The “white globe appearance” (WGA): a novel marker for a correct diagnosis of early gastric cancer by magnifying endoscopy with narrow-band imaging (M-NBI)

Abstract

Background and study aims: Although magnifying endoscopy with narrow-band imaging (M-NBI) is useful for the diagnosis of gastric mucosal lesions, differentiating between early cancer (EC) and low grade adenoma (LGA) remains a challenge. During M-NBI examination, we have noted the presence of a small, white lesion with a globular shape underneath cancerous gastric epithelium, and have termed this endoscopic finding the “white globe appearance” (WGA). The aim of this study was to determine whether or not the WGA could be an endoscopic marker for distinguishing EC from LGA. Methods: We retrospectively analyzed both the M-NBI scans and resected specimens of a total of 111 gastric lesions from 95 consecutive patients. Our main outcome was a difference in the prevalence of the WGA in EC and LGA. Results: The prevalence of the WGA in EC and LGA was 21.5 % (20 /93) and 0 % (0 /18), respectively (P = 0.039). The sensitivity, specificity, positive predictive value, and negative predictive value for differentiating between EC and LGA, according to the presence of the WGA, were 21.5, 100, 100, and 19.8 %, respectively. Conclusion: A positive WGA in a suspicious lesion on M-NBI would be an adjunct to the M-NBI diagnosis of possible EC because the specificity and positive predictive value of the WGA for differentiating between EC and LGA were extremely high. The WGA could be a novel endoscopic marker for differentiating between EC and LGA.

White globe appearance is a novel specific endoscopic marker for gastric cancer: A prospective study

“…WGA is a small (<1 mm) white lesion with a globular shape located underneath the gastric epithelium. Based on pathological investigations, we speculate that WGA corresponds to intraglandular necrotic debris (IND), defined as eosinophilic material with necrotic epithelial fragments within the lumen of a dilated gland . IND is considered a possible histological marker for cancer .…”

“…The results of this prospective study demonstrate that the prevalence of WGA in GC is significantly higher than in NC, including gastritis (21.4% vs 2.5%). A previous report showed that WGA was present in 21.5% of early GC and in 0% of LGA, and the authors concluded that WGA was useful for the differentiation between GC and LGA . Here, WGA was found to be infrequent in all cases of NC, including gastritis.…”

“…IND is considered a possible histological marker for cancer . We have also retrospectively studied and reported that WGA has high specificity (100%) in differentiating early GC from low‐grade adenoma (LGA) . We hypothesize that WGA can be a useful marker for developing an advanced M‐NBI diagnostic system for GC.…”

“…We identified ‘white globe appearance’ (WGA) as a novel endoscopic marker for GC during M‐NBI observation . WGA is a small (<1 mm) white lesion with a globular shape located underneath the gastric epithelium.…”

Diagnosis of Helicobacter pylori‐related chronic gastritis, gastric adenoma and early gastric cancer by magnifying endoscopy

“…During ME‐NBI, Doyama et al noted the presence of a small, white lesion with a globular shape underneath cancerous gastric epithelium, and have termed this endoscopic finding the WGA (Fig. ) . By careful histological investigation, some of the WGA visualized under ME‐NBI were found to correspond to intraglandular necrotic debris within markedly dilated neoplastic glands, suggesting it may be possible histological marker that is specific for cancer (Fig.…”