**3. Ip type (pedunculated lesion) and non-Ip type (nonpedunculated lesion) of early colorectal carcinoma**

**2. Correlations between lymph node metastasis and early colorectal**

American Joint Committee on Cancer (AJCC) staging system (Table 1).

Tx: No description of the tumor's extent is possible because of incomplete information.

T1: The cancer has grown through the muscularis mucosa and extends into the submucosa.

through them. It has not reached any nearby organs or tissues.

162 Colonoscopy and Colorectal Cancer Screening - Future Directions

**Table 1.** T categories for colorectal cancer of the AJCC staging system.

lymph node dissection is necessary.

The endoscopic mucosal resection and endoscopic submucosal dissection (EMR/ESD) have become useful for early CRC which is defined as a T1 stage tumour whose invasion is limit‐ ed to the mucosa or submucosa according to the T categories for colorectal cancer of the

Tis: The cancer is in the earliest stage (in situ). It involves only the mucosa. It has not grown beyond the muscularis

T2: The cancer has grown through the submucosa and extends into the muscularis propria (thick outer muscle layer).

T3: The cancer has grown through the muscularis propria and into the outermost layers of the colon or rectum but not

T4a: The cancer has grown through the serosa (also known as the visceral peritoneum), the outermost lining of the

T4b:The cancer has grown through the wall of the colon or rectum and is attached to or invades into nearby tissues or

The endoscopic mucosal dissection (EMR: endoscopic mucosal resection and ESD: endo‐ scopic submucosal dissection) of intramucosal carcinoma is accepted as curative, as there is almost negative of lymph node metastasis. [1-4]. However, the reported prevalence rates of lymph node metastasis range from 6 to 12% of all patients with submucosal invasive color‐ ectal carcinoma (SICC) [3-6]. Therefore, the endoscopic mucosal dissected cases of SICC with lymph node metastasis, and after EMR/ESD, surgical resection accompanied with

It has been known that we should be considered be additional resection is required due to the risk of lymph node metastasis following findings (1) massive submucosal invasion: (2) lymphatic/vessel invasion; or (3) poorly differentiated component in resected EMR/ESD specimens [7, 8]. There has been no standard method of measurement of sub‐ mucosal invasion depth. Therefore, Japanese Society for Cancer of the Colon and Rectum has recently demonstrated definite for method of measurement of submucosal invasion

**carcinoma**

mucosa (inner muscle layer).

intestines.

organs.

depth.

Macroscopic type (endoscopic finding) was assessed according to the macroscopic clas‐ sification of early stomach carcinoma, with minor modifications. In shortly, SICCs were div‐ ided into two lesions: pedunculated (Ip type) (Figure. 1, Figure. 2(a)) and nonpedunculated (Non-Ip type) (Figure. 1b, Figure. 2(b)). Nonpedunculated lesion were subclassified as semi‐ pedunculated lesion (Isp type) and sessile lesion (Is type). Respectively. Ip type (pedunculat‐ ed lesion) has typically head with stalk (Figure. 1, Figure 2).

**Figure 1.** Schema of macroscopic (endoscopic) classification of SICCs: pedunculated(Ip type) and nonpedunculat‐ ed(Non-Ip type). Arrowhead: muscularis mucosae.: 0 µm

**Figure 2.** Histological appearance of pedunculated(Ip type) (a) and nonpedunculated(Non-Ip type) (b) on Hematoxy‐ lin and Eosin staining section.

The method used for measurement of submucosal invasion depth (Figure. 3)

On the other hand, nonpedunculated and when the muscularis mucosae could be identified in hematoxylin and eosin stain, the muscularis mucosae was used as baseline and the verti‐ cal distance from this line to the deepest site of invasion represented submucosal invasion depth, (Figure. 4(c))., however, when the muscularis mucosae could not be identified, the su‐

Desmoplastic Reaction in Biopsy Specimens of T1 Stage Colorectal Cancer Plays a Critical Role in Defining the Level...

http://dx.doi.org/10.5772/51900

165

Figure 4. Schema<\$%&?>of<\$%&?>measurement<\$%&?>of<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth.<\$%&?>Ip<\$%&?>type<\$%&?>with<

Figure 4. Schema<\$%&?>of<\$%&?>measurement<\$%&?>of<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth.<\$%&?>Ip<\$%&?>type<\$%&?>with<

