Possibility Of Lymph Node Metastasis Research Articles

The effect of cell type on surgico-pathologic risk factors in endometrial cancer

In this study the effect of histologic subtype as a surgicopathologic risk factor in endometrial cancer is evaluated. We evaluated 182 patients who underwent systematic lymphadenectomy up to the level of the renal vessels and at least 15 lymph nodes were dissected from the pelvic area and 10 lymph nodes from the para-aortic area. investigation of whether endometrioid and aggressive cell types (serous papillary cell and clear cell) affect the distribution of surgicopathologic risk factors among endometrial cancer cases was carried out. Patients in the aggressive cell type group were older and the tumor size was significantly smaller. There was no difference between the two groups for the total number of dissected lymph nodes except for the external iliac area. Although the difference is not statistically significant, the total number of lymph nodes dissected in the aggressive group was less (54.3 vs 62.9, p=0.067) than that of the endometrioid cell type group. While the incidence of pelvic lymph node metastasis in the aggressive group was 59.1% the incidence was 15.6% in the endometrioid cell type group (p>0.001). The possibility of lymph node metastasis for aggressive cell type endometrial carcinoma in the para-aortic area was twice the endometrioid cell type group. It was found that the presence and type (stromal/glandular) of cervical invasion, depth of myometrial invasion and presence of lymphovascular space invasion were not affected by cell type. Aggressive cell types significantly increase the adnexial and lymph node metastasis in endometrial cancer.

Technical issues and new devices of ESD of early gastric cancer

Endoscopic submucosal dissection (ESD) is a highly refined technique compared to conventional endoscopic mucosal resection. It enables complete resection of early gastric cancer (EGC) which has no possibility of lymph node metastasis. Indication for ESD of EGC generally entails early gastric cancer confined to the mucosa with well differentiated histology, though there are clinically suitable expanded criteria. As ESD requires specific skill and expertise, endoscopists need to be familiarized with basic methods and the use of special devices. The essence of the technique is to dissect the submucosal layer with direct vision and maintain the cutting plane above the underlying proper muscle layer. Although there are some differences in the detailed technical aspect, the cardinal method of ESD is now well established and standardized. Furthermore, research and development of new ESD devices that render more efficient, safe ESD are still in progress to improve the overall result of ESD on early gastric cancer.

A case of bilateral pelvic lymph node involvement in stage 1a1 squamous cell carcinoma of cervix and a review of the literature

Stage1a1 cervical cancer has been established to define a subset of the disease in patients who may safely be managed more conservatively and who have an excellent prognosis. Recently, however, a number of stage 1a1 cases with lymph node metastasis have been reported. Some of these cases had positive lymphovascular space invasion (LVSI), which some studies have identified as a negative prognostic factor. There is still, however, disagreement between the International Federation of Gynecology and Obstetrics (FIGO) and the Society of Gynecologic Oncologists (SGO) regarding whether LVSI may be used as a staging criterion. We report a 36-year-old patient with stage 1a1 cervical cancer who was diagnosed with multiple pelvic and parametrial lymph node metastases. Histopathology showed extensive LVSI. While stage 1a1 cases may still be managed conservatively, physicians must consider the possibility of lymph node metastasis, particularly in patients with positive LVSI, and counsel patients accordingly.

CNS and lung metastasis of sebaceous epithelioma in a dog

Sebaceous epithelioma is a common canine cutaneous neoplasm characterized by a preponderance of basaloid cells with few well-differentiated sebocytes. It is considered a low-grade malignancy, as it may occasionally recur at the excision site; the possibility of lymph node metastasis is anecdotally reported, and distant metastases have never been observed. This case report presents the clinical and pathological features of a sebaceous epithelioma of the upper lip with a highly aggressive behaviour. The patient was a 9-year-old female dachshund that developed local recurrence 11 months after the excision of the primary sebaceous epithelioma and multiple lung and central nervous system metastases 5 months later. The designation epitheliomatous sebaceous carcinoma has been suggested for aggressive sebaceous epitheliomas, although differential criteria are still to be determined.

