Diagnostic limitations of magnifying endoscopy with narrow-band imaging in early gastric cancer

Abstract

Background and study aims Magnifying endoscopy with narrow band imaging (M-NBI) has made a huge contribution to endoscopic diagnosis of early gastric cancer (EGC). However, we sometimes encountered false-negative cases with M-NBI diagnosis (i. e., M-NBI diagnostic limitation lesion: M-NBI-DLL). However, clinicopathological features of M-NBI-DLLs have not been well elucidated. We aimed to clarify the clinicopathological features and histological reasons of M-NBI-DLLs. Patients and methods In this single-center retrospective study, M-NBI-DLLs were extracted from 456 EGCs resected endoscopically at our hospital. We defined histological types of M-NBI-DLLs and analyzed clinicopathologically to clarify histological reasons of M-NBI-DLLs. Results Of 456 EGCs, 48 lesions (10.5 %) of M-NBI-DLLs were enrolled. M-NBI-DLLs was classified into four histological types as follows: gastric adenocarcinoma of fundic-gland type (GA-FG, n = 25), gastric adenocarcinoma of fundic-gland mucosal type (GA-FGM, n = 1), differentiated adenocarcinoma (n = 14), and undifferentiated adenocarcinoma (n = 8). Thirty-nine lesions of M-NBI-DLLs were H. pylori-negative gastric cancers (39/47, 82.9 %). Histological reasons for M-NBI-DLLs were as follows: 1) completely covered with non-neoplastic mucosa (25/25 GA-FG, 8/8 undifferentiated adenocarcinoma); 2) well-differentiated adenocarcinoma with low-grade atypia (1/1 GA-FGM, 14/14 differentiated adenocarcinoma); 3) similarity of surface structure (10/14 differentiated adenocarcinoma); and 4) partially covered and/or mixed with a non-neoplastic mucosa (1/1 GA-FGM, 6/14 differentiated adenocarcinoma). Conclusions Diagnostic limitations of M-NBI depend on four distinct histological characteristics. For accurate diagnosis of M-NBI-DLLs, it may be necessary to fully understand endoscopic features of these lesions using white light imaging and M-NBI based on these histological characteristics and to take a precise biopsy.

Endoscopic Features of Gastric Epithelial Neoplasm of Fundic Gland Mucosa Lineage

“…These findings are also thought to stem from the growth pattern of GA-FG, as mentioned above. On magnifying endoscopy according to MESDA-G, GA-FG was diagnosed as non-cancerous in all cases and is considered to be one of the lesions subject to M-NBI diagnostic limitations [ 26 ]. With respect to GA-FGM, however, the prevalence of the four features on M-NBI, except for dilatation of IP, was low at about 30%.…”

CHSY3 As A Potential Therapeutic Target For Gastric Cancer

“…Many patients are diagnosed with advanced tumors as soon as they are checked, and have lost the opportunity for surgery. Obviously, this diagnostic method has certain limitations [21]. Early diagnosis of cancer is the key to improving the overall survival rate of patients, reducing disease-free progression, and reducing the risk of recurrence.…”

Application of artificial intelligence using a convolutional neural network for diagnosis of early gastric cancer based on magnifying endoscopy with narrow‐band imaging

“…In the future, this can be corrected by DL about cases that are difficult to diagnose and diagnostic limitations of EGCs, which will surely reduce false negatives and improve the negative predictive value significantly. Furthermore, we excluded ME‐NBI images of GAFG and diffuse‐type EGC to keep the quality of the AI‐assisted CNN‐CAD system, because some previous studies have reported that they should be dealt as the diagnostic limitations of ME‐NBI by VSCS 3,33 . However, we should evaluate the diagnostic ability of the AI‐assisted CNN‐CAD system for diagnostic limitation cases such as GAFG and diffuse‐type EGC for application to real clinical settings in future.…”