**Figure 4.** Schema of measurement of submucosal invasion depth. Ip type with head invasion (a) and stalk invasion (b),

(c) (d)

(c) (d)

(a) (b)

(a) (b)

Ip<\$%&?>type<\$%&?>with<\$%&?>musucular<\$%&?>mucosae<\$%&?>(c)<\$%&?>and<\$%&?>without<\$%&?>musucular<\$%&?>mucosae<\$%&?>(d)

Ip<\$%&?>type<\$%&?>with<\$%&?>musucular<\$%&?>mucosae<\$%&?>(c)<\$%&?>and<\$%&?>without<\$%&?>musucular<\$%&?>mucosae<\$%&?>(d)

(a) (b)

(a) (b)

Figure 5. Histological<\$%&?>findings<\$%&?>with<\$%&?>depth<\$%&?>of<\$%&?>submucosal<\$%&?>invasion<\$%&?>(μm).<\$%&?>Ip<\$%&?>typ e<\$%&?>with<\$%&?>head<\$%&?>invasion:<\$%&?>0<\$%&?>μm<\$%&?>(a)<\$%&?>and<\$%&?>stalk<\$%&?>invasion:<\$%&?>0<\$%&?>μm<\$%&?>(b

Figure 5. Histological<\$%&?>findings<\$%&?>with<\$%&?>depth<\$%&?>of<\$%&?>submucosal<\$%&?>invasion<\$%&?>(μm).<\$%&?>Ip<\$%&?>typ e<\$%&?>with<\$%&?>head<\$%&?>invasion:<\$%&?>0<\$%&?>μm<\$%&?>(a)<\$%&?>and<\$%&?>stalk<\$%&?>invasion:<\$%&?>0<\$%&?>μm<\$%&?>(b

(c) (d)

**Figure 5.** Histological findings with depth of submucosal invasion (µm). Ip type with head invasion: 0 µm (a) and stalk invasion: X µm (b), non-Ip type with musucular mucosae: Y µm (c) and without musucular mucosae: Z µm (d) on Hem‐

(c) (d)

Ip<\$%&?>type<\$%&?>with<\$%&?>musucular<\$%&?>mucosae:<\$%&?>0<\$%&?>μm<\$%&?>(c)<\$%&?>and<\$%&?>without<\$%&?>musucular<\$%& ?>mucosae:<\$%&?>0<\$%&?>μm<\$%&?>with<\$%&?>tumor<\$%&?>bading<\$%&?>(d)<\$%&?>on<\$%&?>Hematoxylin<\$%&?>and<\$%&?>Eosin<\$%

Ip<\$%&?>type<\$%&?>with<\$%&?>musucular<\$%&?>mucosae:<\$%&?>0<\$%&?>μm<\$%&?>(c)<\$%&?>and<\$%&?>without<\$%&?>musucular<\$%& ?>mucosae:<\$%&?>0<\$%&?>μm<\$%&?>with<\$%&?>tumor<\$%&?>bading<\$%&?>(d)<\$%&?>on<\$%&?>Hematoxylin<\$%&?>and<\$%&?>Eosin<\$%&?>staining<\$%&?>section.

**4.<\$%&?>Correlations<\$%&?>between<\$%&?>lymph<\$%&?>node<\$%&?>metastasis<\$%&?>an d<\$%&?>depth<\$%&?>of<\$%&?>submucosal<\$%&?>invasive<\$%&?>colorectal<\$%&?>carcino**

**4.<\$%&?>Correlations<\$%&?>between<\$%&?>lymph<\$%&?>node<\$%&?>metastasis<\$%&?>an d<\$%&?>depth<\$%&?>of<\$%&?>submucosal<\$%&?>invasive<\$%&?>colorectal<\$%&?>carcino**

