White opaque substance within superficial elevated gastric neoplasia as visualized by magnification endoscopy with narrow-band imaging: a new optical sign for differentiating between adenoma and carcinoma

Yao, Kenshi; Iwashita, Akinori; Tanabe, Hiroshi; Nishimata, Nobuaki; Nishizaki, Takashi; Maki, Shinichiro; Takaki, Yasuhiro; Hirai, Fumihito; Hisabe, Takashi; Nishimura, Taku; Matsui, Toshiyuki

doi:10.1016/j.gie.2008.04.011

Cited by 147 publications

(158 citation statements)

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“…Moreover, the surface appearance of an adenoma may also be an important factor for the diagnosis of malignancy [32] . Recent novel diagnostic modalities, including imageenhanced endoscopy, are useful for the differentiation of intraepithelial neoplasia [33] . Yao [33] reported that finding a white opaque substance on magnified endoscope with narrow band imaging differentiates intraepithelial neoplasia with a sensitivity of 94% and a specificity of 96%.…”

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confidence: 99%

“…Recent novel diagnostic modalities, including imageenhanced endoscopy, are useful for the differentiation of intraepithelial neoplasia [33] . Yao [33] reported that finding a white opaque substance on magnified endoscope with narrow band imaging differentiates intraepithelial neoplasia with a sensitivity of 94% and a specificity of 96%. Moreover, confocal laser endomicroscopy is reported to identify gastric superficial cancer/HGIN lesions with high validity and reliability compared to conventional white-light endoscopy and histological analysis for the final diagnosis [34] .…”

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confidence: 99%

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Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Nishida¹

2011

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Treatment strategies, whether as follow-up or "total incisional biopsy" for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen, are controversial due to problems associated with the diagnostic accuracy of endoscopic forceps biopsy and questions about the safety and efficacy of endoscopic treatment. Based on the histological findings of the biopsy specimen, it is difficult to differentiate between reactive or regenerative changes, inflammation and neoplastic changes, intraepithelial and invasive tumors. Therefore, gastric neoplasia diagnosed as noninvasive intraepithelial often develop into invasive carcinoma during follow-up. Recent advances in endoscopic modalities and treatment devices, such as image-enhanced endoscopy and highfrequency generators, may make endoscopic treatment, such as endoscopic submucosal dissection (ESD), a therapeutic option for gastric intraepithelial neoplasia, including low-grade neoplasms. Future studies are required to evaluate whether ESD is a valid strategy for gastric intraepithelial neoplasm with regard to safety and cost effectiveness.

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Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Nishida¹

2011

WJGP

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“…We previously reported that magnifying endoscopy with narrow-band imaging (ME-NBI) enables endoscopists to diagnose early gastric cancer more accurately than with conventional endoscopy, because ME-NBI can visualize the microanatomy of the superficial part of the gastric mucosa [10][11][12][13][14]. In addition, we reported the characteristic findings of papillary adenocarcinoma as visualized using ME-NBI, with vessels within the circular intervening part surrounded by circular marginal crypt epithelium, that we have labeled the vessels within epithelial circle (VEC) pattern [15,16].…”

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confidence: 99%

“…and T.N. ), who are familiar with this procedure and ME-NBI, using a high-resolution magnifying upper gastrointestinal (GI) endoscope (GIF-Q240Z; Olympus, Tokyo, Japan) or a high-definition magnifying upper GI endoscope (GIF-H260Z; Olympus), and an electronic endoscopy system (Evis Lucera Spectrum; Olympus), as described previously [10][11][12][13][14]. Before the examination, a soft black hood is mounted on the tip of the endoscope to enable the endoscopist to consistently fix the mucosa at a distance of approximately 2 mm, at which maximal magnification of the endoscopic image can be obtained.…”

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The vessels within epithelial circle (VEC) pattern as visualized by magnifying endoscopy with narrow-band imaging (ME-NBI) is a useful marker for the diagnosis of papillary adenocarcinoma: a case-controlled study

et al. 2013

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Background and aims Pathological studies indicate papillary adenocarcinomas are more aggressive than tubular adenocarcinomas, but a definitive diagnosis is difficult using conventional endoscopy alone. The vessels within an epithelial circle (VEC) pattern, visualized using magnifying endoscopy with narrow-band imaging (ME-NBI), may be a feature of papillary adenocarcinoma. The aims of our study were to investigate whether the VEC pattern is useful in the preoperative diagnosis of papillary adenocarcinoma and to determine whether VEC-positive adenocarcinomas are more malignant than VEC-negative lesions. Patients and materials From 395 consecutive early gastric cancers resected using the endoscopic submucosal dissection method, we analyzed 35 VEC-positive lesions and 70 VEC-negative control lesions matched for size and macroscopic type. We evaluated (1) the correlation between the incidence of VEC-positive cancers and the histological papillary structure and (2) differences in the incidence of coexisting undifferentiated carcinoma in VEC-positive and VEC-negative cancers and the incidence of submucosal and vascular invasion.Results Histological papillary structure was seen in 94 % (33/35) of VEC-positive and 9 % (6/70) of VEC-negative cancers, a significant difference (P \ 0.001). The incidence of coexisting undifferentiated carcinoma was 23 % (8/35) in VEC-positive and 3 % (2/70) in VEC-negative cancers (P = 0.002). The incidence of submucosal invasion by the carcinoma was 26 % (9/35) in VEC-positive cancers and 10 % (7/70) in VEC-negative cancers (P = 0.045). Conclusions The VEC pattern as visualized using ME-NBI is a promising preoperative diagnostic marker of papillary adenocarcinoma. Coexisting undifferentiated carcinoma and submucosal invasion were each seen in approximately one fourth of VEC-positive cancers.

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“…The answer is that we sometimes encounter difficulties in visualizing the subepithelial MV architecture in cases of elevated-type epithelial neoplasia [9]. Accordingly, we established a comprehensive diagnostic system-the VS classification system-involving both the MV and MS patterns, in order to facilitate the diagnosis of neoplasias of all macroscopic types (depressed, flat, and elevated types).…”

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How is the VS (vessel plus surface) classification system applicable to magnifying narrow-band imaging examinations of gastric neoplasias initially diagnosed as low-grade adenomas?

White opaque substance within superficial elevated gastric neoplasia as visualized by magnification endoscopy with narrow-band imaging: a new optical sign for differentiating between adenoma and carcinoma

Cited by 147 publications

References 20 publications

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

The vessels within epithelial circle (VEC) pattern as visualized by magnifying endoscopy with narrow-band imaging (ME-NBI) is a useful marker for the diagnosis of papillary adenocarcinoma: a case-controlled study

How is the VS (vessel plus surface) classification system applicable to magnifying narrow-band imaging examinations of gastric neoplasias initially diagnosed as low-grade adenomas?

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