù. ÀÇ»çÀÇ ±ÇÀ¯¸¦ µû¸£Áö ¾Ê¾Ò´ø ºÐÀÔ´Ï´Ù. ÃßÀû ³»½Ã°æÀ» ¹ÞÁö ¾Ê°í Áö³»´Ù°¡ 5³â ¸¸¿¡ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ¸·Î Áø´ÜµÇ¾ú½À´Ï´Ù. ÀÇ»çÀÇ ±ÇÀ¯¿¡ µû¶ó ÃßÀû°Ë»ç¸¦ ¹Þ´ø ȯÀÚ Áß ¾ÈŸ±î¿î °á°ú·Î ³¡³­ ȯÀÚ´Â ¾ø¾ú½À´Ï´Ù. ÃßÀû°üÂûÀÇ ÈûÀº ´ë´ÜÇÕ´Ï´Ù.

ÀÓ»ó°­»ç, Àü°øÀÇ ¿©·¯ºÐ. Ȥ½Ã ±³¼ö´Ô ȯÀÚÀÇ Á¶Á÷°Ë»ç¿¡¼­ À§¾ÏÀÌ ³ª¿ÀÁö ¾Ê´õ¶óµµ ³Ê¹« ½Ç¸ÁÇÏÁö ¸¶½Ê½Ã¿À. ³²µéµµ ±×·± °æÇèÀ» ¸¹ÀÌ °¡Áö°í ÀÖ½À´Ï´Ù. ´Ù¸¸ °¨Ãß°í ÀÖÀ» »ÓÀÔ´Ï´Ù. 'ȯÀÚ-ÀÇ»ç °ü°è'°¡ ÁÁÀ¸¸é ¸ðµÎ ÁÁÀº °á°ú°¡ ³ª¿É´Ï´Ù. ÀûÀýÇÑ ÃßÀû°üÂûÀÌ Áß¿äÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù.


3. ȯÀÚ¿¡°Ô ¾î¶»°Ô ¼³¸íÇÒ °ÍÀΰ¡

Çö½ÇÀûÀ¸·Î Àú´Â ¾Æ·¡¿Í °°ÀÌ ¼³¸íÇÏ°í ÀÖ½À´Ï´Ù (Âü°í: ÀÌÁØÇà ¿Ü·¡ ¼³¸í¼­, accessed: 2020-3-15)

[ÀÇ·Ú ÈÄ Ã¹ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ È®ÀεÇÁö ¾ÊÀº °æ¿ì]

º´ÀÌ ÀÛÀ¸¸é ȯÀÚ¿¡°Ô´Â ÁÁÀº ÀÏÀÌÁö¸¸ ÀÇ·áÁø¿¡°Ô´Â ±î´Ù·Î¿î ¸éÀÌ ÀÖ½À´Ï´Ù. Áø´Ü°ú Ä¡·á°á°ú Çؼ®ÀÌ ½±Áö ¾Ê±â ¶§¹®ÀÔ´Ï´Ù. º´ÀÌ Å©¸é Áø´Ü°ú Ä¡·á ¿øÄ¢ÀÌ ¸íÈ®ÇØÁöÁö¸¸ ȯÀÚ¿¡°Ô´Â ³ª»Û ÀÏÀÔ´Ï´Ù. ÀÛÀº À§¾ÏÀº ¹ß°ßÇϱ⠾î·Æ½À´Ï´Ù. Á¶Á÷°Ë»ç ÈÄ¿¡´Â ¸ð¾çÀÌ ´Þ¶óÁö¹Ç·Î ´õ¿í ¾î·Æ½À´Ï´Ù. ù Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀ¸·Î È®ÀεǾúÀ¸³ª Àç°Ë¿¡¼­ È®ÀεÇÁö ¾Ê¾ÒÀ» ¶§¿¡´Â ÀÏ´Ü Àç°ËÇغ¸´Â ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ±×·¡µµ È®ÀεÇÁö ¾ÊÀ¸¸é »ó´çÇÑ °í¹ÎÀÌ ÇÊ¿äÇÕ´Ï´Ù.

ÀÏ´Ü ³»½Ã°æ Àç°ËÀ» ±ÇÇÕ´Ï´Ù.


