Endocytoscopic Observation of Non-Ampullary Mucosal Duodenal Cancer

Kumagai, Youichi; Higashi, Morihiro; Muramatsu, Shunsuke; Mochiki, Erito; Ishida, Hideyuki

doi:10.1159/000506930

Cited by 8 publications

(12 citation statements)

References 14 publications

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“…The use of ECS adds additional cellular information in real time to the findings of NBI magnification endoscopy in vivo. We previously reported that "enlarged oval-shaped nuclei" are a characteristic feature of duodenal cancer when using the maximum magnification power of the ECS 12 . In the present study, enlarged oval nuclei were confirmed in all of the duodenal cancer lesions.…”

Section: Discussionmentioning

confidence: 99%

“…The endocytoscopy system (ECS) is a novel ultra-high-magnification endoscope that can visualize surface epithelial cells 10 . We have previously reported the features of normal duodenal mucosa, duodenal adenoma and non-ampullary mucosal duodenal cancer revealed by ECS 11,12 . Nuclei in normal duodenal mucosa were found to show a regular arrangement in each villus and goblet cells were sparse, whereas adenomatous lesions showed loss of goblet cells and spindle-shaped nuclei with loss of polarity.…”

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confidence: 99%

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Endocytoscopic observation with methylene blue staining for duodenal neoplasms associated with familial adenomatous polyposis

Kumagai

Yamamoto

Higashi

et al. 2020

Sci Rep

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Duodenal cancer is a leading cause of death after colectomy in patients with familial adenomatous polyposis (FAP). Detailed endoscopic evaluation of duodenal lesions with potential for carcinoma development is therefore mandatory. Here we investigated the features of duodenal lesions in FAP patients using an endocytoscopy system (ECS). We retrospectively reviewed duodenal lesions in 15 cases of FAP using an ECS (GIF-H290EC) with methylene blue (MB) as the vital dye. With reference to the Spigelman classification, we investigated the number of lesions using white light (WL), narrow-band imaging (NBI), and MB staining. Using the maximum magnification power of the ECS we investigated the histology (duct openings or finger-like projections) and grade of dysplasia (presence or absence of enlarged oval-shaped nuclei) of the lesions. The number of duodenal lesions increased in ascending order of WL, NBI, and MB (P < 0.05). Among 51 MB-unstained lesions, 46 (90.2%) were proven to be duodenal neoplasms histologically. Duct openings were seen in 90.2% of tubular adenomas and tubulovillous adenomas. Finger-like projections were seen in 33.3% of tubular adenomas and in 88.2% of tubulovillous adenomas. Enlarged oval-shaped nuclei were observed in 100% of duodenal cancers, 33.3% of high-grade adenomas, and 9.4% of low-grade adenomas. MB staining allows more accurate detection of duodenal neoplasms in comparison to conventional WL and NBI observation. In cases of FAP, use of the maximum magnification power of the ECS may allow selection of lesions with high malignant potential.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Endocytoscopic observation with methylene blue staining for duodenal neoplasms associated with familial adenomatous polyposis

Kumagai

Yamamoto

Higashi

et al. 2020

Sci Rep

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“…37 Concerning duodenal cancer, few articles have reported the ECS features of nonampullary duodenal cancer. 37À39 Also, the ECS features of NAMDC, with reference to conventional histology combined with the mucin phenotype, were evaluated by the same group 40 who showed that oval-shaped nuclei and nuclear enlargement were the primary characteristics of this cancer.…”

Section: Small Bowelmentioning

confidence: 99%

Endocytoscopy for Luminal Gastrointestinal Diseases: A Systematic Review

Alkandari

Neumann

2021

Techniques and Innovations in Gastrointestinal Endoscopy

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“…4 We have previously reported that enlarged oval-shaped nuclei are a feature of duodenal cancer that can be visualized using endocytoscopy. 5 A 28-year-old woman with PJS underwent upper gastrointestinal endoscopy for periodic surveillance of gastrointestinal neoplasms. PJS was diagnosed on the basis of typical mucocutaneous pigmentation and PJ polyps in the jejunum and colon.…”

Section: Mucosal Duodenal Cancer Originating From a Peutz-jeghers Polyp: Endocytoscopic Featuresmentioning

confidence: 99%

“…The present study corroborates previous findings to maintain that CH-EUS should always be combined to EUS-tissue sampling and CT to obtain as much information as possible in PanNENs patients. 5 Authors declare no conflict of interest for this article.…”

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confidence: 99%

Mucosal duodenal cancer originating from a Peutz–Jeghers polyp: Endocytoscopic features

Kumagai

Higashi

Ishida

2021

Digestive Endoscopy

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Contrast-enhanced harmonic EUS (CH-EUS) has achieved large interest in the detection and characterization of pancreatic neoplasms. We read the manuscript by Ishikawa et al. about CH-EUS in the evaluation of pancreatic neuroendocrine neoplasms (PanNENs). 1 They enrolled 47 patients with newly-diagnosed PanNENs, comparing CH-EUS to computed tomography (CT) and histology. The tumors were classified as either aggressive or non-aggressive according to pathological or biological features. CH-EUS proved to be superior to CT in the diagnosis of aggressive PanNENs in terms of sensitivity and accuracy (94.7% vs 17.6% and 97.9% vs 66.7%, respectively) with the same specificity (100%).Conservative management of small (<2 cm), non-functional G1-G2 PanNENs is currently advised. 2 However, Ishikawa et al. showed that even small low-grade PanNENs can develop aggressive behavior. Surprisingly, 7/47 (14.9%) low-grade and 11/47 (23.4%) small neoplasms had a malignant course. Of note, 18/19 (94.7%) aggressive PanNENs showed a hypo-enhancement pattern in the late phase at CH-EUS.Hypo-enhancement of a pancreatic lesion at CH-EUS should always raise the suspicion of malignancy. 3 On the other hand, hyper-enhancement is a strong predictor of a diagnosis different from adenocarcinoma and is often related to PanNENs. Other hyper-enhanced lesions are massforming pancreatitis and metastases from kidney cancer and from hematologic malignancies. 4 In Ishikawa et al. study, histopathological examination revealed that aggressive PanNENs had higher percentage of fibrosis indicators and smaller vessel area than non-aggressive ones, explaining their hypo-enhancement.Tissue acquisition, together with patients' medical history, is still pivotal for the diagnosis of pancreatic tumors. However, since histological grading of PanNENs is not strongly predictive of their favorable course, we usually rely on suboptimal parameters such as Ki67 and size. The present study corroborates previous findings to maintain that CH-EUS should always be combined to EUS-tissue sampling and CT to obtain as much information as possible in PanNENs patients. 5 Authors declare no conflict of interest for this article.

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Endocytoscopic Observation of Non-Ampullary Mucosal Duodenal Cancer

Cited by 8 publications

References 14 publications

Endocytoscopic observation with methylene blue staining for duodenal neoplasms associated with familial adenomatous polyposis

Endocytoscopic observation with methylene blue staining for duodenal neoplasms associated with familial adenomatous polyposis

Endocytoscopy for Luminal Gastrointestinal Diseases: A Systematic Review

Mucosal duodenal cancer originating from a Peutz–Jeghers polyp: Endocytoscopic features

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