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

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.

Squamous cell metaplasia of the rectum associated with a longstanding ulcerative colitis (clinical cases report)

INTRODUCTION: squamous cell metaplasia in the rectum is found in patients with longstanding inflammation or infectious lesions [1]. Colonoscopy plays a major role in the diagnostic of squamous cell metaplasia, especially with the use of Narrow Band Imaging (NBI) or Blue Light Imagining (BLI), which allows for targeted visualization of intraepithelial capillary loopspeculiar for the squamous epithelium [1,2]. The final conclusion cannot be reached without morphological diagnostics. We would like to show on two clinical cases of patients with a longstanding ulcerative colitis the occurrence of squamous cell metaplasia in the rectum. These areas of metaplasia may be the source of squamous cell cancer.CLINICAL CASES: a clinical cases of squamous cell metaplasia in the rectum in two patients with a longstanding ulcerative colitis (9 and 14 years) are presented. The total ulcerative colitis was verified in both patients by colonoscopy. Against the background of endoscopic remission, flat whitish areas of irregular shape, up to 3 cm in size, in the form of “tongues” of metaplastic epithelium with clear boundaries were found in the low rectum. When examined in a Narrow Band Imaging (NBI) and Blue Light Imagining (BLI), the microvascular pattern in the detected areas was identical in structure to the microvascular pattern of the squamous epithelium. The biopsies confirmed the presence of squamous cell epithelium.CONCLUSION: patients with a longstanding ulcerative colitis may have squamous cell metaplasia of the rectal mucosa, which can be detected by colonoscopy in white light. Using a Narrow Band Imaging (NBI) followed by a targeted biopsy allows the most accurate diagnosis to be established. Patients of this group require repeated colonoscopies using the above methods, since areas of metaplasia can be a source of squamous cell cancer of the rectum.

Squamous cell metaplasia of the rectum associated with a longstanding ulcerative colitis (clinical cases report)

INTRODUCTION: squamous cell metaplasia in the rectum is found in patients with longstanding inflammation or infectious lesions [1]. Colonoscopy plays a major role in the diagnostic of squamous cell metaplasia, especially with the use of Narrow Band Imaging (NBI) or Blue Light Imagining (BLI), which allows for targeted visualization of intraepithelial capillary loopspeculiar for the squamous epithelium [1,2]. The final conclusion cannot be reached without morphological diagnostics. We would like to show on two clinical cases of patients with a longstanding ulcerative colitis the occurrence of squamous cell metaplasia in the rectum. These areas of metaplasia may be the source of squamous cell cancer.CLINICAL CASES: a clinical cases of squamous cell metaplasia in the rectum in two patients with a longstanding ulcerative colitis (9 and 14 years) are presented. The total ulcerative colitis was verified in both patients by colonoscopy. Against the background of endoscopic remission, flat whitish areas of irregular shape, up to 3 cm in size, in the form of “tongues” of metaplastic epithelium with clear boundaries were found in the low rectum. When examined in a Narrow Band Imaging (NBI) and Blue Light Imagining (BLI), the microvascular pattern in the detected areas was identical in structure to the microvascular pattern of the squamous epithelium. The biopsies confirmed the presence of squamous cell epithelium.CONCLUSION: patients with a longstanding ulcerative colitis may have squamous cell metaplasia of the rectal mucosa, which can be detected by colonoscopy in white light. Using a Narrow Band Imaging (NBI) followed by a targeted biopsy allows the most accurate diagnosis to be established. Patients of this group require repeated colonoscopies using the above methods, since areas of metaplasia can be a source of squamous cell cancer of the rectum.

Morphological Changes in Nasal Mucosa in Patients with Sarcoidosis.

Objectives: The purpose of this study was the evaluation of any alterations in the microvascular network of the nasal mucosa in patients with pulmonary sarcoidosis and the investigation of potential correlations with olfactory acuity and serum levels of angiotensin-converting enzyme (sACE). Design: Patients’ nasal mucosa was examined with contact endoscopy (CE). A novel classification scheme for the microvascular pattern at the anterior septal mucosa (Little’s area) was introduced and implemented. Olfaction was tested using sniffin’sticks. Fifteen healthy subjects served as controls. Participants: 15 patients with pulmonary sarcoidosis and sinonasal symptoms. Main outcome measures: Microvascular pattern at the anterior septal mucosa (Little’s area). Olfaction tested using sniffin’sticks. Setting: Tertiary referral medical centre. Results: The nasal microvascular network was disrupted under CE in most (14/15) patients, while in one patient no microvascular net could be detected. Moreover, hyposmia was documented in four patients and complete anosmia in one patient. In healthy subjects, a very strong correlation between vascular pattern of the mucosa and olfactory test results was found (r=0.93). Conclusions: Contact endoscopy findings show promise and should be further tested, to evaluate their validity as a surrogate marker of mucosal nasal inflammation in sarcoidosis patients with sinonasal symptoms. Vascular patterns of nasal mucosa and olfaction seem to be strong correlated.

