Multicenter prospective study on the histological diagnosis of gastric cancer by narrow band imaging-magnified endoscopy with and without acetic acid

Abstract Background and study aims The usefulness of endoscopy for diagnosing histological type remains unclear. This study aimed to examine the diagnostic accuracy of white light endoscopy (WLE), magnified endoscopy with narrow band imaging (NBI-ME), and NBI-ME with acetic acid enhancement (NBI-AA) for histological type of gastric cancer. Patients and methods Patients with depressed-type gastric cancers resected by endoscopic submucosal dissection were prospectively enrolled, and 221 cases were analyzed. Histological type was diagnosed by WLE, followed by NBI-ME and NBI-AA. Histological type was classified into differentiated adenocarcinoma and undifferentiated adenocarcinoma. Histological type was diagnosed based on lesion color in WLE, surface patterns (pit, villi, and unclear) and vascular irregularities in NBI-ME, and surface patterns in NBI-AA. Results Histological types of target areas were differentiated adenocarcinoma and undifferentiated adenocarcinoma in 206 and 15 cases, respectively. Diagnostic accuracy of WLE, NBI-ME, and NBI-AA for the histological type was 96.4 % (213/221), 96.8 % (214/221), and 95.5 % (211/221), respectively. No significant differences were observed among modalities. Positive predictive value based on endoscopic findings in NBI-ME was 98.0 % (149/152) for the villi pattern, 100 % (19/19) for the irregular pit pattern, 100 % (9/9) for the unclear surface pattern with a vascular network, 90.3 % (28/31) for the unclear surface pattern with mild vascular irregularity, and 88.9 % (8/9) for the unclear surface pattern with severe vascular irregularity. Conclusions NBI-ME and NBI-AA did not show any advantages over WLE for diagnostic accuracy. Villi pattern, irregular pit pattern, and vascular network may be useful for identifying differentiated adenocarcinoma.

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Additive Effects of Evaluating Micro-Surface and Microvascular Patterns Using Magnifying Endoscopy with Narrow-Band Imaging for Gastric Cancer

10.21203/rs.3.rs-882467/v1 ◽

2021 ◽

Author(s):

Yusuke Horiuchi ◽

Toshiaki Hirasawa ◽

Naoki Ishizuka ◽

Junki Tokura ◽

Mitsuaki Ishioka ◽

...

Keyword(s):

Gastric Cancer ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Evaluation Method ◽

Narrow Band ◽

Narrow Band Imaging ◽

Magnifying Endoscopy ◽

Additive Effects ◽

Surface Patterns ◽

Microvascular Pattern

Abstract No studies have compared the performance of microvascular and micro-surface patterns alone with their combination in magnifying endoscopy with narrow-band imaging for diagnosing gastric cancer. This study aimed to clarify the difference in diagnostic performance between these methods. Thirty-three participating endoscopists underwent specialized training in magnifying endoscopy evaluated microvascular and micro-surface patterns for images of 106 cancerous and 106 non-cancerous cases. If classified as “irregular”, the lesion was diagnosed as cancerous. To evaluate diagnostic performance, we compared the diagnostic accuracy, sensitivity, and specificity among the methods. Performance-related items did not significantly differ between the microvascular and micro-surface patterns. However, the diagnostic accuracy and sensitivity were significantly higher when using the combination of these methods than when using the microvascular pattern alone (percentage [95% confidence interval]: 82.1% [76.4–86.7] vs. 76.4% [70.3–81.6], P = 0.0005; and 69.8% [60.5–77.8] vs. 63.2% [53.7–71.8], P = 0.0082, respectively). The additive effects on diagnostic accuracy and sensitivity were 5.7% and 6.6%, respectively. The combination of micro-surface and microvascular patterns has superior diagnostic accuracy and sensitivity for diagnosing gastric cancer than the evaluation method using microvascular pattern alone. Our results may contribute to improving the diagnosis of gastric cancers.

