Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.
Categorias
Reescritas a partir da fonte e citadas
I
1 de 3
Type I
Adenocarcinoma of the distal esophagus whose center (epicenter) lies 1 to 5 cm above the anatomical gastroesophageal junction (GEJ); tumor burden is essentially esophageal.
CondutaTreated as an esophageal carcinoma: the standard surgical treatment is subtotal esophagectomy with proximal gastrectomy (endoscopic treatment only at very early stage).
RiscoHighest distant-metastasis rate of the three types in the cited series (~31.5% vs ~15% for II and ~4.6% for III); overall survival did not differ significantly by Siewert type (median OS ~26.6 months overall), with stage, grade and recurrence the independent OS predictors.
verificadoClassification of adenocarcinoma of the oesophagogastric junction (Siewert)Criteria & figures: PMC5448566 (Cao et al.), Introduction (type I = 1-5 cm above GEJ) and Results/Discussion (metastasis ~31.5%; OS not different by type, median ~26.6 mo; stage/grade/recurrence independent OS factors). Surgery: same source ('subtotal esophagectomy and proximal gastrectomy').
II
2 de 3
Type II
True junctional (cardia) adenocarcinoma whose center lies within the zone from 1 cm above to 2 cm below the anatomical gastroesophageal junction (GEJ); the most controversial category as it straddles the true junction.
CondutaDistal esophagectomy with total gastrectomy is preferred for type II tumors (the source does not specify a lymphadenectomy level for type II).
RiscoIntermediate distant-metastasis rate (~15%) and intermediate disease-free survival (~14 months) in the cited series; overall survival did not differ significantly between Siewert types.
verificadoClassification of adenocarcinoma of the oesophagogastric junction (Siewert)Criteria: PMC5448566 (Cao et al.), Introduction (type II = 1 cm above to 2 cm below GEJ). Management & figures: same source ('Distal esophagectomy and total gastrectomy are preferred in type II tumors'; metastasis ~15%; DFS ~14 mo; OS not different by type).
III
3 de 3
Type III
Subcardial gastric adenocarcinoma that infiltrates the GEJ/distal esophagus from below, with its center located 2 to 5 cm below the anatomical gastroesophageal junction (GEJ); tumor burden is essentially gastric.
CondutaTreated as a gastric carcinoma: total gastrectomy with D1 (gastric-cancer-protocol) lymph node dissection.
RiscoLowest distant-metastasis rate (~4.6%) and the longest disease-free survival (~20.8 months) of the three types in the cited series, though overall survival did not differ significantly by Siewert type (p=0.5).
verificadoClassification of adenocarcinoma of the oesophagogastric junction (Siewert)Criteria: PMC5448566 (Cao et al.), Introduction (type III = 2-5 cm below GEJ). Management & figures: same source ('total gastrectomy and D1 lymph node dissection' for type III; metastasis ~4.6%; DFS ~20.8 mo; OS not different by type).
Lógica de decisão estruturada
{
"categories": [
"I",
"II",
"III"
]
}
Referência, não é dispositivo médico. Confira a publicação primária vigente. O radiologista que assina o laudo continua autor e responsável.