Endoscopic features of submucosal invasive non-ampullary duodenal carcinomas.
localization
submucosal invasion
submucosal tumor-like appearance
superficial non-ampullary duodenal carcinoma
tumor diameter
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
11
06
2019
revised:
16
09
2019
accepted:
17
09
2019
pubmed:
17
10
2019
medline:
8
10
2020
entrez:
17
10
2019
Statut:
ppublish
Résumé
It is imperative to distinguish superficial non-ampullary duodenal carcinomas (NADCs) between intramucosal and submucosal invasive carcinoma for treatment selection. The aim of this study was to evaluate the clinicopathological differences of intramucosal and submucosal carcinoma. This was a retrospective, single-center study comprising 134 patients with 137 superficial NADCs during May 2005 and March 2018. Clinicopathological characteristics and treatment outcomes data were used to perform a comparative analysis of endoscopic findings, preoperative diagnoses of depth of cancer, and treatment outcomes of histologically diagnosed intramucosal and submucosal carcinoma. Of the 137 NADCs, 125 (91%) were intramucosal, and 12 (9%) were submucosal. The proportion of submucosal carcinoma was significantly higher on the oral side of the papilla than on the anal side (16% vs 1%, P = 0.002). Submucosal tumor-like appearance was more frequent in submucosal than in intramucosal carcinoma (58% vs 13%, P = 0.001). There was no significant difference in tumor diameter between the groups, but 33% of submucosal carcinomas were ≤ 10 mm. Correct preoperative diagnosis of depth was achieved in 33% of submucosal carcinoma. Submucosal carcinoma was frequently underestimated when tumor diameters were ≤ 10 mm. Conversely, intramucosal carcinoma was frequently overestimated when the tumor was ≥ 30 mm and had thickness or giant nodules. Lymph node metastasis was found in one submucosal carcinoma patient. The possibility of submucosal invasion should be considered when NADCs are located on the oral side of the papilla or have submucosal tumor-like appearance even if tumor diameters are ≤ 10 mm.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
It is imperative to distinguish superficial non-ampullary duodenal carcinomas (NADCs) between intramucosal and submucosal invasive carcinoma for treatment selection. The aim of this study was to evaluate the clinicopathological differences of intramucosal and submucosal carcinoma.
METHODS
METHODS
This was a retrospective, single-center study comprising 134 patients with 137 superficial NADCs during May 2005 and March 2018. Clinicopathological characteristics and treatment outcomes data were used to perform a comparative analysis of endoscopic findings, preoperative diagnoses of depth of cancer, and treatment outcomes of histologically diagnosed intramucosal and submucosal carcinoma.
RESULTS
RESULTS
Of the 137 NADCs, 125 (91%) were intramucosal, and 12 (9%) were submucosal. The proportion of submucosal carcinoma was significantly higher on the oral side of the papilla than on the anal side (16% vs 1%, P = 0.002). Submucosal tumor-like appearance was more frequent in submucosal than in intramucosal carcinoma (58% vs 13%, P = 0.001). There was no significant difference in tumor diameter between the groups, but 33% of submucosal carcinomas were ≤ 10 mm. Correct preoperative diagnosis of depth was achieved in 33% of submucosal carcinoma. Submucosal carcinoma was frequently underestimated when tumor diameters were ≤ 10 mm. Conversely, intramucosal carcinoma was frequently overestimated when the tumor was ≥ 30 mm and had thickness or giant nodules. Lymph node metastasis was found in one submucosal carcinoma patient.
CONCLUSIONS
CONCLUSIONS
The possibility of submucosal invasion should be considered when NADCs are located on the oral side of the papilla or have submucosal tumor-like appearance even if tumor diameters are ≤ 10 mm.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
821-826Informations de copyright
© 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Alwmark A, Andersson A, Lasson A. Primary carcinoma of the duodenum. Ann. Surg. 1980; 191: 13-18.
Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann. Surg. 2009; 249: 63-71.
Kakushima N, Ono H, Yoshida M et al. Characteristics and risk factors for sporadic non-ampullary duodenal adenocarcinoma. Scand. J. Gastroenterol. 2017; 52: 1253-1257.
Sellner F. Investigations on the significance of the adenoma-carcinoma sequence in the small bowel. Cancer 1990; 66: 702-715.
Kakushima N, Kanemoto H, Tanaka M, Takizawa K, Ono H. Treatment for superficial non-ampullary duodenal epithelial tumors. World J. Gastroenterol. 2014; 20: 12501-12508.