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Diagnostic limitations of magnifying endoscopy with narrow-band imaging in early gastric cancer

Endoscopy International Open ◽

10.1055/a-1220-6389 ◽

2020 ◽

Vol 08 (10) ◽

pp. E1233-E1242

Author(s):

Kohei Matsumoto ◽

Hiroya Ueyama ◽

Takashi Yao ◽

Daiki Abe ◽

Shotaro Oki ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Gastric Adenocarcinoma ◽

Narrow Band ◽

Narrow Band Imaging ◽

Magnifying Endoscopy ◽

Clinicopathological Features ◽

Fundic Gland ◽

Undifferentiated Adenocarcinoma ◽

Histological Characteristics

Abstract Background and study aims Magnifying endoscopy with narrow band imaging (M-NBI) has made a huge contribution to endoscopic diagnosis of early gastric cancer (EGC). However, we sometimes encountered false-negative cases with M-NBI diagnosis (i. e., M-NBI diagnostic limitation lesion: M-NBI-DLL). However, clinicopathological features of M-NBI-DLLs have not been well elucidated. We aimed to clarify the clinicopathological features and histological reasons of M-NBI-DLLs. Patients and methods In this single-center retrospective study, M-NBI-DLLs were extracted from 456 EGCs resected endoscopically at our hospital. We defined histological types of M-NBI-DLLs and analyzed clinicopathologically to clarify histological reasons of M-NBI-DLLs. Results Of 456 EGCs, 48 lesions (10.5 %) of M-NBI-DLLs were enrolled. M-NBI-DLLs was classified into four histological types as follows: gastric adenocarcinoma of fundic-gland type (GA-FG, n = 25), gastric adenocarcinoma of fundic-gland mucosal type (GA-FGM, n = 1), differentiated adenocarcinoma (n = 14), and undifferentiated adenocarcinoma (n = 8). Thirty-nine lesions of M-NBI-DLLs were H. pylori-negative gastric cancers (39/47, 82.9 %). Histological reasons for M-NBI-DLLs were as follows: 1) completely covered with non-neoplastic mucosa (25/25 GA-FG, 8/8 undifferentiated adenocarcinoma); 2) well-differentiated adenocarcinoma with low-grade atypia (1/1 GA-FGM, 14/14 differentiated adenocarcinoma); 3) similarity of surface structure (10/14 differentiated adenocarcinoma); and 4) partially covered and/or mixed with a non-neoplastic mucosa (1/1 GA-FGM, 6/14 differentiated adenocarcinoma). Conclusions Diagnostic limitations of M-NBI depend on four distinct histological characteristics. For accurate diagnosis of M-NBI-DLLs, it may be necessary to fully understand endoscopic features of these lesions using white light imaging and M-NBI based on these histological characteristics and to take a precise biopsy.

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Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2010.01.054 ◽

2010 ◽

Vol 72 (1) ◽

pp. 127-135 ◽

Cited By ~ 75

Author(s):

Reiji Higashi ◽

Toshio Uraoka ◽

Jun Kato ◽

Kenji Kuwaki ◽

Shin Ishikawa ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Training Program ◽

Pattern Analysis ◽

Narrow Band ◽

Narrow Band Imaging ◽

Pit Pattern ◽

Experienced Endoscopists

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Brief Education on Microvasculature and Pit Pattern for Trainees Significantly Improves Estimation of the Invasion Depth of Colorectal Tumors

Gastroenterology Research and Practice ◽

10.1155/2014/245396 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Joon Sung Kim ◽