The<\$%&?>Japanese<\$%&?>collaborative<\$%&?>retrospectively<\$%&?>study<\$%&?>for<\$%&?>865<\$%&?>SICCs.<\$%&?>This<\$ %&?>nationwide<\$%&?>survey<\$%&?>not<\$%&?>only<\$%&?>represents<\$%&?>a<\$%&?>rst<\$%&?>for<\$%&?>Japan,<\$%&?>bu t<\$%&?>reviewing<\$%&?>the<\$%&?>literature<\$%&?>using<\$%&?>PubMed<\$%&?>revealed<\$%&?>no<\$%&?>similar<\$%&?>sur veys<\$%&?>from<\$%&?>anywhere<\$%&?>in<\$%&?>the<\$%&?>world<\$%&?>at<\$%&?>that<\$%&?>time<\$%&?>[3]<\$%&?>This<\$ %&?>study<\$%&?>reported<\$%&?>that<\$%&?>pedunculated<\$%&?>(Ip<\$%&?>type)<\$%&?>SICC,<\$%&?>rate<\$%&?>of<\$%&?>l ymph<\$%&?>node<\$%&?>metastasis<\$%&?>was<\$%&?>never<\$%&?>in<\$%&?>head<\$%&?>invasion<\$%&?>cases<\$%&?>and<\$ %&?>stalk<\$%&?>invasion<\$%&?>cases<\$%&?>with<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth<\$%&?><<\$%&?>3000<\$%&

The<\$%&?>Japanese<\$%&?>collaborative<\$%&?>retrospectively<\$%&?>study<\$%&?>for<\$%&?>865<\$%&?>SICCs.<\$%&?>This<\$ %&?>nationwide<\$%&?>survey<\$%&?>not<\$%&?>only<\$%&?>represents<\$%&?>a<\$%&?>rst<\$%&?>for<\$%&?>Japan,<\$%&?>bu t<\$%&?>reviewing<\$%&?>the<\$%&?>literature<\$%&?>using<\$%&?>PubMed<\$%&?>revealed<\$%&?>no<\$%&?>similar<\$%&?>sur veys<\$%&?>from<\$%&?>anywhere<\$%&?>in<\$%&?>the<\$%&?>world<\$%&?>at<\$%&?>that<\$%&?>time<\$%&?>[3]<\$%&?>This<\$ %&?>study<\$%&?>reported<\$%&?>that<\$%&?>pedunculated<\$%&?>(Ip<\$%&?>type)<\$%&?>SICC,<\$%&?>rate<\$%&?>of<\$%&?>l ymph<\$%&?>node<\$%&?>metastasis<\$%&?>was<\$%&?>never<\$%&?>in<\$%&?>head<\$%&?>invasion<\$%&?>cases<\$%&?>and<\$ %&?>stalk<\$%&?>invasion<\$%&?>cases<\$%&?>with<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth<\$%&?><<\$%&?>3000<\$%&

Ip<\$%&?>type)<\$%&?>SICC,<\$%&?>rate<\$%&?>of<\$%&?>lymph<\$%&?>node<\$%&?>metastasis<\$%&?>was<\$%&?>also<\$%&?>0 %<\$%&?>if<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth<\$%&?>was<\$%&?><1000<\$%&?>μm<\$%&?>(Table<\$%&?>3).<\$%&? >In<\$%&?>multivariate<\$%&?>analysis,<\$%&?>SM<\$%&?>depth<\$%&?><1000μm<\$%&?>(P<\$%&?><0.006),<\$%&?>sprouting<\$% &?>(P<\$%&?><0.002),<\$%&?>and<\$%&?>lymphatic<\$%&?>invasion<\$%&?>(P<0.0001)<\$%&?>represented<\$%&?>signicant<\$%&

Ip<\$%&?>type)<\$%&?>SICC,<\$%&?>rate<\$%&?>of<\$%&?>lymph<\$%&?>node<\$%&?>metastasis<\$%&?>was<\$%&?>also<\$%&?>0 %<\$%&?>if<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth<\$%&?>was<\$%&?><1000<\$%&?>μm<\$%&?>(Table<\$%&?>3).<\$%&? >In<\$%&?>multivariate<\$%&?>analysis,<\$%&?>SM<\$%&?>depth<\$%&?><1000μm<\$%&?>(P<\$%&?><0.006),<\$%&?>sprouting<\$% &?>(P<\$%&?><0.002),<\$%&?>and<\$%&?>lymphatic<\$%&?>invasion<\$%&?>(P<0.0001)<\$%&?>represented<\$%&?>signicant<\$%&

?>μm<\$%&?>if<\$%&?>lymphatic<\$%&?>invasion<\$%&?>was<\$%&?>negative<\$%&?>(Table<\$%&?>2).<\$%&?>

?>μm<\$%&?>if<\$%&?>lymphatic<\$%&?>invasion<\$%&?>was<\$%&?>negative<\$%&?>(Table<\$%&?>2).<\$%&?>

perficial aspect of the SICC was used as baseline, (Figure. 4(d)).