[µÎ¹ø°¿¡¼­µµ ¾È ³ª¿ÔÀ» ¶§]

º´ÀÌ ÀÛÀ¸¸é ȯÀÚ¿¡°Ô´Â ÁÁÀº ÀÏÀÌÁö¸¸ ÀÇ·áÁø¿¡°Ô´Â ±î´Ù·Î¿î ¸éÀÌ ÀÖ½À´Ï´Ù. Áø´Ü°ú Ä¡·á°á°ú Çؼ®ÀÌ ½±Áö ¾Ê±â ¶§¹®ÀÔ´Ï´Ù. º´ÀÌ Å©¸é Áø´Ü°ú Ä¡·á ¿øÄ¢ÀÌ ¸íÈ®ÇØÁöÁö¸¸ ȯÀÚ¿¡°Ô´Â ³ª»Û ÀÏÀÔ´Ï´Ù. ÀÛÀº À§¾ÏÀº ¹ß°ßÇϱ⠾î·Æ½À´Ï´Ù. Á¶Á÷°Ë»ç ÈÄ¿¡´Â ¸ð¾çÀÌ ´Þ¶óÁö¹Ç·Î ´õ¿í ¾î·Æ½À´Ï´Ù. ù Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀ¸·Î È®ÀεǾúÀ¸³ª ¹Ýº¹µÈ Àç°Ë¿¡¼­ È®ÀεÇÁö ¾Ê¾ÒÀ» ¶§ ¾î¶»°Ô ÇÏ´Â °ÍÀÌ ÃÖ¼±ÀÏÁö Àü¹®°¡µé »çÀÌ¿¡¼­µµ ÀÇ°ßÀÌ ºÐºÐÇÕ´Ï´Ù.

¿©·¯ Àǻ翡°Ô ¹°¾îº¸¸é ¸ðµÎ ´Ù¸¥ ÀÇ°ßÀ» °¡Áö°í ÀÖ½À´Ï´Ù. º´ÀÌ ³Ê¹« À۾Ƽ­ ¹ß»ýÇÏ´Â ¹®Á¦ÀÎ °æ¿ì°¡ ¸¹Áö¸¸, ±Ë¾çÇü À§¾ÏÀÇ °æ¿ì ¼¼Æ÷°¡ Å»¶ôµÇ¾î ÀÌ·¯ÇÑ ÀÏÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. µå¹°°Ô º´ÀÌ Á¡¸·ÇÏ·Î ÀÚ¶ó´Â ŸÀÔÀ̱⠶§¹®¿¡ Á¶Á÷°Ë»ç¿¡¼­ ¾È ³ª¿À´Â ¼öµµ ÀÖ½À´Ï´Ù. ȯÀÚºÐÀÇ ´ä´äÇÑ ¸¶À½Àº Àß ÀÌÇØÇÒ ¼ö ÀÖ½À´Ï´Ù¸¸, ±â°è°¡ ¾Æ´Ñ Àΰ£ÀÇ ¸öÀ» ´ë»óÀ¸·Î ÇÏ´Â ÀÇÇп¡´Â ÀÌ·± ºÎºÐÀÌ ¸¹½À´Ï´Ù. µÎ °¡Áö ¹æ¹ýÀÌ ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù.

