Controversies in the diagnosis and management of early gastric cancer

Early diagnosis and treatment is the key to improving the prognosis of gastric cancer. The past decades have wimessed the rapid advances in the diagnosis and management of early gastric cancer （EGC）： endoscopy has played an increasingly important role, whereas laparoscopic techniques have also been introduced for EGC treatment. In China, the proportion of EGC is gradually increasing, and this condition will soon become a hot research topic. In this article, we will elucidate some major controversies in the diagnosis and management of EGC.

Upgrading the definition of early gastric cancer: better staging means more appropriate treatment

Since Murakami defined early gastric cancer(EGC) as a "carcinoma limited to the gastric mucosa and/or submucosa regardless of the lymph node status", several authors have focused on the most influential histopathological parameters for predicting the development of lymph node metastases by considering the lymph node status as an important prognostic factor. A few authors have also considered the depth of invasion as one of the keys to explaining the existence of subgroups of patients affected by EGC with poor prognoses. In any case, EGC is still considered an initial phase of tumor progression with good prognosis. The introduction of modern endoscopic devices has allowed a precise diagnosis of early lesions, which can lead to improved definitions of tumors that can be radically treated with endoscopic mucosal resection or endoscopic submucosal dissection(ESD). Given the widespread use of these techniques, the Japanese Gastric Cancer Association( JGCA) identified in 2011 the standard criteria that should exclude the presence of lymph node metastases. At that time, EGCs with nodal involvement should have been asserted as no longer fitting the definition of an early tumor. Some authors have also demonstrated that the morphological growth pattern of a tumor, according to Kodama's classification, is one of the most important prognostic factors, thereby suggesting the need to report it in histopathological drafts. Notwithstanding the acquired knowledge regarding the clinical behavior of EGC, Murakami's definition is still being used. This definition needs to be upgraded according to the modern staging of the disease so that the appropriate treatment would be selected.

普通白光胃镜与放大胃镜结合窄带成像技术在萎缩性胃炎和早期胃癌中的诊断价值

目的探究普通白光胃镜与放大胃镜结合窄带成像技术(ME-NBI)在萎缩性胃炎和早期胃癌中的诊断价值。方法回顾性选取2016年3月到2017年3月至复旦大学附属中山医院徐汇医院就诊的人群的资料,共计243例。经过受试人员同意后对患者行白光胃镜检查,之后再对患者行放大胃镜结合窄带成像技术检查,采集可疑部位组织进行病理学检查,比较两种检查方式灵敏度、特异度、阳性预测值、阴性预测值和准确性的差异。结果 243例受试人员中,行常规白光胃镜检查结果发现内镜下存在有可疑病灶,经胃镜下多点取活检标本病理证实:萎缩性胃炎226例;早期胃癌17例。普通白光胃镜检测显示,萎缩性胃炎检出率为94.7%(214/226),早期胃癌的检出率为29.4%(5/17);放大胃镜结合窄带成像技术检测显示,萎缩性胃炎检出率为99.6%,早期胃癌的检出率为88.2%(15/17),两组检查方法检出率差异具有统计学意义(P<0.05)。普通白光胃镜组对早期胃癌诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确性分别为93.2%、53.5%、25.3%、97.4%、54.0%,而放大胃镜结合窄带成像技术组对早期胃癌诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确性分别为88.2%、99.4%、97.3%、94.3%、97.0%,后者准确性显著高于前者,且差异具有统计学意义(P<0.05)。结论放大胃镜结合窄带成像技术可以显著提高萎缩性胃炎和胃癌患者的检出率,且对早期胃癌患者检测准确率高,操作简便,可执行性强,有助于早期筛查和诊断工作的进行。