Characteristic findings of high-grade cervical intraepithelial neoplasia or more on magnifying endoscopy with narrow band imaging

2018 ◽  
Vol 23 (4) ◽  
pp. 707-714 ◽  
Author(s):  
Kunihisa Uchita ◽  
Kenji Kanenishi ◽  
Koki Hirano ◽  
Hideki Kobara ◽  
Noriko Nishiyama ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Intraepithelial Neoplasia ◽  
Magnifying Endoscopy ◽  
High Grade

scholarly journals Quality Assessment of Endoscopic Forceps Biopsy Samples under Magnifying Narrow Band Imaging for Histological Diagnosis of Cervical Intraepithelial Neoplasia: A Feasibility Study

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 360
Author(s):  
Kunihisa Uchita ◽  
Hideki Kobara ◽  
Kenji Yorita ◽  
Yuriko Shigehisa ◽  
Chihiro Kuroiwa ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Intraepithelial Neoplasia ◽  
Final Diagnosis ◽  
Punch Biopsy ◽  
High Grade ◽  
Current Standard ◽  
Forceps Biopsy ◽  
Endoscopic Forceps Biopsy

The current standard for diagnosing cervical intraepithelial neoplasia (CIN) is colposcopy followed by punch biopsy. We have developed flexible magnifying endoscopy with narrow band imaging (ME-NBI) for the diagnosis of CIN. Here, we investigated the feasibility of targeted endoscopic forceps biopsy (E-Bx) under guidance of ME-NBI for the diagnosis of CIN. We prospectively enrolled 32 consecutive patients with confirmed or suspected high-grade CIN undergoing cervical conization. Next to colposcopy, the same patients underwent ME-NBI just before conization. ME-NBI was performed, and 30 E-Bx samples were taken from lesions suspicious for high-grade CIN and 15 from non-suspicious mucosa. We recalled 82 punch biopsy (P-Bx) specimens taken from lesions suspicious for high-grade CIN under colposcopic examination before enrollment. The proportion of sufficient biopsy samples, which had an entire mucosal layer with subepithelial tissue, for the diagnosis of CIN was evaluated by both methods. Performance of targeted E-Bx for the final diagnosis of at least high-grade CIN was calculated. Seventeen P-Bx specimens were unavailable. The proportion of sufficient samples with E-Bx was 84%, which was similar to that with P-Bx (87%) (p = 0.672). The sensitivity, specificity, and accuracy of ME-NBI using E-Bx was 92%, 81%, and 88%, respectively. In conclusion, ME-NBI-guided E-Bx samples were feasible for histological diagnoses of CIN, and further investigation of its diagnostic accuracy is warranted.

scholarly journals Flexible magnifying endoscopy with narrow band imaging versus colposcopy for diagnosing uterine cervical neoplasms: a multicenter, prospective, non-randomized, paired comparison study

2021 ◽  
Author(s):  
Hideki Kobara ◽  
Kunihisa Uchita ◽  
Noriya Uedo ◽  
Jun Kunikata ◽  
Kenji Yorita ◽  
...  
Keyword(s):  
Pap Smear ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Paired Comparison ◽  
Intraepithelial Neoplasia ◽  
Punch Biopsy ◽  
Magnifying Endoscopy ◽  
Detection Sensitivity ◽  
Comparison Study ◽  
Cervical Intraepithelial Neoplasia Grade

Objective To investigate the detection ability of flexible magnifying endoscopy with narrow band imaging (ME-NBI) for cervical intraepithelial neoplasia grade two or worse (CIN2+) compared with colposcopy. Design Multicenter, prospective, non-randomized, paired comparison study. Setting Three Japanese medical centers. Population Japanese women. Methods Eligible patients had positive PAP smear test results, suspicious high-grade CIN in previous colposcopy, or definitive CIN3 diagnosed previously. A gastrointestinal endoscopist examined the cervix using ME-NBI in an endoscopy room and, subsequently, a gynecologist blinded to the ME-NBI findings performed colposcopy in a different room. CIN2+ locations were documented in a scheme immediately after each examination. Punch biopsy samples were obtained from all areas diagnosed as CIN2+ with both methods and from one normal area. The reference standard was the presence of at least one histological diagnosis of CIN2+ among all biopsy specimens. Main outcome measures The primary outcome was the detection sensitivity of patients with CIN2+, comparing ME-NBI and colposcopy. Results We enrolled 88 patients. The detection sensitivity for patients with CIN2+ was not statistically different between the two methods (both: 79%, 95% CI: 66%–88%). For diagnosing CIN2+, ME-NBI tended to show a higher sensitivity than colposcopy (69% vs. 58%, respectively), while its specificity tended to be lower vs. colposcopy (55% vs. 70%, respectively). Patients reported significantly less discomfort and embarrassment with ME-NBI vs. colposcopy. Conclusion ME-NBI showed comparable sensitivity to colposcopy for detecting CIN2+ lesions, and ME-NBI was more patient-acceptable.

scholarly journals Does previous biopsy lead to cancer overdiagnosis of superficial non-ampullary duodenal epithelial tumors?