(1) ¿ì¼± ¿ÜºÎ °á°ú¸¦ ¹Ï°í Áö±Ý ´çÀå ¼ö¼úÇÏ´Â °ÍÀÔ´Ï´Ù. ÀÌ·¯ÇÑ Á¢±Ù¹ýÀº ¾ÏÀÇ Ä¡·á°¡ Áö¿¬µÇÁö ¾Ê´Â´Ù´Â °ÍÀÌ ÀåÁ¡ÀÔ´Ï´Ù. ±×·¯³ª ±¤¹üÀ§ÇÑ À§ÀýÁ¦¼ú ÈÄÀÇ º´¸®Á¶Á÷¿¡¼­ ¾ÏÀÌ È®ÀεÇÁö ¾Ê´Â ¼ö°¡ ÀÖ½À´Ï´Ù. À̴ ù º´¼ÒÀÇ Å©±â°¡ ¸Å¿ì À۱⠶§¹®¿¡ ¹ß»ýÇÏ´Â ¹®Á¦ÀÏ °ÍÀÔ´Ï´Ù. ¸Å¿ì ÀÛÀº À§¾ÏÀº Á¶Á÷°Ë»ç¸¸À¸·Îµµ Á¦°ÅµÉ ¼ö ÀÖÀ» °ÍÀ̸ç, Á¶Á÷°Ë»ç·Î Á¦°ÅµÇÁö ¾Ê¾Ò´Ù°í ÇÏ´õ¶ó°í ¼ö¼ú ÈÄ º´¸®°Ë»çÀÇ ½½¶óÀÌµå »ùÇÿ¡ À§¾ÏÁ¶Á÷ÀÌ Æ÷ÇÔµÇÁö ¾ÊÀ» ¼öµµ ÀÖ½À´Ï´Ù. ¼ö¼ú±îÁö Çߴµ¥ ¾ÏÀÌ È®ÀεÇÁö ¾Ê´Â´Ù¸é ȯÀÚ ÀÔÀå¿¡¼­´Â ´õ¿í È¥¶õ½º·¯¿ï °ÍÀÔ´Ï´Ù (³»°¡ ¾ÏÀ̶ó´Â ¸»Àΰ¡ ¾Æ´Ï¶ó´Â ¸»Àΰ¡???). ¾ÆÁÖ °£È¤ Á¶Á÷°Ë»ç »ùÇÃÀÌ ¹Ù²î¾î ¾ÏÀÌ ¾Æ´Ñµ¥ ¾ÏÀ¸·Î ³ª¿À´Â °æ¿ìµµ ÀÖÀ» °ÍÀÔ´Ï´Ù (ÀÇ·á°¡ Àü»êÈ­µÈ ÃÖ±Ù¿¡´Â µå¹® ÀÏÀÔ´Ï´Ù).

(2) ´Ù¸¥ ¹æ¹ýÀº ÃßÀû ³»½Ã°æ °Ë»ç¸¦ Çϸ鼭 ´Ù½Ã ¾ÏÀÌ ³ª¿À¸é ±× ¶§ Ä¡·áÇÏ´Â Àü·«ÀÔ´Ï´Ù. ÀÌ·¯ÇÑ Á¢±Ù¹ýÀº ¼ö¼ú Àü º´¼Ò¿¡ ´ëÇÑ Æò°¡°¡ ¸íÈ®ÇÏ´Ù´Â ÀåÁ¡ÀÌ ÀÖÀ¸³ª ¾ÏÀÇ Ä¡·á°¡ Áö¿¬µÉ ¼ö ÀÖ´Ù´Â ´ÜÁ¡µµ ÀÖ½À´Ï´Ù. ¸î ³â ÈÄ À§¾ÏÀÌ ÁøÇ༺À¸·Î ³ª¿À¸é, º¸´Ù ÀÏÂï Ä¡·áÇÏÁö ¾Ê¾Ò´ø °ÍÀ» ȯÀÚµéÀÌ ÈÄȸÇÒ ¼ö ÀÖ´Â ÀÏÀÔ´Ï´Ù.

Çö½ÇÀûÀ¸·Î´Â ´Ù½Ã Çѹø ³»½Ã°æÀ» ÇØ º¸´Â °ÍÀÌ ÃÖ¼±ÀÔ´Ï´Ù. ¸¸¾à¿¡ Àç°Ë¿¡¼­µµ ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀ¸¸é ¾Õ¼­ ¾ð±ÞÇÑ µÎ ¹æ¹ý Áß Çϳª¸¦ ¼±ÅÃÇÒ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.