Bo-In Lee ◽

Hwang Choi ◽

Bong Koo Kang ◽

Jong In Kim ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Narrow Band ◽

Narrow Band Imaging ◽

Pattern Identification ◽

Submucosal Invasion ◽

Colorectal Tumors ◽

Pit Pattern ◽

Invasion Depth ◽

White Light Endoscopy ◽

Magnifying Chromoendoscopy

Objectives. This study was performed to evaluate the effectiveness of education for trainees on the gross findings identified by conventional white-light endoscopy (CWE), the microvascular patterns identified by magnifying narrow-band imaging endoscopy (MNE), and the pit patterns identified by magnifying chromoendoscopy (MCE) in estimation of the invasion depth of colorectal tumors.Methods. A total of 420 endoscopic images of 35 colorectal tumors were used. Five trainees estimated the invasion depth of the tumors by reviewing the CWE images before education. Afterwards, the trainees estimated the invasion depth of the same tumors after brief education on CWE, MNE and MCE images, respectively.Results. The initial diagnostic accuracy for deep submucosal invasion before education and after education on CWE, MNE, and MCE findings was 54.3%, 55.4%, 67.4%, and 76.6%, respectively. The diagnostic accuracy increased significantly after MNE education (P=0.028). The specificity for deep submucosal invasion before education and after education on CWE, MNE, and MCE findings was 47.9%, 45.7%, 65.0%, and 80.7%, respectively. The specificity increased significantly after MNE (P=0.002) and MCE (P=0.005) education.Conclusion. Brief education on microvascular pattern identification by MNE and pit pattern identification by MCE significantly improves trainees’ estimations of the invasion depth of colorectal tumors.

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Diagnosis of histological type of early gastric cancer by magnifying narrow‐band imaging: A multicenter prospective study

DEN Open ◽

10.1002/deo2.61 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Takashi Kanesaka ◽

Noriya Uedo ◽

Hisashi Doyama ◽

Naohiro Yoshida ◽

Takashi Nagahama ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Prospective Study ◽

Narrow Band ◽

Narrow Band Imaging ◽

Histological Type ◽

Multicenter Prospective Study

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S1415: Diagnostic Accuracy of Narrow-Band Imaging and Pit Pattern Analysis Significantly Improved for Less Experienced Endoscopists Following Expanded Training Program

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2010.03.189 ◽

2010 ◽

Vol 71 (5) ◽

pp. AB155-AB156

Author(s):

Reiji Higashi ◽

Toshio Uraoka ◽

Jun Kato ◽

Shin Ishikawa ◽

Kenji Kuwaki ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Training Program ◽

Pattern Analysis ◽

Narrow Band ◽

Narrow Band Imaging ◽

Pit Pattern ◽

Experienced Endoscopists

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Diagnostic Ability of Magnifying Narrow-Band Imaging for the Extent of Early Gastric Cancer: A Systematic Review and Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2021/5543556 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Yingying Hu ◽

Xueqin Chen ◽

Maher Hendi ◽

Jianmin Si ◽

Shujie Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Diagnostic Accuracy ◽

Tumor Invasion ◽

Narrow Band ◽

Narrow Band Imaging ◽

Occupied Site ◽

Macroscopic Type ◽

Subgroup Analyses ◽

H Pylori

Background. Accurate delineation of tumor margin is essential for complete resection of early gastric cancer (EGC). The objective of this study is to assess the performance of magnifying endoscopy with narrow-band imaging (ME-NBI) for the accurate demarcation of EGC margins. Methods. We searched PubMed, EMBASE, Web of Science, and Cochrane Library databases up to March 2020 to identify eligible studies. The diagnostic accuracy of ME-NBI for EGC margins was calculated, and subgroup analyses were performed based on tumor size, depth of tumor invasion, tumor-occupied site, macroscopic type, histological type, Helicobacter pylori (H. pylori), and endoscopists’ experience. Besides, we also evaluated the negative and positive resection rates of the horizontal margin (HM) of EGC after endoscopic submucosal dissection (ESD) and surgery. Results. Ten studies comprising 1018 lesions were eligible in the databases. The diagnostic accuracy of ME-NBI for the demarcation of EGC margins was 92.4% (95% confidence interval (CI): 86.7%-96.8%). According to ME-NBI subgroup analyses, the rate of accurate evaluation of EGC margins was not associated with H. pylori infection status, tumor size, depth of tumor invasion, tumor-occupied site, macroscopic type, histological type, and endoscopists’ experience, and no statistical differences were found in subgroup analyses. Moreover, the negative and positive resection rates of HM after ESD and surgery were 97.4% (95% CI: 92.1%-100%) and 2.6% (95% CI: 0.02%-7.9%), respectively. Conclusions. ME-NBI enables a reliable delineation of the extent of EGC.

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