Dr. Ravishankar Asokkumar, MBBS, MRCP, FRCP Profile picture
Nov 7, 2020 β€’ 6 tweets β€’ 4 min read β€’ Read on X
1/ There is a confusion between early vs advanced cancer & Superficial vs Deep Ca
πŸ‘‰ Early Ca-Invasion depth to submucosa only, irrespective of nodal status
πŸ‘‰ Advanced Ca- invasion beyond submucosa with regional nodes or distant metastasis
#GITwitter #MedTwitter #Gastroresidents Image
2/ Superficial lesions- those that are believed to be endoscopically resectable

Deep lesions- those that are deemed β€œtoo deep” to be scooped, and thus endoscopically unresectable

#GIFellows #ACG #Tweetorial Image
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
πŸ‘Ž Depressed lesion
πŸ‘Ž Kudo V pit pattern
πŸ‘Ž NICE 3 pattern
πŸ‘Ž Fold convergence
πŸ‘Ž Non-lifting sign Image
4/After endoscopic treatment, curative or non-curative resection is established based on histology

Curative cut
πŸ‘Well or mod differentiated
πŸ‘Good lateral margins (>1mm)
πŸ‘Confined to superficial submucosa (<1mm)(Level3 in polypoid lesion)
πŸ‘No LV involvement
πŸ‘No tumor budding Image
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 Image
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

pubmed.ncbi.nlm.nih.gov/31445686/

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