4. ESD¸¦ À§ÇØ ÀÇ·ÚµÈ È¯ÀÚ¿¡¼­ Àç°ËÀ» ÇÒ °ÍÀΰ¡?

À§¾ÏÀÌ ¹ß°ßµÇ¾î ³»½Ã°æ Ä¡·á¸¦ À§ÇÏ¿© ÀÇ·ÚµÈ °æ¿ì ³»½Ã°æ Àç°ËÀ» ÇÒ °ÍÀÎÁö ¸» °ÍÀÎÁö °í¹ÎÀÔ´Ï´Ù. º´¼Ò¸¦ ´Ù½Ã »ìÇÇ°í synchronous lesionÀÌ ¾ø´ÂÁö °üÂûÇϱâ À§ÇÏ¿© Ç×»ó Àç°ËÀ» ÇÏ´Â ESD Àü¹®°¡µµ °è½Ã´Â °ÍÀ¸·Î ¾Ë°í ÀÖ½À´Ï´Ù. Àú´Â ù ³»½Ã°æ °Ë»çÀÇ »çÁøÀÌ ±ú²ýÇÏ¿© º´¼ÒÀÇ Æ¯¼ºÀ» Àß ÆľÇÇÒ ¼ö ÀÖ´Â °æ¿ì¿¡´Â Àç°ËÀ» ÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù. Á¦ ³ª¸§ÀÇ ÀÌÀ¯´Â ¿©·¯°¡ÁöÀÔ´Ï´Ù.

(1) ³»½Ã°æ Àç°ËÀ» Çϸé Á¶Á÷°Ë»ç¸¦ Çϱ⠸¶·ÃÀε¥, ÀÌ ¶§ ¾ÏÀ¸·Î È®ÀεÇÁö ¾Ê´Â °æ¿ìµµ ¸¹½À´Ï´Ù. ÇÑ º´¿ø¿¡¼­´Â ¾ÏÀ̶ó°í Çߴµ¥ Àç°Ë¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀ¸¸é ȯÀڷμ­´Â È¥¶õ½º·¯¿ï ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ÀÌ È¯ÀÚ°¡ ±×·± °æ¿ì¿´½À´Ï´Ù.

ÁÂÃø: °³¾÷°¡ ù ³»½Ã°æ; ¿ìÃø: ³»½Ã°æ Àç°Ë. Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀ½. ESD¸¦ ±ÇÀ¯¹Þ¾ÒÀ¸³ª 2Â÷ ÀÇ°ßÀ» À§ÇÏ¿© Á¦ ¿Ü·¡¸¦ ãÀ¸¼Ì°í ESD¸¦ ¹ÞÀ¸½É (°á°ú´Â ¾Æ·¡ ÂüÁ¶).

(2) Á¶Á÷°Ë»ç¸¦ ¹Ýº¹Çϸé Ä¡·á°¡ ¾î·Á¿öÁú ¼ö ÀÖ½À´Ï´Ù. ±Ë¾çÀÌ ¸¸µé¾îÁö°í ±× ¶§¹®¿¡ ¾à°£ÀÇ fibrosis°¡ ¹ß»ýÇϱ⠶§¹®ÀÔ´Ï´Ù. ¹°·Ð À§¿¡¼­´Â ¾à°£ÀÇ submucosal fibrosis´Â ESD¿¡ Å« ¹æÇØ´Â µÇÁö ¾Ê½À´Ï´Ù.

(3) Á¶Á÷°Ë»ç¸¦ ¹Ýº¹Çϸé ESD º´¸®°á°ú¿¡¼­ no residual tumor°¡ ³ª¿À´Â °æ¿ì°¡ ¸¹Àº °Í °°½À´Ï´Ù. ÀÌ ¶ÇÇÑ È¯Àڷμ­´Â ÀÌÇØÇϱ⠾î·Á¿î ºÎºÐÀÔ´Ï´Ù.

(4) ³»½Ã°æ Àç°ËÀ» Çϸ鼭 »ö¼Ò³»½Ã°æ ȤÀº È®´ë³»½Ã°æÀ¸·Î »ó¼¼È÷ °üÂûÇÏ°í Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê´Â ¹æ¹ýµµ °¡´ÉÇÏÁö¸¸ Åë»óÀûÀÎ °æ¿ì°¡ ¾Æ´Õ´Ï´Ù.

(5) Synchronous lesionÀº ESD ÈÄ ÃßÀû °Ë»ç¿¡¼­ ¹ß°ßÇÏ´õ¶óµµ Ä¡·á¿¡´Â º° ¹®Á¦°¡ ¾ø½À´Ï´Ù.

Àç°Ë¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾Æ º´¿øÀ» ¿Å°Ü Àú¸¦ ã¾Æ¿À½Å ºÐÀε¥, ESD´Â ¹«³­È÷ Àß µÇ¾ú°í °á°úµµ ³ª»ÚÁö ¾Ê¾Æ ´ÙÇàÀ̾ú½À´Ï´Ù.


