japanese classification of gastric carcinoma 3rd english edi

日本胃癌分类(最新版)-英文

GastricCancer

DOI10.1007/s10120-011-0041-5

SPECIALARTICLE

Japaneseclassi cationofgastriccarcinoma:3rdEnglishedition

JapaneseGastricCancerAssociation

ÓTheInternationalGastricCancerAssociationandTheJapaneseGastricCancerAssociation2011

1Generalprinciples

Gastriccancer ndingsarecategorizedandrecordedusingtheuppercaselettersT,H,etc.TheextentofdiseaseforeachparameterisexpressedbyArabicnumeralsfollowingtheletter(e.g.,T3H1);wheretheextentofdiseaseisunknown,Xisused.Theclinicalandpathologicalclassi- cationsarederivedfrominformationacquiredfromvar-iousclinical,imaging,andpathologicalsources(listedinTable1).Theclinicalclassi cation(c)isderivedattheconclusionofpretreatmentassessmentbeforeadecisionismaderegardingtheappropriatenessofsurgery.Thisclas-si cationisanessentialguidetotreatmentselectionandenablestheevaluationoftherapeuticoptions.Thepatho-logicalclassi cation(p)isbasedontheclinicalclassi -cationsupplementedormodi edbyadditionalevidenceacquiredfrompathologicalexamination.Thisinformsdecision-makingregardingadditionaltherapyandprovidesprognosticinformation.WherethereisdoubtregardingtheT,N,orMcategory,thelessadvancedcategoryshouldbeused.

Histologicaltumor ndingsarerecordedinthefollow-ingorder:tumorlocation,macroscopictype,size,histo-logicaltype,depthofinvasion,cancer–stromarelationship,patternofin ltration,lymphaticinvasion,venousinvasion,lymphnodemetastasis,andresectionmargins.Forexam-ple:L,Less,Type2,50920mm,tub1[tub2,pT2,int,INFb,ly1,v1,pN1(2/13),pPM0,pDM0(seesubsequenttextforanexplanationoftheabbreviations).

2Anatomicalextentandstageofgastriccarcinoma2.1Descriptionoftheprimarytumor2.1.1Sizeandnumberoflesions

Thetwogreatestdimensionsshouldberecordedforeachlesion.Wheretherearemultiplelesions,thetumorwiththemostadvancedTcategory(orthelargestlesionwheretheTstageisidentical)isclassi ed.2.1.2Tumorlocation

2.1.2.1ThethreegastricregionsandtheesophagogastricjunctionThestomachisanatomicallypidedintothreeportions,theupper(U),middle(M),andlower(L)parts,bythelinesconnectingthetrisectedpointsonthelesserandgreatercurvatures(Fig.1).Gastrictumorsaredescribedbythepartsinvolved.Ifmorethanonepartisinvolved,allinvolvedportionsshouldberecordedindescendingorderofdegreeofinvolvement,withthepartcontainingthebulkoftumor rst,e.g.,LMorUML.TumorextensionintotheesophagusorduodenumisrecordedasEorD,

respectively.

Theonlineversionoftheprefatoryarticlereferredtointhisarticlecanbefoundunderdoi:10.1007/s10120-011-0040-6.Englisheditioneditors:TakeshiSano(&),YasuhiroKodera.e-mail:takeshi.sano@jfcr.or.jp

JapaneseGastricCancerAssociation(&)

Associationof ce,FirstDepartmentofSurgery,KyotoPrefecturalUniversityofMedicine,

Kawaramachi,Kamigyo-ku,Kyoto602-0841,Japane-mail:jgca@koto.kpu-m.ac.jp

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日本胃癌分类(最新版)-英文

Table1Clinicalandpathologicalclassi cationClinicalclassi cation(c)

Pathologicalclassi cation(c)

Physicalexamination,imagingHistologicalexaminationofstudies,endoscopic,laparoscopicsurgicallyorendoscopicallyandsurgical ndings,biopsy,resectedspecimens;peritonealcytology,biochemicalandlavagecytology.biologicalinvestigations.

Theareaextending2cmaboveto2cmbelowtheesophagogastricjunction(EGJ)isdesignatedtheEGJarea.TumorshavingtheirepicenterinthisareaaredesignatedEGJcarcinomasirrespectiveofhistologicaltype.ThelocationofanEGJcarcinomaisdescribedusingthesym-bolsE(proximal2cmsegment)andG(distal2cmseg-ment),withthedominantareaofinvasiondescribed rst,i.e.,E,EG,E=G(bothareasequallyinvolved),GE,orG.ThedistancebetweenthetumorcenterandtheEGJisrecorded.

TheEGJisde nedastheborderbetweentheesophagealandgastricmuscles.Clinicallythisisidenti edbyoneofthefollowing:(a)thedistalendofthelongitudinalpali-sadingsmallvesselsintheloweresophagusatendoscopy;(b)thehorizontalleveloftheangleofHisshownbybar-iummealexamination;(c)theproximalendofthelongi-tudinalfoldsofthegreatercurveofthestomachshownatendoscopyorbariummealstudy;or(d)thelevelofthemacroscopiccaliberchangeoftheresectedesophagusandstomach.Itisimportanttonotethatthesquamocolumnarjunction(SCJ)doesnotalwayscoincidewiththeEGJ.Clinically,thetumorlocationisoftenexpressedascardia,fundus,body,incisura,andantrum.

2.1.2.2Cross-sectionalpartsofthestomachThestom-ach’scross-sectionalcircumferenceispidedintofourequalparts:thelesser(Less)andgreater(Gre)curvatures,andtheanterior(Ant)andposterior(Post)walls(Fig.2).CircumferentialinvolvementisrecordedasCirc.

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JapaneseGastricCancerAssociation

2.1.2.3CarcinomaintheremnantstomachCarcinomaintheremnantstomachencompassesallcarcinomasarisingintheremnantstomachfollowingagastrectomy,irrespectiveofthehistologyoftheprimarylesion(benignormalignant)oritsriskofrecurrence,theextentofresection,ormethodofreconstruction.Thefollowinginformationshouldberecorded,aswellas,ifavailable,informationontheextentofresectionandtypeofreconstructionofthepreviousgastrectomy.a.

Theprimarylesionatthepreviousgastrectomy:benign(B),malignant(M),orunknown(X).

b.Thetimeintervalelapsedbetweenthepreviousgastrec-tomyandthecurrentdiagnosis,inyears(unknown:X).c.Tumorlocationintheremnantstomach:anastomotic

site(A),gastricsutureline(S),othergastricsite(O),ortotalremnantstomach(T).Extensionintotheesoph-agus(E),duodenum(D),orjejunum(J)isrecorded.Examples:B-20-S,M-09-AJ.2.1.3Macroscopictypes

2.1.3.1Basicclassi cationGrosstumormorphologyiscategorizedaseithersuper cialoradvancedtype.Super- cialtypeistypicalofT1tumorswhileT2–4tumorsusuallymanifestasadvancedtypes(Fig.3).Viewedfromthemucosalsurface,grosstumorappearanceiscategorizedintosixtypes(Table2).Type0issubpidedaccordingtotheMacroscopicClassi cationofEarlyGastricCancer(Sect.2.1.3.2).Althoughmacroscopictypeisdeterminedregardlessofthedepthoftumorinvasion,theTcategoryshouldalsoberecorded.

2.1.3.2Subclassi cationofType0(Fig.4,modi edfromtheJapaneseEndoscopySocietyClassi cationof1962)Super- cialtumorswitht …… 此处隐藏：26803字，全部文档内容请下载后查看。喜欢就下载吧 ……