Effectiveness of Magnifying Narrow-Band Imaging Endoscopy for Differential Diagnosis between the High-Risk Mixed-Type and Low-Risk Simple-Type of Low-Grade, Well-Differentiated Gastric Tubular Adenocarcinoma

Abstract

Backgrounds. Magnifying endoscopy with narrow-band imaging (NBI-ME) is useful for diagnosing differentiated early gastric cancer (D-EGC). D-EGC is classified as high- or low-grade based on its glandular architectural and cytological atypia. Low-grade, well-differentiated tubular adenocarcinoma (LG-tub1) mixed with high-grade tub1 (HG-tub1) and/or other histological types (M-LG-tub1) may indicate a primitive high-risk malignant lesion compared to histologically simple-type LG-tub1 (S-LG-tub1). Because LG-tub1 is occasionally difficult to diagnose due to its unclear demarcation under conventional white light endoscopy, early precise diagnoses are important. Methods. We compared NBI-ME and postendoscopic submucosal dissection histological findings for 30 S-LG-tub1 and 15 M-LG-tub1 lesions. We classified the NBI-ME findings of S-LG-tub1 (and not D-EGC) into four patterns. The differential diagnosis between M-LG-tub1 and S-LG-tub1 depended on the presence of more than one of these patterns without or with other patterns (referred to as “limited-to-four-pattern [LFP] sign-positive” and “sign-negative”, resp.). Result. The sensitivity, specificity, accuracy, positive and negative predictive values, and intraobserver and interobserver agreement, using the “LFP sign” for the differential diagnosis between M-LG-tub1 and S-LG-tub1, were 87.9%, 91.7%, 88.9%, 96.7%, 73.3%, and k = 0.842 and k = 0.737, respectively. Conclusion. NBI-ME may be useful in differentiating between high-risk M-LG-tub1 and low-risk S-LG-tub1.

Endoscopic, clinicopathological, and growth characteristics of minute gastric cancer

“…In 97.56% of MGC lesions, microsurface irregularity was detected, including size variation, expansion, and contraction or fusion of glands. In addition, 79.27% of the MGC lesions showed microvascular irregularity (eg, thickening or distortion) 14,15 . The rate of microsurface irregularity in MGC was significantly higher than that of microvascular irregularity, and microvascular irregularity was generally accompanied by microsurface irregularity.…”

“…In addition, 79.27% of the MGC lesions showed microvascular irregularity (eg, thickening or distortion). 14,15 The rate of microsurface irregularity in MGC was significantly higher than that of microvascular irregularity, and microvascular irregularity was generally accompanied by microsurface Note: The table included 28 patients with data at time t0 and t1. Assuming that the date when MGC was endoscopically diagnosed was t1 and date of the prior endoscopic examination was t0.…”

Risk of multiple early gastric cancers in a patient with precursor lesions and endoscopic surveillance for 7 years

“…Magnifying endoscopy with narrow-band imaging (ME-NBI), the use of which is steadily increasing, is useful for assessing the lateral spread and histological type of differentiated EGC and for enabling targeted biopsies. [3–5]…”

How to adjust endoscopic findings to histopathological findings of the stomach: a “histopathology-oriented” correspondence method helps to understand endoscopic findings

“…Many studies have attempted to correlate pathological images to endoscopic images. Some studies have examined correspondence in a small area using two markings as landmarks [11]. Yagi et al examined the detailed relationship between endoscopic findings and histology by investigating the length of the intervening section and depth of the glands [12].…”