1. Classification of superficial neoplastic lesion : stomach 소 화 기 내 과 황보 영

2. Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case

4. ‘‘superficial’’ endoscopic appearance suggests that the depth of penetration is not more than into the submucosa there is no infiltration of the muscularis propria  Type 0

7. Incidence of Esophageal Adenocarcinoma Esophageal AdenoCA Melanoma Prostate cancer Breast, Lung, Colon NCI 2006

8. Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case

10. Terminology and Definitions Metaplasia  transformation of an epithelium to another type of epithelium with distinct morphology and function  Intestinal metaplasia 3 type type I (Complete): absorptive cells with a well- defined brush border, some goblet cells type II and III (Incomplete) :columnar intermediate cells and goblet cells that secrete sialomucin (type II) or sulfomucin (type III)

11.  In the distal esophagus, metaplasia 3 types cardiac or junctional-type glands : mucus-secreting cells oxyntic-type epithelium, parietal and chief cells are present intestinal type epithelium ‘‘specialized intestinal metaplasia.’’

12. Adenoma or Dysplasia? Noninvasive neoplastic lesion of the columnar epithelium Adenoma: protruding (polypoid) Dysplasia: flat or depressed (non-polypoid) Vienna consensus classification : adenoma and dysplasia are both replaced by ‘‘intraepithelial neoplasia.’’ p-TNM : p-Tis, p-T1m, p-T1sm

13. Low vs High

14. Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case

15. Type 0 neoplastic lesions

16. 0-I vs 0-II

17. 0-II

19. 0-III Barrettt’s esophagus

21. Cutoff Limit StomachColon

22. Squamous cell neoplasia in the esophagus

24. Endoscopic Stage Morphology  depth of invasion Type 0-I lesion  diameter : predictive criterion Submucosal invasion increases with the diameter Type 0-II lesions  morphologic subtypes Invasion of the submucosa more frequent in depressed lesions (IIc) Morphologic stage + EUS  High predictive value

25. Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case

26. Distribution of category in Japan

29. Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case

30. Baseline Characteristics 나이 60.2(24-84) 성별 (M/F) 69/27 최대직경 ( cm) 3.49 (0.18~8.5) 부위 Antrum : 60 Body: 36 Cardia: 0 LN 전이 6/96 (6.2%) 분화도 Well : 30 Moderate : 29 Poorly : 37 심달도 M : 50 Sm1: 27 Sm2: 5 Sm3: 14

31. n% 0-I7.2% 0-I5 0-I + IIa2 0-IIa,b38.5% 0-IIa7 0-IIa + IIb3 0-IIb25 0-IIb + IIa2 0-IIc46.8% 0-IIc20 0-IIc + IIa1 0-IIc + IIb3 0-IIb + IIc21 0-III7.2% 0-IIc + III5 0-III2 Total96

32. N ◦ total N ◦ mN ◦ sm% sm 0-I86% 0-I51480% 0-I + IIa202100% 0-IIa,b32% 0-IIa75229% 0-IIa + IIb31267% 0-IIb2519624% 0-IIb + IIa202100% 0-IIc47% 0-IIc2012840% 0-IIc + IIa101100% 0-IIc + IIb32133% 0-IIb + IIc2191257% 0-III85% 0-IIc + III51480% 0-III202100% Total96504648%

33. 심달도에 따른 LN 전이 M n/N(%) 0/50(0) Sm1 n/N(%) 1/27(3.7) Sm2 + Sm3 n/N(%) 5/19(26.3)

34. Stomach-nodal invasion Size in mmN<500µ n/N (%) >500µ n/N (%) <10160/15 (0)0/1 (0) 10~20430/38 (0)1/5 (20) 21~30191/11 (9)3/8 (38) >30180/13 (0)1/5 (20) Total961/77 (1.2)5/19 (26.3)

35. Contents 1. Paris workshop 의 역사적 배경, 의의 2. Terminology, Definition 3. Superficial lesion 의 분류방법 4. Japan Data 5. KHMC Data 6. Case

36. 0-I MSM3

37. 0-I + IIa SM2

38. 0-IIa MM

39. 0-IIb MM

40. 0-IIc SM3

41. 0-IIa + IIb SM3

42. 0-IIb + IIa SM2

43. 0-III SM1

44. 0-IIc + IIa SM1

45. 0-IIc + IIb MSM3

46. 0-IIb +IIc SM1M

47. 0-IIc + III MSM1

48. 감사합니다