Stomach, ESD: Early gastric carcinoma
1. Location : cardia
2. Gross type : EGC type IIa
3. Histologic type : tubular adenocarcinoma, well differentiated (see note)
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 8 mm (2) vertical diameter, 6 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 6 mm, proximal 4 mm, anterior 6 mm, posterior 8 mm, deep 500 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent

¸¹Àº °Ë»ç, ¹Ýº¹ °Ë»ç°¡ ²À ÁÁÀº °ÍÀº ¾Æ´Õ´Ï´Ù. MinimalÇÑ °Ë»ç·Î ¹Ù¶÷Á÷ÇÑ °á°ú¸¦ ¾òÀ» ¼ö ÀÖ´Ù¸é ±×°ÍÀÌ ÃÖ¼±ÀÔ´Ï´Ù. À̸¦ À§ÇÏ¿© ³»½Ã°æÀ» óÀ½ ÇϽô ºÐÀÇ ¿ªÇÒÀÌ Áß¿äÇÕ´Ï´Ù. º´¼Ò¸¦ Àß °üÂûÇÏ°í Á¤È®È÷ ±â¼úÇÏ°í ÃÖÁ¾ º´¸®°á°ú°¡ ³ª¿À¸é Áï½Ã Ä¡·á¿¡ µé¾î°¥ ¼ö ÀÖµµ·Ï »ó¼¼È÷ °üÂûÇÏ°í ÀÚ¼¼ÇÑ ±â·ÏÀ» ³²±âµµ·Ï ¾Ö¾¹½Ã´Ù. À̸¦ À§Çؼ­´Â ÇÑ ½Ã°£¿¡ 4-5°³ ÀÌ»óÀÇ ³»½Ã°æ °Ë»ç´Â °ï¶õÇÏ°ÚÁö¿ä.

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[FAQ]

[2016-8-5. ¾Öµ¶ÀÚ ÆíÁö]

¿À´Ãµµ ±³¼ö´ÔÀÇ °­ÀÇ Àß µé¾ú½À´Ï´Ù. Áö¹æ °ËÁø¼¾ÅÍ¿¡¼­ ÀÏÇÏ´Â ¼ÒÈ­±â³»°ú ÀÇ»çÀÔ´Ï´Ù. Àú´Â ¸ÅÀÏ ¾Æħ Ãâ±ÙÇϸé Ä¿ÇÇ ÇÑÀÜ ¸¶½Ã¸é¼­ ±³¼ö´ÔÀÇ ¸ÞÀÏÀ» º¸´Â ½Ã°£ÀÌ ÇÏ·ç Áß °¡Àå Áñ°Å¿î ½Ã°£ÀÎ°Í °°½À´Ï´Ù.

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°¨»çÇÕ´Ï´Ù. ¿ÇÀº ¸»¾¸ÀÔ´Ï´Ù. º´¸® Àǻ絵 ¿Ïº®ÇÏÁö´Â ¾Ê½À´Ï´Ù.

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¿­¾ÇÇÑ È¯°æ¿¡¼­µµ ȯÀÚ¸¦ À§ÇÏ¿© ¿­½ÉÈ÷ ÀÏÇÏ´Â ¿©·¯ºÐÀ» Á¸°æÇÕ´Ï´Ù. '³»½Ã°æ Àç°Ë'À» ó¹æÇϱ⿡ ¾Õ¼­ º´¸®°ú¿¡ ã¾Æ°¡ °¨È÷ ÀçÆǵ¶À» ºÎŹÇϼ̴ø ¼±»ý´ÔÀ» Á¸°æÇÕ´Ï´Ù. °¨È÷ ÀçÆǵ¶À» ºÎŹÇÒ °ÍÀÌ ¾Æ´Ï¶ó, ´Ã ÀÚ¿¬½º·´°Ô ÀçÆǵ¶À» ºÎŹÇÒ ¼ö Àִ ȯ°æÀ» ±â´ëÇÕ´Ï´Ù. Àúµµ ³ª¸§´ë·Î ³ë·ÂÇÏ°Ú½À´Ï´Ù.


