Can magnifying endoscopy with narrow-band imaging discriminate between carcinomas and low grade adenomas in gastric superficial elevated lesions?

• Published in: Endoscopy International Open Vol. 4; no. 11; pp. E1203 - E1210
• Main Authors: Nonaka, Takashi, Inamori, Masahiko, Honda, Yasushi, Kanoshima, Kenji, Inoh, Yumi, Matsuura, Mizue, Uchiyama, Shiori, Sakai, Eiji, Higurashi, Takuma, Ohkubo, Hidenori, Iida, Hiroshi, Endo, Hiroki, Fujita, Koji, Kusakabe, Akihiko, Atsukawa, Kazuhiro, Takahashi, Hisao, Tateishi, Yoko, Maeda, Shin, Ohashi, Kenichi, Nakajima, Atsushi
• Format: Journal Article
• Language: English
• Published: Stuttgart · New York Georg Thieme Verlag KG 01-11-2016
• Subjects: Original article
• ISSN: 2364-3722; 2196-9736
• DOI: 10.1055/s-0042-117632

Background and study aims:
The aim of this study was to investigate the capability of magnifying endoscopy with narrow-band imaging (ME-NBI) to discriminate between early carcinomas (EC) and low grade adenomas (LGA) in gastric superficial elevated epithelial neoplasias.
Patients and methods:
We investigated 100 consecutive cases of gastric superficial elevated epithelial neoplasias that were removed using endoscopic submucosal dissection. The pathological diagnostic criteria were based on the revised Vienna classification; category 4 (mucosal high grade neoplasia) and category 5 (submucosal invasion by carcinoma) lesions were diagnosed as EC, whereas category 3 (mucosal low grade neoplasia) lesions were diagnosed as LGA. The associations between the postoperative pathological diagnoses and the ME-NBI findings were analyzed, and included the shape, specification, and area of irregularity in the microvascular architecture (MV) and the microsurface structure (MS).
Results:
Seventy-nine EC and 21 LGA cases diagnosed postoperatively were evaluated retrospectively. The lesion size (median; range (mm)) was significantly larger in the EC group (14; 2 – 95) compared to the LGA group (5; 2 – 16) (
P
 < 0.001). Wavy forms in the MV shapes (
P
 = 0.031), extension in the MV specifications (
P
 = 0.035), and area with MV irregularity (
P
 = 0.001) were found to be statistically significant predictive findings for EC. Villous forms in the MS shapes (
P
 = 0.026), enlargement in the MS specifications (
P
 = 0.044), and area with MS irregularity (
P
 = 0.021) were also found to be statistically significant predictive findings for EC. The rates of preoperative sensitivity, specificity, and diagnostic accuracy of ME-NBI for discriminating EC were 86.1 %, 38.9 %, and 75 %, respectively.
Conclusions:
The present study suggests that ME-NBI is useful for the differential diagnosis of EC and LGA in gastric superficial elevated epithelial neoplasias.
Study registration: UMIN000012925.