Can magnifying endoscopy with narrow-band imaging discriminate between carcinomas and low grade adenomas in gastric superficial elevated lesions?

Takashi Nonaka, Masahiko Inamori, Yasushi Honda, Kenji Kanoshima, Yumi Inoh, Mizue Matsuura, Shiori Uchiyama, Eiji Sakai, Takuma Higurashi, Hidenori Ohkubo, Hiroshi Iida, Hiroki Endo, Koji Fujita, Akihiko Kusakabe, Kazuhiro Atsukawa, Hisao Takahashi, Yoko Tateishi, Shin Maeda, Kenichi Ohashi, Atsushi Nakajima, Takashi Nonaka, Masahiko Inamori, Yasushi Honda, Kenji Kanoshima, Yumi Inoh, Mizue Matsuura, Shiori Uchiyama, Eiji Sakai, Takuma Higurashi, Hidenori Ohkubo, Hiroshi Iida, Hiroki Endo, Koji Fujita, Akihiko Kusakabe, Kazuhiro Atsukawa, Hisao Takahashi, Yoko Tateishi, Shin Maeda, Kenichi Ohashi, Atsushi Nakajima

Abstract

Background and study aims: The aim of this study was to investigate the capability of magnifying endoscopy with narrow-band imaging (ME-NBI) to discriminate between early carcinomas (EC) and low grade adenomas (LGA) in gastric superficial elevated epithelial neoplasias. Patients and methods: We investigated 100 consecutive cases of gastric superficial elevated epithelial neoplasias that were removed using endoscopic submucosal dissection. The pathological diagnostic criteria were based on the revised Vienna classification; category 4 (mucosal high grade neoplasia) and category 5 (submucosal invasion by carcinoma) lesions were diagnosed as EC, whereas category 3 (mucosal low grade neoplasia) lesions were diagnosed as LGA. The associations between the postoperative pathological diagnoses and the ME-NBI findings were analyzed, and included the shape, specification, and area of irregularity in the microvascular architecture (MV) and the microsurface structure (MS). Results: Seventy-nine EC and 21 LGA cases diagnosed postoperatively were evaluated retrospectively. The lesion size (median; range (mm)) was significantly larger in the EC group (14; 2 - 95) compared to the LGA group (5; 2 - 16) (P < 0.001). Wavy forms in the MV shapes (P = 0.031), extension in the MV specifications (P = 0.035), and area with MV irregularity (P = 0.001) were found to be statistically significant predictive findings for EC. Villous forms in the MS shapes (P = 0.026), enlargement in the MS specifications (P = 0.044), and area with MS irregularity (P = 0.021) were also found to be statistically significant predictive findings for EC. The rates of preoperative sensitivity, specificity, and diagnostic accuracy of ME-NBI for discriminating EC were 86.1 %, 38.9 %, and 75 %, respectively. Conclusions: The present study suggests that ME-NBI is useful for the differential diagnosis of EC and LGA in gastric superficial elevated epithelial neoplasias.

Study registration: UMIN000012925.

Conflict of interest statement

Competing interests: None

Figures

Fig. 1
Fig. 1
Eight patterns of the microvascular architecture (MV) shape using magnifying endoscopy with narrow-band imaging (ME-NBI).
Fig. 2
Fig. 2
ME-NBI findings showing the MV specifications.
Fig. 3
Fig. 3
ME-NBI findings showing an area with MV irregularity.
Fig. 4
Fig. 4
Eight patterns of the microsurface structure (MS) shape using ME-NBI.
Fig. 5
Fig. 5
ME-NBI findings showing the MS specifications.
Fig. 6
Fig. 6
ME-NBI findings showing an area with MS irregularity.
Fig. 7
Fig. 7
ME-NBI findings showing a complex pattern.

