The essential problem of over-measuring the depth of submucosal invasion in pT1 colorectal cancer

A depth of submucosal invasion (DSI) of ≥1000 μm is an important risk factor for lymph node metastasis (LNM) in patients with submucosal invasive (pT1) colorectal cancer (CRC), according to the European Society of Gastrointestinal Endoscopy and the Japanese Society for Cancer of the Colon and Rectum...

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Published in:Virchows Archiv : an international journal of pathology 2022-02, Vol.480 (2), p.323-333
Main Authors: Aizawa, Daisuke, Sugino, Takashi, Oishi, Takuma, Hotta, Kinichi, Imai, Kenichiro, Shiomi, Akio, Notsu, Akifumi, Ikegami, Masahiro, Shimoda, Tadakazu
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Language:English
Subjects:
Cancer
Colon
Colon cancer
Colorectal cancer
Colorectal carcinoma
Colorectal Neoplasms - pathology
Endoscopy
Humans
Invasiveness
Lymph nodes
Lymphatic Metastasis
Medicine
Medicine & Public Health
Metastases
Neoplasm Invasiveness - pathology
Original Article
Pathology
Patients
Rectal Neoplasms
Retrospective Studies
Risk analysis
Risk Factors
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Sugino, Takashi
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Ikegami, Masahiro
Shimoda, Tadakazu
description A depth of submucosal invasion (DSI) of ≥1000 μm is an important risk factor for lymph node metastasis (LNM) in patients with submucosal invasive (pT1) colorectal cancer (CRC), according to the European Society of Gastrointestinal Endoscopy and the Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines. According to the latter, if the location of the muscularis mucosae in the invasive area is not confirmed, the DSI can be measured from the surface. In these cases, a ‘remaining intramucosal lesion’ (rIL), which is in the invasive area, is sometimes observed. To avoid over-measuring the DSI, we proposed a ‘modified DSI’ (mDSI), which excludes the rIL from the JSCCR DSI. We investigated the characteristics and effectiveness of the rIL and mDSI by grouping cases with polypoid growth (PG) and non-polypoid growth (NPG) histologically. Three hundred and thirty-nine consecutive patients with pT1 CRC were examined. LNM was detected in 37 cases. The distribution of the DSI and rIL was significantly higher in PG than in NPG cases ( P
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According to the latter, if the location of the muscularis mucosae in the invasive area is not confirmed, the DSI can be measured from the surface. In these cases, a ‘remaining intramucosal lesion’ (rIL), which is in the invasive area, is sometimes observed. To avoid over-measuring the DSI, we proposed a ‘modified DSI’ (mDSI), which excludes the rIL from the JSCCR DSI. We investigated the characteristics and effectiveness of the rIL and mDSI by grouping cases with polypoid growth (PG) and non-polypoid growth (NPG) histologically. Three hundred and thirty-nine consecutive patients with pT1 CRC were examined. LNM was detected in 37 cases. The distribution of the DSI and rIL was significantly higher in PG than in NPG cases ( P &lt;0.001). There was no difference in the mDSI distribution between the PG-/NPG-type cases. An rIL was observed in 39% (127/301) of cases, in which the location of the muscularis mucosae could not be determined or estimated and the mDIS could be estimated. 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subjects Cancer
Colon
Colon cancer
Colorectal cancer
Colorectal carcinoma
Colorectal Neoplasms - pathology
Endoscopy
Humans
Invasiveness
Lymph nodes
Lymphatic Metastasis
Medicine
Medicine & Public Health
Metastases
Neoplasm Invasiveness - pathology
Original Article
Pathology
Patients
Rectal Neoplasms
Retrospective Studies
Risk analysis
Risk Factors
title The essential problem of over-measuring the depth of submucosal invasion in pT1 colorectal cancer
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