Usefulness and faults of the sentinel lymph node biopsy using dye technique in distal gastrectomy for gastric cancer

e15509 Background: We apply sentinel node biopsy (SNB) in distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. We assessed usefulness and faults of intraoperative diagnosis of lymph node metastasis in this regard. Methods: Surgical procedures: Patent blue (1%) is injected submucosally into 4 to 5 different sites at 1 mL per site around the primary tumor. If blue nodes are found, biopsy and diagnosis of metastasis are performed at this point. Subjects and methods: The study was conducted in 96 gastric cancer patients with a preoperative diagnosis of T1 or mp invasion. Informed consent was obtained from the all patients. There were 65 males and 31 females with a mean age of 64.2 years. Tumor invasion of m, sm, mp, ss, and se was identified in 44, 38, 8, 2, and 4 patients, respectively. All patients underwent open distal gastrectomy (DG) (n=31) or laparoscopy-assisted distal gastrectomy (LADG) (n=65) and Billroth-I reconstruction. Results: The mean number of BNs dissected was 4.5 and 3.7 in DG and LADG cases, respectively. Intraoperative identification and biopsy of BNs could be performed in 34 of 35 DG patients and in 58 of 61 LADG patients. Of the 34 patients in whom BNs were identified, 5 had metastases in BNs confirmed by intraoperative frozen section diagnosis in DG cases. On the other hand, of the 58 LADG patients in whom BNs were identified, 5 had metastases in BNs confirmed by intraoperative frozen section diagnosis in LADG case. False-negative rate was 1.9%. Conclusions: SNB can be performed in LADG as well as in DG. For the case that shows infiltration up to MP, the possibility of lymph node metastasis for other lymph node is considered to be negligible. In obese cases we had some cases of no BNs and false-negative. In consequence, as long as the infiltration is lower than MP, and confirmed that metastasis was not found by blue node biopsy, distal gastrectomy using limited surgery would be thought to be done safely. No significant financial relationships to disclose.

Increased Risk of Lymph Node Metastasis in Mucosal Gastric Cancer with Extra Indication for Endoscopic Mucosal Resection

Selected cases of clinical mucosal gastric cancer can be treated endoscopically. But mucosal gastric cancer, which has a higher incidence of lymph node metastasis, should be treated by gastrectomy with lymph node dissection. Laparoscopy-assisted gastrectomy is usually indicated for the surgical treatment of mucosal gastric cancer. From April 2005 to December 2007, 148 consecutive patients with clinical mucosal gastric cancer who underwent laparoscopy-assisted gastrectomy were investigated to clarify the clinicopathologic findings in this patient group. Of the patients who underwent gastrectomy, 93 (63%) had tumors>20 mm in diameter and 92 (62%) had undifferentiated cancer. The frequency of lymph node metastasis was 8% (12 patients). One patient had second-compartment lymph node metastasis (station 8a). In patients with lymph node metastasis, 11 (92%) had an ulcer scar and 11 (92%) had undifferentiated tumors. None of the patients met the criteria for extended endoscopic submucosal dissection. The incidence of lymph node metastasis in patients with mucosal gastric cancer in whom gastrectomy is indicated is higher than reported previously. More careful consideration is needed for the possibility of lymph node metastasis in this era of endoscopic submucosal dissection.

β-catenin expression:the role in carcinogenesis and development of human breast cancer

Objective To explore the role of β-catenin expression in breast carcinogenesis. Methods β-cateninin expression of the breast diseases was detected by immunohistochcmical staining. A-mong them, there were cases with intraductal papilloma n=25, DBCH (disease of the breast cystic hyper-plasia) n = 27, DBCH with ADH(atypical ductal hyperplasia) n=26, DCIS(ductal carcnoma in situ) n=29 and IDC(invasive ductal cancinoma)n=58. Results The positive rates of β-catcnin expression in in-traductal papilloma,DBCH, DBCH with ADH, DCIS, and IDC were 4.0%, 3.7%, 23.1%, 72.4% and 79.3%, respectively. The expression of simple membranous β-catenin was statistically related with tumor size, lymph node metastasis and TNM staging (P<0.05), the expression rate was higher in patients with smaller size, no lymph node metastasis and stage Ⅰ or Ⅱ, but not with tumor grading and age of the pa-tient. The co-expression of membranous and cytoplasmic β-catenin was significantly correlated with lymph node metastasis, tbe rate rised higherly only in patients with lymph node metastasis (P<0.05). Further-more, the possibility of lymph node metastasis was higher in membranous and cytoplasmic β-catenin co-ex-pression group than in membranous group. Conclusion Positive expression of β-catcnin occurred early and continued to exist during neoplastic transformation of mammary cells;the co-expression of membranous and cytoplasmic β-catenin was significantly related with lymph node metastasis, which implied they might be a risk factor of poor prognosis, whereas the expression of membranous β-catenin only was negtively cor-related with tumor size,lymph node metastasis, and TNM staging,it might be an indicator of good progno-sis. Key words: β-catenin; Breast cancer

Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature

BackgroundCarcinoid tumors are usually considered to have a low degree of malignancy and show slow progression. One of the factors indicating the malignancy of these tumors is their size, and small ampullary carcinoid tumors have been sometimes treated by endoscopic resection.Case presentationWe report a case of a 63-year-old woman with a minute ampullary carcinoid tumor that was 7 mm in diameter, but was associated with 2 peripancreatic lymph node metastases. Mild elevation of liver enzymes was found at her regular medical check-up. Computed tomography (CT) revealed a markedly dilated common bile duct (CBD) and two enlarged peripancreatic lymph nodes. Endoscopy showed that the ampulla was slightly enlarged by a submucosal tumor. The biopsy specimen revealed tumor cells that showed monotonous proliferation suggestive of a carcinoid tumor. She underwent a pylorus-preserving whipple resection with lymph node dissection. The resected lesion was a small submucosal tumor (7 mm in diameter) at the ampulla, with metastasis to 2 peripancreatic lymph nodes, and it was diagnosed as a malignant carcinoid tumor.ConclusionRecently there have been some reports of endoscopic ampullectomy for small carcinoid tumors. However, this case suggests that attention should be paid to the possibility of lymph node metastases as well as that of regional infiltration of the tumor even for minute ampullary carcinoid tumors to provide the best chance for cure.

Sentinel Node Mapping and Skip Metastases in Patients with Early Gastric Cancer

This study was designed to identify the characteristics of patients with early gastric cancers that have skip metastases. The possibility of lymph node metastasis is the most important factor to consider when deciding on the resection procedure for patients with early gastric cancer. From February 2003 through July 2008, 739 patients with early gastric adenocarcinoma underwent gastric resection at the National Cancer Center, Korea, and were included in this study. Patients with skip metastases were analyzed and compared with those without skip metastases. Skip metastases were found in 2.8% of patients with early gastric cancer. Tumor size and the presence of lymphatic invasion were associated with skip metastases by both univariate and multivariate analysis. All skip metastases were metastases to the extraperigastric lymph nodes that skipped across the perigastric lymph nodes. Sixteen patients (66.7%) with these metastases had metastatic lymph nodes at No. 7, 8, and 9 stations. Tumor size should be considered during sentinel lymph node mapping to prevent false-negative results in patients with early gastric cancer. If sentinel nodes are not found in the perigastric lymph nodes, No. 7, 8, and 9 stations should be explored for prevention of false-negative sentinel node mapping results.

Expression of estrogen receptor, progesterone receptor, and human epithelial growth factor receptor 2 in breast cancer and the significance thereof: analysis of 910 cases

To investigate the expression of estrogen receptor (ER), progesterone receptor (PR), and human epithelial growth factor receptor 2 (HER2) in breast cancer, and to explore their correlation with the age of patient, and size, clinic stage, and lymph node metastasis of the tumor. The data of 910 breast cancer, 89.4% of invasive ductal carcinoma, 1.7% of invasive lobular carcinoma, 44 cases 5% of ductal carcinoma in situ, and 4.9% of other pathologic types, 29.9% being less than 2 cm, 45.6% being 2-5 cm, and 24.5% bigger than 5 cm in size, 54.2% without metastasis in lymph node, 25.5% with metastasis in 1-3 lymph nodes, and 20.3% with metastasis in more than 3 lymph nodes respectively, were analyzed retrospectively. Immunohistochemistry was used to detect the expression of ER, PR, and HER2. The ER negative expression rate was 33.0%, and PR negative expression rate was 27.4%, and HER2 overexpression rate was 20.3%. The possibility of lymph node metastasis decreased along with the increase of age (P < 0.001). Tumor size was negatively correlated with the expression of ER and PR (both P < 0.001), and positively correlated with the expression of HER2 (P < 0.001). There was no significant difference between the situation of lymph node metastasis and the expression of ER, PR and HER2 in primary tumors. As good prognostic markers of breast invasive ductal cancer, ER and PR are negatively correlated with the HER2 expression, as a worse prognostic marker. ER/PR positive or HER2 negative tumors are morel likely to be diagnosed at earlier stages.

