Endoscopic features of submucosal invasive non‐ampullary duodenal carcinomas

Takinami, Masaki; Kakushima, Naomi; Yoshida, Masao; Sasaki, Keiko; Takizawa, Kohei; Yabuuchi, Yohei; Kawata, Noboru; Kishida, Yoshihiro; Ito, Sayo; Imai, Kenichiro; Ishiwatari, Hirotoshi; Matsubayashi, Hiroyuki; Ono, Hiroyuki

doi:10.1111/jgh.14870

Cited by 15 publications

(18 citation statements)

References 30 publications

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“…These facts imply that gastric‐type duodenal neoplasms develop more frequently in the pre‐ampullary region and that GFM and HGM are precursors 16,19,23,24 . As to the biological features of gastric‐type and intestinal‐type malignant duodenal lesions, gastric‐type lesions have a higher frequency of HGN/SMC 24–26 and worse survival after resection than do intestinal‐type lesions 16 . In the current study, all gastric‐type lesions developed in the pre‐ampullary region, mostly adjacent to GFM and HGM, and 91% of them were HGN/SMC.…”

Section: Discussionsupporting

confidence: 45%

Pre‐ampullary location and size ≥10 mm are independent predictors for high‐grade superficial non‐ampullary duodenal epithelial tumors

Matsueda

Uedo

Kitamura

et al. 2020

J of Gastro and Hepatol

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Background and Aim The incidence of identified superficial non‐ampullary duodenal epithelial tumors (SNADETs) has been increasing with recent advances in endoscopic diagnosis. Nevertheless, the clinical features of SNADETs with malignant potential remain unclear. The aim of the present study was to clarify the clinical characteristics of high‐grade SNADETs. Methods A total of 328 SNADETs that had been endoscopically or surgically resected between January 2013 and April 2019 were identified from an endoscopic and pathological database. Clinical characteristics were compared between mucosal low‐grade neoplasm (n = 154) and mucosal high‐grade neoplasm/submucosal carcinoma (HGN/SMC, n = 174). Results In univariate analysis, tumor size, pre‐ampullary tumor location, red color, and rough/nodular surface were significantly associated with HGN/SMC. In multivariate analysis (odds ratio [95% confidence interval]), large (≥10 mm) tumor size (odds ratio: 4.5, 95% confidence interval: 2.6–7.7, P < 0.001) and pre‐ampullary tumor location (odds ratio: 2.1, 95% confidence interval: 1.3–3.5, P = 0.004) were independent predictors for HGN/SMC. Analysis of histological phenotypes revealed that the proportion of tumors that were HGN/SMC was much greater for gastric‐type tumors (21/23 lesions, 91%) than for intestinal‐type tumors (150/302 lesions, 50%) (P < 0.001) and that all gastric‐type tumors were located in the pre‐ampullary portion. Conclusions Pre‐ampullary location and large tumor size are independent predictors for HGN/SMC SNADETs. Pre‐ampullary tumor location is significantly associated with gastric histological phenotype. These findings may help in decision making for endoscopic treatment, active indication for pre‐ampullary tumor or tumor ≥10 mm, and understanding the pathophysiology of SNADETs.

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Section: Discussionsupporting

confidence: 45%

Pre‐ampullary location and size ≥10 mm are independent predictors for high‐grade superficial non‐ampullary duodenal epithelial tumors

Matsueda

Uedo

Kitamura

et al. 2020

J of Gastro and Hepatol

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“…We found that approximately half of SM-Ca lesions had a small diameter of �10 mm, which was higher compared to the 37% of M-Ca lesions measuring �10 mm; these findings are consistent with previous studies [5,19]. Furthermore, lesion diameter was similar between the SM-Ca and M-Ca groups (12 mm vs. 12 mm in diameter).…”

Section: Plos Onesupporting

confidence: 91%

Clinical and phenotypical characteristics of submucosal invasive carcinoma in non-ampullary duodenal cancer