[2020-5-21. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô²²¼­´Â EndoTODAY º¸¸¸ 4Çü ÁøÇ༺À§¾Ï¿¡¼­ "ÀÓ»ó»óÀÌ º¸¸¸ 4Çü ÁøÇ༺À§¾Ï¿¡ ÇÕ´çÇÏ¸é ³»½Ã°æ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ È®ÀεÇÁö ¾Ê´õ¶óµµ ¼ö¼úÀ» º¸³»°í ÀÖ½À´Ï´Ù"¿Í °°ÀÌ ´äº¯ ÁֽŠ°ÍÀ» º¸¾Ò½À´Ï´Ù.

1) B-IV °¡ ÀǽɵǴ ȯÀÚ¿¡¼­ Á¶Á÷°Ë»ç°¡ negative ·Î ³ª¿ÔÀ» ¶§, ±³¼ö´Ô²²¼­´Â ¾î¶»°Ô f/uÀ» ÇϽôÂÁö¿ä?

2) B-IV°¡ ÀǽɵǴ ȯÀÚ¿¡¼­ multiple site ¿¡¼­ biopsy ¸¦ Çϸé Á¶Á÷°Ë»çÀÇ ¾ç¼º·üÀÌ ¿Ã¶ó°¥Áö ±Ã±ÝÇÕ´Ï´Ù.

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¿¹. Áß¿äÇÑ Áú¹®ÀÔ´Ï´Ù. À̹ø ±âȸ¿¡ È®½ÇÈ÷ °³³äÀ» Àâ±â ¹Ù¶ø´Ï´Ù.

1) º¸¸¸ 4Çü ÁøÇ༺À§¾ÏÀÌ ÀǽɵǴ ȯÀÚ¿¡¼­´Â follow-upÀ» ÇÏ¸é ¾È µË´Ï´Ù. ¹Ù·Î °á·ÐÀ» ³»¾ß ÇÕ´Ï´Ù. Áö±Ý ´çÀå. Follow-upÀº º¸Åë '¸î ÁÖ ÈÄ Àç°Ë' ȤÀº '¸î °³¿ù ÈÄ Àç°Ë' ȤÀº 'Åõ¾à ÈÄ Àç°Ë'À» ¸»ÇÏ´Â °ÍÀÔ´Ï´Ù. ÀÌ·± ÀǹÌÀÇ follow-upÀº ¸Å¿ì °ï¶õÇÕ´Ï´Ù. Áö±Ý ´çÀå Àç°ËÇÏ°í CT¸¦ Âï¾î¾ß ÇÕ´Ï´Ù. ¿À´Ã ´çÀå... ¸î °³¿ù ÈÄ Àç°ËÇÏ¿© peritoneal seedingÀÌ ÀÖ´Â »óÅ·Π¹ß°ßµÇ¸é °í¼Ò´çÇϱ⠽±»óÀÔ´Ï´Ù (EndoTODAY Medicolegal risk of biopsy negative Borrmann type IV). Àú´Â º¸¸¸ 4ÇüÀÌ ÀǽɵǾú´Âµ¥ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾Æ ÀÇ·ÚµÈ È¯ÀÚ¿¡¼­ ¿Ü·¡ ´çÀÏ ³»½Ã°æ °Ë»ç¸¦ ÇÏ°í, ´ÙÀ½ ³¯ ÀÔ¿ø, ±× ´ÙÀ½ ³¯ ¿Ü°ú Àü°ú, ±× ´ÙÀ½ ³¯ ¼ö¼úÇÑ °æ¿ì±îÁö ÀÖ¾ú½À´Ï´Ù. À̸§ÇÏ¿© Ultra-super-fast high-speed surgical treatment for biopsy-negative Borrmann type IV gastric cancerÀÇ Áõ·Ê¿´½À´Ï´Ù.^^


Stomach, total gastrectomy:
Advanced gastric carcinoma
1. Location : [1] middle third, [2] upper third, [3] lower third, [4] duodenum, Center at body and circle
2. Gross type : Borrmann type 4
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 18x18 cm
6. Depth of invasion : invades serosa (pT4a)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 41 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: pT4a N0