\$%&?>head<\$%&?>invasion<\$%&?>(a)<\$%&?>and<\$%&?>stalk<\$%&?>invasion<\$%&?>(b),<\$%&?>non-

\$%&?>head<\$%&?>invasion<\$%&?>(a)<\$%&?>and<\$%&?>stalk<\$%&?>invasion<\$%&?>(b),<\$%&?>non-

non-Ip type with musucular mucosae (c) and without musucular mucosae (d).

.

.

),<\$%&?>non-

),<\$%&?>non-

**ma** 

**ma** 

&?>staining<\$%&?>section.

And,<\$%&?>For<\$%&?>nonpedunculated<\$%&?>(non-

And,<\$%&?>For<\$%&?>nonpedunculated<\$%&?>(non-

atoxylin and Eosin staining section

**Figure 3.** Algorithm of measurement of submucosal invasion depth.

Firstly, EMR/ESD resected specimens are divided into pedunculated(Ip type) and nonpe‐ dunculated(Non-Ip type). For pedunculated SICC, level 2 according to Haggitt's classificati‐ on [9] was used as the baseline (so-called Haggitt's line), and submucosal invasion depth was measured as the vertical distance from this line to the deepest site of invasion. The base‐ line to distinguish between head invasion, (Figure. 4(a)) and stalk invasion, (Figure. 4(b)). In head invasion, submucosal invasion depth was regarded as 0 µm. When the deepest portion of invasion was located below the baseline, the case was defined as a stalk invasion and the vertical distance from this line to the deepest portion of invasion was utilized as submucosal invasion depth.

On the other hand, nonpedunculated and when the muscularis mucosae could be identified in hematoxylin and eosin stain, the muscularis mucosae was used as baseline and the verti‐ cal distance from this line to the deepest site of invasion represented submucosal invasion depth, (Figure. 4(c))., however, when the muscularis mucosae could not be identified, the su‐ perficial aspect of the SICC was used as baseline, (Figure. 4(d)).

The method used for measurement of submucosal invasion depth (Figure. 3)

164 Colonoscopy and Colorectal Cancer Screening - Future Directions

**Figure 3.** Algorithm of measurement of submucosal invasion depth.

invasion depth.

Firstly, EMR/ESD resected specimens are divided into pedunculated(Ip type) and nonpe‐ dunculated(Non-Ip type). For pedunculated SICC, level 2 according to Haggitt's classificati‐ on [9] was used as the baseline (so-called Haggitt's line), and submucosal invasion depth was measured as the vertical distance from this line to the deepest site of invasion. The base‐ line to distinguish between head invasion, (Figure. 4(a)) and stalk invasion, (Figure. 4(b)). In head invasion, submucosal invasion depth was regarded as 0 µm. When the deepest portion of invasion was located below the baseline, the case was defined as a stalk invasion and the vertical distance from this line to the deepest portion of invasion was utilized as submucosal

Figure 4. Schema<\$%&?>of<\$%&?>measurement<\$%&?>of<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth.<\$%&?>Ip<\$%&?>type<\$%&?>with< \$%&?>head<\$%&?>invasion<\$%&?>(a)<\$%&?>and<\$%&?>stalk<\$%&?>invasion<\$%&?>(b),<\$%&?>non-**Figure 4.** Schema of measurement of submucosal invasion depth. Ip type with head invasion (a) and stalk invasion (b), non-Ip type with musucular mucosae (c) and without musucular mucosae (d). Figure 4. Schema<\$%&?>of<\$%&?>measurement<\$%&?>of<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth.<\$%&?>Ip<\$%&?>type<\$%&?>with< \$%&?>head<\$%&?>invasion<\$%&?>(a)<\$%&?>and<\$%&?>stalk<\$%&?>invasion<\$%&?>(b),<\$%&?>non-Ip<\$%&?>type<\$%&?>with<\$%&?>musucular<\$%&?>mucosae<\$%&?>(c)<\$%&?>and<\$%&?>without<\$%&?>musucular<\$%&?>mucosae<\$%&?>(d)

Ip<\$%&?>type<\$%&?>with<\$%&?>musucular<\$%&?>mucosae<\$%&?>(c)<\$%&?>and<\$%&?>without<\$%&?>musucular<\$%&?>mucosae<\$%&?>(d)

.