2021 ◽  
Vol 09 (01) ◽  
pp. E58-E65
Author(s):  
Shigetsugu Tsuji ◽  
Hisashi Doyama ◽  
Sho Tsuyama ◽  
Akihiro Dejima ◽  
Takashi Nakashima ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Diagnostic Performance ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Magnifying Endoscopy ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
High Grade ◽  
Epithelial Tumors ◽  
Vienna Classification

Abstract Background and study aims We aimed to evaluate the diagnostic performance of magnifying endoscopy with narrow-band imaging (M-NBI) in superficial non-ampullary duodenal epithelial tumors (SNADETs) regarding the absence or presence of biopsy before M-NBI diagnosis. Patients and methods Clinicopathological data were retrospectively reviewed for 99 SNADETs from 99 patients who underwent endoscopic resection. The 99 tumors were divided into the non-biopsy group (32 lesions not undergoing biopsy before M-NBI examination) and the biopsy group (67 lesions undergoing biopsy before M-NBI examination). We investigated the correlation between the M-NBI diagnosis and the histopathological diagnosis of the SNADETs in both groups. Results According to the modified revised Vienna classification, 31 tumors were classified as category 3 (C3) (low-grade adenoma) and 68 as category 4/5 (C4/5) (high-grade adenoma/cancer). The accuracy, sensitivity, and specificity of preoperative M-NBI diagnoses in the non-biopsy group vs the biopsy group were 88 % (95 % confidence interval: 71.0 – 96.5) vs 66 % (51.5 – 75.5), P = 0.02; 95 % (77.2 – 99.9) vs 89 % (76.4 – 96.4), P = 0.39; and 70 % (34.8 – 93.3) vs 14 % (3.0 – 36.3), P < 0.01, respectively. Notably, in the biopsy group, the specificity of M-NBI in SNADETs was low at only 14 % because we over-diagnosed most C3 lesions as C4/5. M-NBI findings might have been compromised by the previous biopsy procedure itself. Conclusions In the non-biopsy group, the accuracy of M-NBI in SNADETs was excellent in distinguishing C4/5 lesions from C3. The M-NBI findings in SNADETs should be evaluated while carefully considering the influence of a previous biopsy.

Endoscopic submucosal dissection by using Clutch cutter and IT knife 2 for early gastric cancer with severe submucosal fibrosis: a case report

MedPharmRes ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 17-21
Author(s):  
Nhan Le ◽  
Phuong Vien ◽  
Nghia Le
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Magnifying Endoscopy ◽  
Gastrointestinal Cancers ◽  
Pathological Result ◽  
Well Differentiated ◽  
Submucosal Fibrosis

Introduction: Gastric cancer is one of the highly malignant gastrointestinal cancers and the third leading cause of cancer death. In the last decade, early gastric cancer (EGC) has been reported by using narrow-band imaging (NBI) magnifying endoscopy. Advances in endoscopic techniques, such as endoscopic submucosal dissection (ESD), have enabled the en bloc resection of these EGC. Although ESD is performed for early gastric cancer, there are still many difficult problems in technique of this procedure. The difficulty of gastric ESD depends on the size and location of a tumor, presence of severe submucosal fibrosis, presence of ulceration... We report a case of our successful ESD by using Clutch cutter and IT knife 2 in treatment of EGC with severe submucosal fibrosis. Case presentation: A 62-year-old man felt an epigastric discomfort two months ago. The narrow-band imaging (NBI) magnifying endoscopy revealed a suspected early gastric cancer type 0 - IIa + IIc (Japanese classification of early gastrointestinal cancers) at the incisura angularis, the size of this lesion was 15 mm in diameter, and pathological result of endoscopic biopsy was a well-differentiated adenocarcinoma. ESD was performed and we found there was severe submucosal fibrosis which was dissected safer and faster by using Clutch cutter and IT knife 2. There were no complications such as severe bleeding and perforation. The size of resected specimen was 60 x 35 mm and the time of procedure was 150 minutes. After ESD, the pathological result was a well differentiated adenocarcinoma, pT1a, UL(-), LY(-), V(-), no cancer cell in vertical and horizontal margins. The healing time of ESD-induced ulcer was 5 weeks without local recurrence. Conclusion: Through this case, we aim to emphasize the importance of using Clutch cutter and IT knife 2 as a modified technique which makes ESD a safe procedure in treatment of EGC with severe submucosal fibrosis.

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