2) B-IV°¡ ÀǽɵǴ ȯÀÚ¿¡¼­ multiple site¿¡¼­ Á¶Á÷°Ë»ç¸¦ ÇÏ¸é ¾ç¼º·üÀÌ ¿Ã¶ó°¥Áö Áú¹®À» Á̴ּµ¥¿ä... Á¶Á÷°Ë»ç ¸¹ÀÌ ÇÏ´Â °ÍÀº º°·Î Áß¿äÇÏÁö ¾Ê½À´Ï´Ù. »ç½Ç °ÅÀÇ Áß¿äÇÏÁö ¾Ê½À´Ï´Ù. Àß ÇÏ´Â °ÍÀÌ Áß¿äÇÕ´Ï´Ù. Á¶Á÷°Ë»çÀÇ ÁúÀÌ Áß¿äÇÏÁö ¾çÀº Áß¿äÇÏÁö ¾Ê½À´Ï´Ù. Á¶Á÷°Ë»ç ´ëÃæ ÇÏ¿© ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀ¸¸é false sense of safety¸¸ »ý±é´Ï´Ù. ¾ÆÁÖ ÁÁÁö ¾Ê½À´Ï´Ù. ¾È ÇÏ´À´Ï¸¸ ¸øÇÕ´Ï´Ù. ¸¹ÀÌ ÇÏÁö ¸¶½Ã°í Àß ÇϽʽÿÀ.

»ç½Ç Á¶Á÷°Ë»ç´Â ±×´ÙÁö Áß¿äÇÏÁö ¾Ê½À´Ï´Ù. ³»½Ã°æ À°¾È¼Ò°ßÀÌ ÈξÀ Áß¿äÇÕ´Ï´Ù. ImpressionÀ» Àß Àâ´Â °ÍÀÌ Áß¿äÇÕ´Ï´Ù. º¸¸¸ 4ÇüÀ» ÀǽÉÇÏ´Â °ÍÀÌ 100¹è, 1000¹è Áß¿äÇÕ´Ï´Ù. ÀÏ´Ü º¸¸¸ 4ÇüÀÌ ÀǽɵǸé erosionÀ̳ª ulcer¸¦ ã¾Æ Á¶Á÷°Ë»ç¸¦ ÇϽʽÿÀ. ¿©±â Àú±â ¸· ÇÑ´Ù°í Á¶Á÷ÇÐÀûÀ¸·Î ¾ÏÀÌ È®ÀεǴ °ÍÀº ¾Æ´Õ´Ï´Ù.

¾Æ·¡ ȯÀÚÀÇ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾Ò½À´Ï´Ù. ¿©·¯ºÐÀº ¾î¶»°Ô ÇϽðڽÀ´Ï±î?

Áï½Ã ¿Ü°ú·Î º¸³Â°í ¾Æ·¡¿Í °°Àº °á°ú¿´½À´Ï´Ù. Âü ´ÙÇེ·¯¿î °æ¿ìÀÔ´Ï´Ù. ¿Ü°ú¿¡¼­´Â ¼ö¼ú Àü ³»½Ã°æ °Ë»ç¸¦ ´Ù½Ã ÀÇ·ÚÇÏ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ¿Ü°ú ÀÇ»ç ÀÔÀå¿¡¼­ ¾Æ¹«·¡µµ Á¶Á÷ÇÐÀû È®ÁøÀÌ ÀÖÀ¸¸é ¸¶À½ÀÌ ÆíÇÏ°ÚÁö¿ä. ±×·¯³ª ¿Ü°úÀǻ翡°Ô Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê´õ¶óµµ ²À, ²À, ²À ¼ö¼úÇØ¾ß ÇÑ´Ù°í °­·ÂÈ÷ ÁÖÀåÇØ¾ß ÇÕ´Ï´Ù. Àý´ë ¹°·¯¼­¸é ¾È µË´Ï´Ù.