Kakushima N, Ono H, Takao T, Kanemoto H, Sasaki K. Method and timing of resection of superficial non-ampullary duodenal epithelial tumors. Dig. Endosc. 2014; 26: 35-40.
Goda K, Kikuchi D, Yamamoto Y et al. Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors in Japan: multicenter case series. Dig. Endosc. 2014; 26: 23-29.
Hara Y, Goda K, Dobashi A et al. Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors. World J. Gastroenterol. 2019; 25: 707-718.
Kakushima N, Yoshida M, Iwai T et al. A simple endoscopic scoring system to differentiate between duodenal adenoma and carcinoma. Endosc Int Open. 2017; 5: E763-E768.
Kakushima N, Yoshida M, Yamaguchi Y et al. Magnified endoscopy with narrow-band imaging for the differential diagnosis of superficial non-ampullary duodenal epithelial tumors. Scand. J. Gastroenterol. 2019: 1-7.
Fujisawa T, Tomofuji Y, Kuroda N et al. A case of duodenal cancer with tubule-villous adenoma-report of a case and clinic-pathological review of Japanese literature. Gastroenterol. Endosc. 1995; 37: 2768-2775 (in Japanese with English abstract).
Lambert R. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest. Endosc. 2003; 58: S3-S43.
Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013; 48: 452-458.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 2018; 68: 394-424.
Zhang S, Cui Y, Zhong B et al. Clinicopathological characteristics and survival analysis of primary duodenal cancers: a 14-year experience in a tertiary centre in South China. Int. J. Colorectal Dis. 2011; 26: 219-226.
Maruoka D, Arai M, Ishigami H et al. Sporadic nonampullary duodenal adenoma/carcinoma is associated with not only colon adenoma/carcinoma but also gastric cancer: association of location of duodenal lesions with comorbid diseases. Scand. J. Gastroenterol. 2015; 50: 333-340.
Niwa A, Kuwano S, Tomita H et al. The different pathogeneses of sporadic adenoma and adenocarcinoma in non-ampullary lesions of the proximal and distal duodenum. Oncotarget 2017; 8: 41078-41090.
Toba T, Inoshita N, Kaise M et al. Clinicopathological features of superficial non-ampurally duodenal epithelial tumor; gastric phenotype of histology correlates to higher malignant potency. J. Gastroenterol. 2018; 53: 64-70.
Matsueda K, Kanzaki H, Matsueda K et al. The clinicopathological differences of sporadic non-ampullary duodenal epithelial neoplasm depending on tumor location. J. Gastroenterol. Hepatol. 2019; 34: 1540-1544.
Genta RM, Kinsey RS, Singhal A, Suterwala S. Gastric foveolar metaplasia and gastric heterotopia in the duodenum: no evidence of an etiologic role for Helicobacter pylori. Hum. Pathol. 2010; 41: 1593-1600.
Matsubara A, Ogawa R, Suzuki H et al. Activating GNAS and KRAS mutations in gastric foveolar metaplasia, gastric heterotopia, and adenocarcinoma of the duodenum. Br. J. Cancer 2015; 112: 1398-1404.
Yoshida M, Shimoda T, Abe M et al. Clinicopathological characteristics of non-ampullary duodenal tumors and their phenotypic classification. Pathol. Int. 2019; 69: 398-406 [Epub ahead of print].
Han SL, Cheng J, Zhou HZ, Zeng QQ, Lan SH. The surgical treatment and outcome for primary duodenal adenocarcinoma. J. Gastrointest. Cancer 2010; 41: 243-247.
Scott-Coombes DM, Williamson RC. Surgical treatment of primary duodenal carcinoma: a personal series. Br. J. Surg. 1994; 81: 1472-1474.
Cannon ME, Carpenter SL, Elta GH et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest. Endosc. 1999; 50: 27-33.
Ito K, Fujita N, Noda Y et al. Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest. Endosc. 2007; 66: 740-747.
Artifon EL, Couto D Jr, Sakai P, da Silveira EB. Prospective evaluation of EUS versus CT scan for staging of ampullary cancer. Gastrointest. Endosc. 2009; 70: 290-296.
Ojha A, Zacherl J, Scheuba C, Jakesz R, Wenzl E. Primary small bowel malignancies: single-center results of three decades. J. Clin. Gastroenterol. 2000; 30: 289-293.
Murray MA, Zimmerman MJ, Ee HC. Sporadic duodenal adenoma is associated with colorectal neoplasia. Gut 2004; 53: 261-265.