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1/ There is a confusion between early vs advanced cancer & Superficial vs Deep Ca
Early Ca-Invasion depth to submucosa only, irrespective of nodal status
Advanced Ca- invasion beyond submucosa with regional nodes or distant metastasis
#GITwitter #MedTwitter #Gastroresidents
Early Ca-Invasion depth to submucosa only, irrespective of nodal status Advanced Ca- invasion beyond submucosa with regional nodes or distant metastasis#GITwitter #MedTwitter #Gastroresidents
2/ Superficial lesions- those that are believed to be endoscopically resectable
Deep lesions- those that are deemed “too deep” to be scooped, and thus endoscopically unresectable
#GIFellows #ACG #Tweetorial
Deep lesions- those that are deemed “too deep” to be scooped, and thus endoscopically unresectable
#GIFellows #ACG #Tweetorial
3/ The decision for endoscopic resection is based on combination of morphological and advanced imaging appearance (NBI/Chromo) @giendo_roy
High Risk for Submucosal Invasion
Depressed lesion
Kudo V pit pattern
NICE 3 pattern
Fold convergence
Non-lifting sign
High Risk for Submucosal Invasion
Depressed lesion Kudo V pit pattern NICE 3 pattern Fold convergence Non-lifting sign
4/After endoscopic treatment, curative or non-curative resection is established based on histology
Curative cut
Well or mod differentiated
Good lateral margins (>1mm)
Confined to superficial submucosa (<1mm)(Level3 in polypoid lesion)
No LV involvement
No tumor budding
Curative cut
Well or mod differentiatedGood lateral margins (>1mm)Confined to superficial submucosa (<1mm)(Level3 in polypoid lesion)No LV involvementNo tumor budding
5/There are numerous facts that we use reflexively when assessing the malignant potential of a polyp. At times, a single finding is enough to diagnose SM invasion. Other times, combination two or more findings needed for diagnosis.
How we use these information in decision making
How we use these information in decision making
When assessing the potential for invasive cancer, because of our difficulty to combine the specificities of different findings, our decisions are skewed by heuristics and biases.
To understand more on system thinking and overcoming biases, checkout https://pubmed.ncbi.nlm.nih.gov/31445686/
To understand more on system thinking and overcoming biases, checkout https://pubmed.ncbi.nlm.nih.gov/31445686/
