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Mizutani M.,Tokyo Metropolitan Cancer Detection Center | Takahashi H.,Showa University | Hanamura S.,Showa University | Nagahama M.,Showa University
Journal of the Showa Medical Association

The superficial spreading type of early gastric cancer, which accounts for 4.7% of all patients with early gastric cancer, typically appears at a relatively young age. Most tumors of this cancer are classified into two histological categories: undifferentiated and moderately differentiated. Macroscopically, the superficial spreading type of early gastric cancer is generally classified into superficial depressed or combined type. Lesions are located in the middle portion of the stomach, and typically on the posterior wall or the lesser curvature. Most patients with this cancer are diagnosed with the mixed-histologic type and are diagnosed as having submucosal invasive gastric cancer. The superficial spreading type of early gastric cancer is generally classified into gastric or mixed gastric/intestinal phenotypes. The percentage of gastric ulcers and ulcer scars is high. In surgical cases, the positive rates of lymph node metastases are also significantly high. While there are some similarities between superficial spreading type and multiple early gastric cancers, differences also exist. The undifferentiated superficial spreading type of early gastric cancer is thought to be composed of a mass of multiple gastric cancers. In contrast, the differentiated superficial spreading type of early gastric cancer begins as a single focus, which then slowly progresses in a horizontal direction rather than forming a mass of multiple gastric cancers. Source

Fu K.,Juntendo University | Yamamura A.,Tokyo Metropolitan Cancer Detection Center
Surgical Endoscopy and Other Interventional Techniques

Background Various methods are reported as aids to cecal intubation for cases in which colonoscopy is difficult. This study aimed to investigate prospectively whether a gastroscope with magnification function, narrow-band imaging (NBI), and a soft black hood can aid insertion in cases of difficult colonoscopy and facilitate both accurate diagnosis and safe treatment. Methods This prospective study recruited 177 patients. All were examined with a magnifying gastroscope. A commercially available soft black hood was attached to the gastroscope during insertion and magnification. Difficult colonoscopy was anticipated before colonoscopy in cases of patients with at least one of the following factors: low BMI (<20 kg/m 2), adhesion due to previous surgery, or previous colonoscopy that could not reach to the cecum. The success rate and duration of cecal intubation then were assessed. All detected lesions were evaluated by magnifying NBI and then classified as non-neoplastic or neoplastic for endoscopic diagnosis. Subsequently, all the lesions were removed and examined histologically for comparison. Results The overall success rate of cecal intubation was 100% (177/177), and the mean time taken to reach the cecum was 5.9 min. A total of 156 lesions were detected endoscopically, and the overall diagnostic accuracy of NBI with magnification was 98.7%. No associated complications occurred. Conclusion Magnifying gastroscopy using a soft black hood and NBI is useful for cecal intubation in cases wherein colonoscopy is difficult, facilitating accurate diagnosis and safe treatment. © 2011 Springer Science+Business Media, LLC. Source

Few reports discuss the growth progress of superficial carcinomas of the esophagus and numerous questions remain, thus we evaluated the carcinoma growth progression in 53 cases of submucosal carcinomas of the esophagus. Regarding growth form and speed, we examined 11 cases with an inspection history within the past two years. The growth form could be roughly classified into 3 types: patterns A, B (B-1, B-2, B-3), and C. The 53 cases of submucosal carcinomas of the esophagus were classified into these 3 types; most patterns were B-2 and, then pattern A. As for growth speed, it was surmised that patterns A and C were fast, and pattern B-1 was the slowest, and patterns B-2 and B-3 in the middle. In connection with histological type, there were many cases from which poorly differentiated type of squamous cell carcinoma permeates deeply into submucosal layer in pattern A. Pattern B was also to have a high rate of poorly to moderately differentiated type of squamous cell carcinoma, and it participates in growth progression into the submucosal layer. Source

Yamazato T.,Tokyo Metropolitan Cancer Detection Center | Oyama T.,Saku Central Hospital | Yoshida T.,Foundation for Detection of Early Gastric Carcinoma. | Baba Y.,Foundation for Detection of Early Gastric Carcinoma. | And 2 more authors.
Internal Medicine

Objective Early detection of gastric cancer by screening endoscopy facilitates endoscopic treatment in place of open surgery. The aim of this study was to evaluate whether 2 years intensive training improved the detection of gastric cancer by screening endoscopy. Methods An endoscopist who had trained for 6 years as a general physician, performed screening endoscopy at Imari Arita Kyoritsu Hospital before (group I) and after (group II) intensive training in the diagnosis of early gastric cancer in consecutive patients. Results Background characteristics, including age (61.6 vs. 62.2 years) and sex, did not differ between the groups. Before training, 10 gastric neoplasms were detected in 937 patients in group I: four early gastric cancers, one gastric adenoma, and five advanced gastric cancer. After training, 36 gastric neoplasms were detected in 937 patients in group II: 18 early gastric cancers, 11 gastric adenoma, five advanced gastric cancer, and one each of gastric carcinoid and malignant lymphoma. The detection rate for early gastric cancer was significantly improved by training [group I: 4/937 (0.4%) vs. group II: 18/937 (1.9%)], although the detection rate for advanced gastric cancer did not differ before and after training. The proportion of early gastric cancer + adenoma to advanced cancer was higher in group II (5/5 vs. 29/5 in group I). Conclusion Intensive training in upper gastrointestinal endoscopy screening dramatically improved the detection rate for early gastric cancer, although the detection rate for advanced gastric cancer was not affected. © 2012 The Japanese Society of Internal Medicine. Source

Yokoyama A.,National Hospital Organization Kurihama Alcoholism Center | Oda J.,Tokyo Metropolitan Cancer Detection Center | Iriguchi Y.,Tokyo Metropolitan Cancer Detection Center | Kumagai Y.,Kumagai Satellite Clinic | And 4 more authors.
Diseases of the Esophagus

A strong association between inactive aldehyde dehydrogenase-2 (ALDH2) and risk of esophageal cancer has been demonstrated in East Asian drinkers. An alcohol flushing questionnaire asking about past and current tendency for facial flushing to occur after drinking a glass (≈180mL) of beer predicts the presence of inactive ALDH2 among Japanese aged 40 years or older with a sensitivity and specificity of approximately 90%. We invented a health-risk appraisal (HRA) model that makes it possible to identify Japanese men who are at high risk for esophageal cancer based on their past and current alcohol flushing tendency, drinking, smoking, and intake of vegetables and fruits. Between 2008 and 2009, 2221 Japanese men aged 50 years or older filled out the HRA questionnaire before undergoing a screening examination by upper gastrointestinal endoscopy at five medical facilities. The endoscopic examination resulted in a diagnosis of esophageal cancer in 19 subjects, and 117 (5.27%) subjects had an HRA score ≥11. The proportion of subjects with an HRA score ≥11 was higher in the 50-69 age group (6.11-6.88%) than in 70-89 age group (2.84-2.86%). The esophageal cancer detection rate was 4.27% among the subjects with an HRA score ≥11 and only 0.67% among the other subjects. Based on a receiver operating characteristic curve analysis, when an HRA score of ≥9 was used for subjects aged 50-69 years and of ≥8 for those aged 70-89 years as the cutoff value to select individuals with a high risk for esophageal cancer, its sensitivity and false-positive rate was 52.6% and 15.2%, respectively, and the cancer detection rate was 2.91% in the high-risk group, as opposed to 0.48% in the other group. In conclusion, the high detection rates for esophageal cancer in the high-risk groups encouraged screening based on our HRA model in larger Japanese populations. © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus. Source

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