.

),<\$%&?>non-

),<\$%&?>non-

**ma** 

**ma** 

&?>staining<\$%&?>section.

&?>staining<\$%&?>section.

And,<\$%&?>For<\$%&?>nonpedunculated<\$%&?>(non-

And,<\$%&?>For<\$%&?>nonpedunculated<\$%&?>(non-

Figure 5. Histological<\$%&?>findings<\$%&?>with<\$%&?>depth<\$%&?>of<\$%&?>submucosal<\$%&?>invasion<\$%&?>(μm).<\$%&?>Ip<\$%&?>typ (c) (d) Figure 5. Histological<\$%&?>findings<\$%&?>with<\$%&?>depth<\$%&?>of<\$%&?>submucosal<\$%&?>invasion<\$%&?>(μm).<\$%&?>Ip<\$%&?>typ e<\$%&?>with<\$%&?>head<\$%&?>invasion:<\$%&?>0<\$%&?>μm<\$%&?>(a)<\$%&?>and<\$%&?>stalk<\$%&?>invasion:<\$%&?>0<\$%&?>μm<\$%&?>(b **Figure 5.** Histological findings with depth of submucosal invasion (µm). Ip type with head invasion: 0 µm (a) and stalk invasion: X µm (b), non-Ip type with musucular mucosae: Y µm (c) and without musucular mucosae: Z µm (d) on Hem‐ atoxylin and Eosin staining section

e<\$%&?>with<\$%&?>head<\$%&?>invasion:<\$%&?>0<\$%&?>μm<\$%&?>(a)<\$%&?>and<\$%&?>stalk<\$%&?>invasion:<\$%&?>0<\$%&?>μm<\$%&?>(b

Ip<\$%&?>type<\$%&?>with<\$%&?>musucular<\$%&?>mucosae:<\$%&?>0<\$%&?>μm<\$%&?>(c)<\$%&?>and<\$%&?>without<\$%&?>musucular<\$%& ?>mucosae:<\$%&?>0<\$%&?>μm<\$%&?>with<\$%&?>tumor<\$%&?>bading<\$%&?>(d)<\$%&?>on<\$%&?>Hematoxylin<\$%&?>and<\$%&?>Eosin<\$%

Ip<\$%&?>type<\$%&?>with<\$%&?>musucular<\$%&?>mucosae:<\$%&?>0<\$%&?>μm<\$%&?>(c)<\$%&?>and<\$%&?>without<\$%&?>musucular<\$%& ?>mucosae:<\$%&?>0<\$%&?>μm<\$%&?>with<\$%&?>tumor<\$%&?>bading<\$%&?>(d)<\$%&?>on<\$%&?>Hematoxylin<\$%&?>and<\$%&?>Eosin<\$%

**4.<\$%&?>Correlations<\$%&?>between<\$%&?>lymph<\$%&?>node<\$%&?>metastasis<\$%&?>an d<\$%&?>depth<\$%&?>of<\$%&?>submucosal<\$%&?>invasive<\$%&?>colorectal<\$%&?>carcino**

**4.<\$%&?>Correlations<\$%&?>between<\$%&?>lymph<\$%&?>node<\$%&?>metastasis<\$%&?>an d<\$%&?>depth<\$%&?>of<\$%&?>submucosal<\$%&?>invasive<\$%&?>colorectal<\$%&?>carcino**

The<\$%&?>Japanese<\$%&?>collaborative<\$%&?>retrospectively<\$%&?>study<\$%&?>for<\$%&?>865<\$%&?>SICCs.<\$%&?>This<\$ %&?>nationwide<\$%&?>survey<\$%&?>not<\$%&?>only<\$%&?>represents<\$%&?>a<\$%&?>rst<\$%&?>for<\$%&?>Japan,<\$%&?>bu t<\$%&?>reviewing<\$%&?>the<\$%&?>literature<\$%&?>using<\$%&?>PubMed<\$%&?>revealed<\$%&?>no<\$%&?>similar<\$%&?>sur veys<\$%&?>from<\$%&?>anywhere<\$%&?>in<\$%&?>the<\$%&?>world<\$%&?>at<\$%&?>that<\$%&?>time<\$%&?>[3]<\$%&?>This<\$ %&?>study<\$%&?>reported<\$%&?>that<\$%&?>pedunculated<\$%&?>(Ip<\$%&?>type)<\$%&?>SICC,<\$%&?>rate<\$%&?>of<\$%&?>l ymph<\$%&?>node<\$%&?>metastasis<\$%&?>was<\$%&?>never<\$%&?>in<\$%&?>head<\$%&?>invasion<\$%&?>cases<\$%&?>and<\$ %&?>stalk<\$%&?>invasion<\$%&?>cases<\$%&?>with<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth<\$%&?><<\$%&?>3000<\$%&