References

    1. Japanese Gastric Cancer Association . Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–112.
    1. Japanese Gastric Cancer Association . Japanese gastric cancer treatment guidelines 2010 (ver. 3) Gastric Cancer. 2011;14:113–123.
    1. Rugge M, Farinati F, Baffa R. et al.Gastric epithelial dysplasia in the natural history of gastric cancer: a multicenter prospective follow-up study. Interdisciplinary Group on Gastric Epithelial Dysplasia. Gastroenterology. 1994;107:1288–1296.
    1. Yamada H, Ikegami M, Shimoda T. et al.Long-term follow-up study of gastric adenoma/dysplasia. Endoscopy. 2004;36:390–396.
    1. Yoon W J, Lee D H, Jung Y J. et al.Histologic characteristics of gastric polyps in Korea: emphasis on discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimen. World J Gastroenterol. 2006;12:4029–4032.
    1. Kim Y J, Park J C, Kim J H. et al.Histologic diagnosis based on forceps biopsy is not adequate for determining endoscopic treatment of gastric adenomatous lesions. Endoscopy. 2010;42:620–626.
    1. Yao K, Anagnostopoulos G K, Ragunath K. Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy. 2009;41:462–467.
    1. Kato M, Kaise M, Yonezawa J. et al.Magnifying endoscopy with narrow-band imaging achieves superior accuracy in the differential diagnosis of superficial gastric lesions identified with white-light endoscopy: a prospective study. Gastrointest Endosc. 2010;72:523–529.
    1. Ezoe Y, Muto M, Uedo N. et al.Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology. 2011;141:2017–2025.
    1. Nakamura M, Shibata T, Tahara T. et al.The usefulness of magnifying endoscopy with narrow-band imaging to distinguish carcinoma in flat elevated lesions in the stomach diagnosed as adenoma by using biopsy samples. Gastrointest Endosc. 2010;141:1070–1075.
    1. Nonaka K, Arai S, Ban S. et al.Prospective study of the evaluation of the usefulness of tumor typing by narrow band imaging for the differential diagnosis of gastric adenoma and well-differentiated adenocarcinoma. Dig Endosc. 2011;23:146–152.
    1. Miwa K, Doyama H, Ito R. et al.Can magnifying endoscopy with narrow band imaging be useful for low grade adenomas in preoperative biopsy specimens? Gastric Cancer. 2012;15:170–178.
    1. Tsuji Y, Ohata K, Sekiguchi M. et al.Magnifying endoscopy with narrow-band imaging helps determine the management of gastric adenomas. Gastric Cancer. 2012;15:414–418.
    1. Gotoda T, Yanagisawa A, Sasako M. et al.Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–225.
    1. Dixon M F. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut. 2002;51:130–131.
    1. Nonaka T, Inamori M, Kanoshima K. et al.Evaluation of endoscopic findings for discriminating between early carcinomas and low-grade adenomas in superficial elevated gastric lesions. Turk J Gastroenterol. 2016;27:108–114.
    1. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–458.
    1. Xuan Z X, Ambe K, Enjoji M. Depressed adenoma of the stomach, revisited. Histologic, histochemical, and immunohistochemical profiles. Cancer. 1991;67:2382–2389.
    1. Tamai N, Kaise M, Nakayoshi T. et al.Clinical and endoscopic characterization of depressed gastric adenoma. Endoscopy. 2006;38:391–394.
    1. Folkman J, Klagsbrun M. Angiogenic factors. Science. 1987;235:442–447.
    1. Liu H, Li Y Q, Yu T. et al.Confocal endomicroscopy for in vivo detection of microvascular architecture in normal and malignant lesions of upper gastrointestinal tract. J Gastroenterol Hepatol. 2008;23:56–61.
    1. Tao G, Xing-Hua L, Ai-Ming Y. et al.Enhanced magnifying endoscopy for differential diagnosis of superficial gastric lesions identified with white-light endoscopy. Gastric Cancer. 2014;17:122–129.
    1. Yao K, Doyama H, Gotoda T. et al.Diagnostic performance and limitations of magnifying narrow-band imaging in screening endoscopy of early gastric cancer: a prospective multicenter feasibility study. Gastric Cancer. 2014;17:669–679.
    1. Maki S, Yao K, Nagahama T. et al.Magnifying endoscopy with narrow-band imaging is useful in the differential diagnosis between low-grade adenoma and early cancer of superficial elevated gastric lesions. Gastric Cancer. 2013;16:140–146.

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