A Significant Correlation between Nuclear CXCR4 Expression and Axillary Lymph Node Metastasis in Hormonal Receptor Negative Breast Cancer

In breast cancer, the expression pattern of CXCR4 may be correlated with the degree of axillary lymph node involvement. The aim of this study was to evaluate the contributing factors that contribute to the correlation between CXCR4 expression and axillary lymph node metastasis in breast cancer. Between August 1997 and August 2002, sections of paraffin-embedded tissue were obtained from 107 patients who received optimal treatment for breast cancer. The expression of CXCR4 was evaluated by immunohistochemical staining. A significant correlation was found in the expression of nuclear CXCR4 and lymph node metastasis (P = 0.03). We found a significant correlation between a high nuclear expression of CXCR4 and axillary lymphatic metastasis in estrogen and progesterone receptor negative breast cancer (P = 0.01 and P = 0.01). There was a significant correlation between the high expression of nuclear CXCR4 and axillary lymphatic metastasis in comparisons between positive estrogen and/or progesterone receptor expression and negative expression (P = 0.02). Our results showed that high expression of nuclear CXCR4 was significantly correlated with lymph node metastasis in breast cancer. The high expression of nuclear CXCR4 in hormone receptor negative breast cancer was associated with a high possibility of lymph node metastasis.

Correlation between the expression abnormalities of E-cadherin-β-catenin complex and lymph node metastasis (LNM) in early gastric cancer

15105 Background: Therapy for early gastric cancer (GC) varies according to risk of LNM. When the possibility of LNM is very remote, the primary lesion can be resected by the minimally invasive endoscopic surgery only. Therefore, useful parameters predicting LNM are needed. E-cadherin, a component of the cell-cell junctional structure, is known to correlate with GC. In vitro, previous studies elucidated that disorders of cell-cell junction increased the potential of metastasis, and that phosphorylation of β-catenin by c-erbB-2 induced loss of membranous E-cadherin and β-catenin, resulting in junctional structure disorders. Here we evaluated significance of analysis of these molecules in LNM prediction in early GC. Methods: The clinicopathological features and immunohistochemical expressions of E-cadherin, β-catenin, and c-erbB-2 in the primary lesion were studied in 28 patients (LNM +ve group: 14, LNM1 -ve group: 14) selected from 272 patients who underwent radical surgery for early GC between April 2000 to March 2004 at our hospital. All the patients consented to use of their stomach tissues for the clinical study afterwards. Statistical analysis was performed by t-test or χ2 test. Results: The clinicopathological features showed no significant differences between both groups. Loss of the membranous E-cadherin was noticed in 12 (85%) of the 14 LNM +ve patients, and in 8 (57%) of the 14 LNM -ve patients (p=0.209). This result was more remarkable in the intestinal type GC as the corresponding figures were 83% (5 of 6 ) and 16% (1 of 6) (p=0.083), respectively. Loss of the membranous β-catenin also showed a remarkable similar trend in the intestinal type GC, and the corresponding figures were 100% (6 of 6) and 50% (3 of 6) (p=0.182), respectively. Two patients showed over-expression of c-erbB2 and nuclear accumulation of β-catenin, and both had intestinal type GC with LNM. Conclusions: These results suggested that the same molecular signal pathway - as in vitro - including E-cadherin, β-catenin, and c-erbB2 induced LNM in early GC (intestinal type). We concluded that analysis of the expressions of these molecules is useful for not only LNM prediction but also determination of the therapeutic modality especially in intestinal type early GC. No significant financial relationships to disclose.

Prediction of lymph node metastasis with binary logistic regression in gastric carcinoma

To investigate more specific markers to predict the lymph node metastasis in gastric carcinoma. The expression of heparanase mRNA was detected by reverse transcription polymerase chain reaction (RT-PCR) in 43 cases with gastric cancer. The expressions of CD44V6, MMP-7, nm23 and syndecan-1 protein were examined by streptavidin-peroxidase (SP) two-step method. Clinicopathological features influencing lymphatic metastasis such as age,sex,tumor size,tumor location, Borrmann classification, histological type, differentiation and serosal infiltration were also analyzed. Twenty-seven cases (62.8%) in 43 gastric cancer patients had lymphatic metastasis. The incidence of metastatic lymph nodes was(36.3 +/- 30.8)%. The median incidence was 19%. Univariate analysis showed that tumor size, serosal infiltration, expressions of heparanase mRNA, CD44V6, nm23 and syndecan-1 protein were risk factors for lymph node metastasis in gastric carcinoma. Multivariate analysis showed expressions of nm23 and syndecan-1 protein, serosal infiltration were independent factors for lymph node metastasis. Gastric cancer with serosal infiltration, positive expressions of nm23 and syndecan-1 has greater possibility of lymph node metastasis.