The<\$%&?>Japanese<\$%&?>collaborative<\$%&?>retrospectively<\$%&?>study<\$%&?>for<\$%&?>865<\$%&?>SICCs.<\$%&?>This<\$ %&?>nationwide<\$%&?>survey<\$%&?>not<\$%&?>only<\$%&?>represents<\$%&?>a<\$%&?>rst<\$%&?>for<\$%&?>Japan,<\$%&?>bu t<\$%&?>reviewing<\$%&?>the<\$%&?>literature<\$%&?>using<\$%&?>PubMed<\$%&?>revealed<\$%&?>no<\$%&?>similar<\$%&?>sur veys<\$%&?>from<\$%&?>anywhere<\$%&?>in<\$%&?>the<\$%&?>world<\$%&?>at<\$%&?>that<\$%&?>time<\$%&?>[3]<\$%&?>This<\$ %&?>study<\$%&?>reported<\$%&?>that<\$%&?>pedunculated<\$%&?>(Ip<\$%&?>type)<\$%&?>SICC,<\$%&?>rate<\$%&?>of<\$%&?>l ymph<\$%&?>node<\$%&?>metastasis<\$%&?>was<\$%&?>never<\$%&?>in<\$%&?>head<\$%&?>invasion<\$%&?>cases<\$%&?>and<\$ %&?>stalk<\$%&?>invasion<\$%&?>cases<\$%&?>with<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth<\$%&?><<\$%&?>3000<\$%&

Ip<\$%&?>type)<\$%&?>SICC,<\$%&?>rate<\$%&?>of<\$%&?>lymph<\$%&?>node<\$%&?>metastasis<\$%&?>was<\$%&?>also<\$%&?>0 %<\$%&?>if<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth<\$%&?>was<\$%&?><1000<\$%&?>μm<\$%&?>(Table<\$%&?>3).<\$%&? >In<\$%&?>multivariate<\$%&?>analysis,<\$%&?>SM<\$%&?>depth<\$%&?><1000μm<\$%&?>(P<\$%&?><0.006),<\$%&?>sprouting<\$% &?>(P<\$%&?><0.002),<\$%&?>and<\$%&?>lymphatic<\$%&?>invasion<\$%&?>(P<0.0001)<\$%&?>represented<\$%&?>signicant<\$%&

Ip<\$%&?>type)<\$%&?>SICC,<\$%&?>rate<\$%&?>of<\$%&?>lymph<\$%&?>node<\$%&?>metastasis<\$%&?>was<\$%&?>also<\$%&?>0 %<\$%&?>if<\$%&?>submucosal<\$%&?>invasion<\$%&?>depth<\$%&?>was<\$%&?><1000<\$%&?>μm<\$%&?>(Table<\$%&?>3).<\$%&? >In<\$%&?>multivariate<\$%&?>analysis,<\$%&?>SM<\$%&?>depth<\$%&?><1000μm<\$%&?>(P<\$%&?><0.006),<\$%&?>sprouting<\$% &?>(P<\$%&?><0.002),<\$%&?>and<\$%&?>lymphatic<\$%&?>invasion<\$%&?>(P<0.0001)<\$%&?>represented<\$%&?>signicant<\$%&

?>μm<\$%&?>if<\$%&?>lymphatic<\$%&?>invasion<\$%&?>was<\$%&?>negative<\$%&?>(Table<\$%&?>2).<\$%&?>

?>μm<\$%&?>if<\$%&?>lymphatic<\$%&?>invasion<\$%&?>was<\$%&?>negative<\$%&?>(Table<\$%&?>2).<\$%&?>