Stomach, total gastrectomy: Advanced gastric carcinoma
- Histologic type : tubular adenocarcinoma, poorly differentiated
- Depth of invasion : penetrates subserosal connective tissue (pT3)
- Resection margin: free from carcinoma
- Lymph node metastasis : no metastasis in 36 regional lymph nodes (pN0)
- Lymphatic invasion : not identified
- Venous invasion : not identified
- Perineural invasion : present
- Peritoneal cytology : negative

¹°·Ð ¿Ü·¡ Áø·á ÈÄ¿¡µµ ³õÄ¡´Â °æ¿ì°¡ ÀÖÁö¸¸, screening setting¿¡¼­ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ» ³õÄ¡´Â °æ¿ì´Â Á¤¸» ¸¹ÀÌ °æÇèÇÏ¿´½À´Ï´Ù. Á¶±Ý¸¸ ¸Ô¾îµµ ºÒÆíÇÏ°í üÁßµµ ºüÁö°í ¹º°¡ À§Àå°ú Áõ¼¼°¡ ÀÖÀ¸¸é Â÷ºÐÈ÷ ¿Ü·¡ ÁøÂûÀ» ¹Þ¾Æ¾ß ÇÕ´Ï´Ù. ±×·¡¼­ ¾ÏÀº ¾Æ´ÑÁö ÀǽÉÇÏ´Â »óÅ¿¡¼­ Á¶½É½º·´°Ô ³»½Ã°æ °Ë»ç¸¦ ¹Þ¾Æ¾ß ÇÕ´Ï´Ù. ±×·± Áß¿äÇÑ °úÁ¤À» »ý·«ÇÏ°í ±×³É °ÇÁøÀ» ¹ÞÀ¸¸é °ÇÁø¿¡¼­´Â ¹«Áõ»óÀ» °¡Á¤Çϱ⠶§¹®¿¡ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀÌ ÀÚ²Ù miss µÇ´Â °Í °°½À´Ï´Ù. ±Ù°Å´Â ¾ø½À´Ï´Ù. ±×³É Á¦ ´À³¦ÀÔ´Ï´Ù. ±×·± °æ¿ì¸¦ ³Ê¹« ¸¹ÀÌ ºÁ¼­ °¡Áö°Ô µÈ ´À³¦ÀÔ´Ï´Ù. À¯Áõ»ó ȯÀÚ¸¦ ¹«Áõ»ó ¼ºÀΰú ¼¯´Â °ÍÀº ¸Å¿ì ³ª»Û ÀÏÀÔ´Ï´Ù. ¸Å¿ì ¸Å¿ì ³ª»Û ÀÏÀÔ´Ï´Ù. ¼±º° Áø·á¼Ò¶óµµ ÇÊ¿äÇÒ °Í °°½À´Ï´Ù. °ÇÁøÇÏ·¯ ¿À¼Ì´Âµ¥ Áõ»óÀÌ ÀÖÀ¸¸é °ÇÁøÀ» ¸ø ¹Þ°Ô ÇÏ°í ÀÏ´Ü ¿Ü·¡ Áø·á ÈÄ Æò°¡¸¦ ¹Þ°í ³­ ´ÙÀ½ ³»½Ã°æ °Ë»ç¸¦ ¹Þµµ·Ï ÇÏ´Â °ÍÀÌ ¿Ã¹Ù¸¥ Á¤Ã¥ ¹æÇâÀÔ´Ï´Ù. Äڷγª ¼±º° Áø·á¼Ò¸¸ ÇÊ¿äÇÑ °Í ¾Æ´Õ´Ï´Ù. À§¾Ï ¼±º° Áø·á¼Òµµ ÇÊ¿äÇÒ °Í °°½À´Ï´Ù.

°Ë»ç ½Ã°£µµ ¹®Á¦ÀÔ´Ï´Ù. À§³»½Ã°æ ÃÖ¼Ò °Ë»ç½Ã°£Àº 5ºÐÀÔ´Ï´Ù. 1-2ºÐ¿¡ ³¡³ª´Â À§³»½Ã°æÀÌ ¾ó¸¶³ª ¸¹ÀºÁö ¾Æ´Â »ç¶÷Àº ´Ù ¾Ð´Ï´Ù. ±× °úÁ¤¿¡¼­ º¸¸¸ 4Çü ´Ù ³õÄ¡´Â °ÍÀÔ´Ï´Ù. 5ºÐ ÀÌ»ó °Ë»çÇսôÙ. (EndoTODAY 2013³â ¾î¶² Áú¹®¿¡ ´äÇÕ´Ï´Ù)


[References]

1) EndoTODAY Á¶Á÷°Ë»ç

2) EndoTODAY ¾Ï Àǽɺ´¼Ò¿¡¼­ Á¶Á÷°Ë»ç À½¼ºÀÏ ¶§ÀÇ Àü·«

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