The elevated level of CXCR4 is correlated with nodal metastasis of human breast cancer

CXCR4, the receptor for stromal cell-derived factor-1(SDF-1), belongs to the chemokine receptor family and has been shown to play an important role in regulating the directional migration of breast cancer cells to sites of metastasis. In the present study, we evaluated the expression of CXCR4 and its association with pathological features and clinical outcome in human breast cancer. Expression of CXCR4 in eight breast cancer cell lines and breast cancer tissues was investigated using conventional PCR. Levels of CXCR4 transcript and protein were examined in human breast cancer tissues (n=120) and corresponding normal tissues (n=32) using real-time quantitative PCR and immunohistochemistry, respectively. The level of CXCR4 expression was analyzed against tumour types, grade, nodal status, recurrence, metastasis, and survival over a median 120 month follow-up period. The expression of CXCR4 was detected in all breast cancer cell lines examined, as well as in breast cancer tissues and breast normal tissues. Breast cancer tissues highly expressed CXCR4 compared with corresponding normal tissues (P=0.029). The level of CXCR4 expression showed a significant difference between node-positive group and node-negative group (19+/-13 vs. 49.7+/-9, respectively, P=0.03). The level of CXCR4 expression was marginal, yet statistically insignificant, higher in tumours from patients with metastatic disease compared with those who remained disease free. No correlation was seen between levels of CXCR4 and the overall survival, although at higher levels of CXCR4 linked to shorter disease free survival (113.0 vs. 136.7 months in patients with low CXCR4, P=0.14, Cox proportional test). The level of CXCR4 expression is significantly correlated with lymph node metastasis. The elevated levels of CXCR4 suggest that the patient has high possibility of lymph node metastasis. CXCR4 may be a useful prognostic indicator and a potential therapeutic target in cancer therapies in patients with breast cancer.

A case of synchronous and metachronous multiple gastric cancer treated with three times of endoscopic mucosal resection and proximal gastrectomy

Seventy-four-year-old male underwent endoscopic mucosal resection (EMR) for double lesions of early gastric cancers. Another elevated lesion at the cardia was pointed out at the time. While strict observation with periodically repeated endoscopic biopsies did not demonstrate malignant change in gastric mucosa in the lesion. Group V was diagnosed by gastric biopsy in the lesion at 8 months after initial EMR. Since endoscopic and radiological examinations suggested invasion into the submucosal layer, whichi increase possibility of lymph node metastasis, proximal gastrectomy with D1＋α lymph node dissection was performed, preserving gastric function. Histopathological findings revealed advanced cancer with invasion into the muscularis propria. One year and two months after the surgery, EMR was performed again against early gastric cancer. We concluded that strict follow-up for metachronously developed gastric cancer will be important, in order to detect cancer at early stage, which will enable to preserve stomach, maintaining QOL, even for quadruple gastric cancers.

リンパ節転移を伴った直径8mmの回腸終末部カルチノイドの1例

A 54-year-old man seen at another hospital for fecal occult blood was found by colonoscopy to have multiple colon polyps and a submucosal tumor 8 mm in diameter in the terminal ileum. A histological diagnosis of carcinoid was made from a biopsy specimen from the ileal lesion. After admission to our institution, we conducted ileocecal resection. Macroscopic findings for the resected specimen showed a submucosal tumor 8×7 mm in diameter in the terminal ileum. Histological findings showed the carcinoid tumor had deeply invaded the submucosal layer and resulted in a regional lymph node metastasis. Carcinoid tumors of the ileum are rare, with our case having the munimum diameter for lymph node metastasis in Japan. In the West, jejunoileal carcinoid tumors are common and about 20% less than 10mm in diameter involve regional lymph node metastasis. Patients with small ileal carcinoid tumors should thus be suitably treated to allow for the possibility of lymph node metastasis.