et al. 2021

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Objective The rare incidence of submucosal invasive non-ampullary duodenal carcinoma has led to scant information in literature; therefore, we compared the clinicopathological features between submucosal invasive carcinoma (SM-Ca), mucosal carcinoma (M-Ca), and advanced carcinoma (Ad-Ca). Materials We retrospectively analyzed 165 patients with sporadic non-ampullary duodenal carcinomas (SNADCs) from four institutions between January 2003 and December 2018. The SNADCs were divided to three groups according to histological diagnosis: SM-Ca, M-Ca, and Ad-Ca. The clinicopathological characteristics and mucin phenotypes were compared between groups. Results Among the 165 SNADCs, 11 (7%) were classified as SM-Ca, 70 (42%) as M-Ca, and 84 (51%) as Ad-Ca. We found that all SM-Ca (P = 0.013) and most Ad-Ca (P = 0.020) lesions were located on the oral-Vater; however, an almost equal distribution of M-Ca lesions was found between the oral- and anal-Vater. No significant difference was observed between the tumor diameter of M-Ca and SM-Ca; however, 45% (5/11) of SM-Ca were ≤10 mm. A total of 73% (8/11) of SM-Ca were classified as gastric phenotype and no lesions were classified as intestinal phenotype; whereas most M-Ca were classified as intestinal phenotype (67%, 8/12). Conclusions SM-Ca lesions were all located on the oral-Vater and were highly associated with the gastric mucin phenotype, which were different from the features of most M-Ca.

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“…We found that about one-half of SM-Ca had small diameter of ≤ 10 mm, which proportion was higher than that in M-Ca ≤ 10 mm (37%). A previous study also reported that 10-33% of SM-Ca were ≤ 10 mm in diameter [3,4]. These results indicate that there is the possibility of SM-Ca even in the small lesion ≤ 10 mm in diameter.…”

Section: Discussionsupporting

confidence: 63%

“…Takinami et al also reported that 58% were mixed macroscopic type among 12 lesions, but not signi cance between M-Ca and SM-Ca [4]. Regarding the macroscopic type for Ad-Ca, in our study, 5% were super cial, 8% were protruded, 79% were ulcerated, and 8% were sclerotic type among 84 lesions.…”

Section: Discussioncontrasting

confidence: 51%

“…Although super cial non-ampullary duodenal epithelial neoplasms were rare [1,2], an opportunity of detection is increasing nowadays because of progress of endoscopic diagnosis [3]. However, the incidence of submucosal invasive carcinoma (SM-Ca) remains very rare [3,4]. This can be judged by the fact that even a multicenter case series study comprised only 10 lesions of SM-Ca out of 396 super cial nonampullary duodenal epithelial neoplasms [3].…”

Section: Introductionmentioning

confidence: 99%

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The clinicopathological features of submucosal invasive non-ampullary duodenal carcinoma

Matsueda¹,

Kanzaki²,

Takenaka³

et al. 2020

Preprint

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Background Little is known about submucosal invasive non-ampullary duodenal carcinoma because of its extreme rarity, so we investigated the clinicopathological features, comparing submucosal invasive carcinoma (SM-Ca) with mucosal carcinoma (M-Ca) and advanced carcinoma (Ad-Ca). Methods We retrospectively analyzed 165 sporadic non-ampullary duodenal carcinomas (SNADCs) at 4 institutions between January 2003 and December 2018. In addition, we compared the mucin phenotype between SM-Ca and M-Ca. Results There were only 11 cases (7%) of SM-Ca, while there were 70 cases of M-Ca (42%) and 84 cases of Ad-Ca (51%). Although the distribution of M-Ca was almost equal between the oral and anal sides of the papilla of Vater, all SM-Ca was located on the oral-Vater (P = 0.013) and Ad-Ca tended to be located on the oral-Vater (P = 0.020). Mixed macroscopic type was more frequent in SM-Ca than in M-Ca (64% vs. 10%, P < 0.001). There was no significant difference in tumor diameter between M-Ca and SM-Ca, but 45% of SM-Ca were ≤ 10 mm. 73% (8/11) of SM-Ca were classified as gastric phenotype and no lesions were intestinal phenotype, whereas most M-Ca were intestinal phenotype (67%, 8/12). Conclusions SM-Ca was highly associated with tumor location (oral-Vater) and gastric mucin phenotype, different from M-Ca. The possibility of SM-Ca should be considered when superficial SNADCs are located on oral-Vater and have mixed macroscopic type even if tumor diameters are ≤ 10 mm.

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Endoscopic features of submucosal invasive non‐ampullary duodenal carcinomas

Cited by 15 publications

References 30 publications

Pre‐ampullary location and size ≥10 mm are independent predictors for high‐grade superficial non‐ampullary duodenal epithelial tumors

Pre‐ampullary location and size ≥10 mm are independent predictors for high‐grade superficial non‐ampullary duodenal epithelial tumors

Clinical and phenotypical characteristics of submucosal invasive carcinoma in non-ampullary duodenal cancer

The clinicopathological features of submucosal invasive non-ampullary duodenal carcinoma

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