Endoscopic Diagnosis of Depth and Extension of Cancer Invasion of Superficial Barrett's Adenocarcinoma

Endoscopic Diagnosis of Depth and Extension of Cancer Invasion of Superficial Barrett’s Adenocarcinoma Iizuka Toshiro, Yahagi Naohisa, Hoteya Shu, Yamamoto Takashi Objective: There are few cases of superficial Barrett’s adenocarcinoma, even though Barrett’s adenocarcinoma is increasing in these days. But there are some cases to indicate endoscopic treatment in advanced of early detection. In an endoscopic treatment it is very important to make a diagnosis of depth and extension of the cancer precisely, because these have a close relation to both recurrence and lymph node metastasis. So we investigated to the accuracy of depth and extension of our cases retrospectively. Subjects and Methods: In this study 13 patients who were diagnosed of superficial Barrtte’s adenocarcinoma between January, 1998 and September, 2005 were included. The accuracy of depth and extension of cancer was investigated. For diagnosing depth of invasion by EUS, a small soft balloon with an effective length of 1 cm was used, as well as a 30 MHz probe from Olympus. For diagnosing extension of invasion, both ordinary endoscopy and spraying indigocarmine were used. Results: Clinicopathological features of all 13 lesions show as follows: there were 5 lesions of m carcinoma and 8 of sm carcinoma histologically, 9 lesions were macroscopically classified as an elevated type and 4 as a depressed type. As a treatment 5 lesions underwent surgical resection, 4 endoscopic resection, and 4 surgical resection after endoscopic treatment. The cancer growth under normal squamous epithelium was detected in 8 cases (62%), this extension size was 5.4 mm in average, and the cancer growth under normal columnar epithelium was detected in 4 cases (31%). The accurate diagnosis rate of depth of invasion by EUS was 77%; diagnosis rate for mucosal carcinoma and submucosal carcinoma was 67 and 86%, respectively. The correct diagnosis rate of lateral margin was 75%, but it was impossible to diagnose lateral margin in 2 cases because of cancer growth under normal squamous epithelium. Discussion: In order to cure superficial Barrett’s adenocarcinoma by endoscopic treatment, it would be a task to make a correct diagnosis of depth and extension of cancer invasion.