Immunohistochemical analysis of lymphocytic infiltration in the tumor microenvironment in patients operated on for laryngeal cancer.

The aim of this study was to evaluate semiquantitative and qualitative analysis of lymphocytic infiltrations in a neoplasm microenvironment in patients with laryngeal cancers and the correlation analysis between the intensitivity degree and composition of lymphocytic infiltration in foreseeing a survival time and probability of the appearance of lymph node metastases. Postoperative specimens from 43 patients (Upper Silesia region) operated on for laryngeal cancer in the 2nd ENT Department, Silesian Medical University in Zabrze between 1985 and 1995 all had unfavorable courses due to tumor recurrences. The patients' ages ranged from 39 to 79 years (mean 57 years). Tissue specimens were subjected to routine processing. The degree of pathological changes was ascertained and immunohistochemical preparations of laryngeal tissue were prepared according to generally accepted methods. The following primary monoclonal antibodies were used: CD 3, CD 20, CD 43, CD 45 RO, CD 56. The distribution analysis of the intensity of the phenotype CD 43 evaluated the lymphocytic infiltration in relation to differentiation of the whole study group. The intensity of CD 43 cell infiltration increased in the group of patients with lymph node metastases. In patients with stage IV disease, a relationship was found between survival time and intensity of cell infiltrations with CD 43 and CD 45 RO lymphocytes. The influence of these two lymphocyte phenotypes in the patient subgroups - one after total laryngectomy with confirmed lymph node metastases and the other group without lymph node metastases - showed their prognostic value. Our analysis of lymphocytic infiltration, mostly of CD 43 cells, in the neoplasm microenvironment indicated a prognostic value for determining a shorter survival time and the possibility of lymph node metastases in patients with recurrences of cancer.

Detection of lymph node metastasis using desmoglein 1 expression in superficial esophageal cancer in relation to the endoscopic mucosal resection.

Endoscopic mucosal resection (EMR) has recently been standardized for mucosal cancer of the esophagus. It may be hypothesized that EMR may be considered to be curative for superficial esophageal cancer (SEC), if the possibility of lymph node metastasis can be excluded beforehand. Ninety patients with p-T1 tumours who underwent esophagectomy were studied. Their primary lesions were stained with anti-Desmoglein 1 antigens using the ABC method. The p-T1 tumors were subdivided into three categories: carcinoma limited to the lamina propria mucosae (19 patients, SEC1), carcinoma invading the lamina muscularis mucosae or with invasion just into the submucosa (27 patients, SEC2), and carcinoma definitely invading the submucosa (44 patients, SEC3). Lymph node metastasis was not observed in the SEC1 patients but was observed in 19% of the SEC2 patients and 41% of the SEC3 patients. None of the SEC1 or SEC2 patients had lymph node metastasis when preserved Desmoglein 1 expression was obtained. The EMR appears to be appropriate therapy for SEC1. Our findings indicate that, for SEC2, preserved expression of Desmoglein 1 may be a helpful aid to exclude the possibility of lymph node metastases. Transthoracic esophagectomy with lymphadenectomy should be selected in the SEC3 patients.

REOPERATION AFTER ENDOSCOPICAL POLYPECTOMY OF EARLY (SM) CARCINOMA OF THE COLORECTUM

Recent progress in endoscopic resection (ER) has led to earlier identification and radical treatment of many colorectal cancers. However, laparotomy should be done for patients in whom sm invasion was detected after ER, owing to the possibility of lymph node metastasis. Studied were patients with sm carcinoma who underwent second surgical operation following ER. 1. In terms of tumor size and macroscopic type, type IIa+IIc or type I carcinomas with longer diameters of 20mm or more were associated with lymphatic metastasis in a high rate. Thus, ER is not good for patients with such sm carcinoma. 2. Sm carcinomas were divided into 3 subdivisions, sml, 2 and 3. No lymph node metastasis was found in patients with sml carcinoma. However, metastasis was discovered in 16-17% of the patients with sm2 or 3 carcinoma. 3. The positive lymphatic metastatic rate was 10, 3% in patients who underwent second surgical operation. 4. Removal of invasive carcinoma of sm2 or more, along with scars, within 1 month after ER led to low lymphatic metastatic rates. 5. Requirements for radical treatment by ER include carcinoma with a longer diameter of 20mm or less, no infiltration to the margins of the resected lesion, well-differentiated adenocarcinoma, and invasion of sml or less.