THE FRACTAL DIMENSION-BASED DESCRIPTOR OF THE MICROVASCULAR PATTERN ON THE HISTOLOGICAL SECTION

The microvascular pattern in the histological section, i.e. the point-pattern composed of capillaries perpendicular to the plane of section, contains information about the three-dimensional structure of the capillary network. Histological processing is followed by the shrinkage of tissue of uncertain magnitude. In order to obtain relevant information, the scale-independent analysis is necessary. We used an approach based on the Minkowski cover of measured set. The true fractal dimension of the point pattern is obviously of zero, but the artificial result of the algorithm can be related to the complexity of shape. We fitted the log-log plot by the modified rounded ramp function and the slope of the oblique part was used as the fractal based descriptor. We demonstrated on histological samples of the heart that this fractal-based parameter has the property of scale and rotation invariance.

Differences in the Microsurface and Microvascular Features between Early Gastric Cancer of Corpus and Antrum under Narrow Band Imaging Magnifying Endoscopy

Background Microsurface structure (MS) and microvascular features (MV) of early gastric cancer (EGC) are associated with the histologic type, invasion depth and macroscopic shape of lesions. However, no studies have reported the differences in the MS and MV features between EGCs of antrum and corpus under magnifying endoscopy with narrow band imaging (ME-NBI).Methods This was a retrospective study including 116 patients with EGC. The characteristics of MS and MV pattern of EGC were evaluated in 2 group, antrum type and corpus type.Results According to the Sakaki’s classification, the MS of EGCs presented as IV, V1 or VI typein in sequence, one level higher than the previous type in the degree of atypia. Tumor location and differentiated degree were identified as independent predictors for MS pattern. For the probability of at least one level higher, in the MS pattern, the corporal EGCs was 5.84 times as high as that of antral EGCs ( χ 2 =9.42, P=0.002, 95%CI 1.89-18.05), and undifferentiated-type lesions was 8.82 times as high as that of the differentiated-type lesions ( χ 2 =11.67, P=0.001, 95%CI 2.53-30.76). No difference in the MV pattern was observed between antral EGCs and corporal EGCs (P=0.7), while the microvascular pattern and microsurface pattern (VS pattern, FNP, ILL-1, ILL-2 and CSP) were significantly different between those 2 groups (P=0.001).Conclusions There are significant differences in the MS and VS pattern of EGC between antrum and corpus types. The antral EGC is less obvious than the corporal EGC, therefore, it is more likely to be missed in clinical gastroscopy.

Differences in the Microsurface and Microvascular Features between Early Gastric Cancer of Corpus and Antrum under Narrow Band Imaging Magnifying Endoscopy

Objectives Microsurface structure (MS) and microvascular features (MV) of early gastric cancer (EGC) are associated with the histologic type, invasion depth and macroscopic shape of lesions. However, no studies have reported the differences in the MS and MV features between EGCs of antrum and corpus under magnifying endoscopy with narrow band imaging (ME-NBI).Methods This is a retrospective study including 116 patients with EGC. The characteristics of MS and MV pattern of EGC were evaluated in 2 group, antrum type and corpus type.Results According to the Sakaki’s classification, the MS of EGCs presented as IV, V1 or VI typein in sequence, one level higher than the previous type in the degree of atypia. Tumor location and differentiated degree were identified as independent predictors for MS pattern. For the probability of at least one level higher, in the MS pattern, the corporal EGCs was 5.84 times as high as that of antral EGCs ( χ 2 =9.42, P=0.002, 95%CI 1.89-18.05), and undifferentiated-type lesions was 8.82 times as high as that of the differentiated-type lesions ( χ 2 =11.67, P=0.001, 95%CI 2.53-30.76). No difference in the MV pattern was observed between antral EGCs and corporal EGCs (P=0.7), while the microvascular pattern and microsurface pattern (VS pattern, FNP, ILL-1, ILL-2 and CSP) were significantly different between those 2 groups (P=0.001).Conclusions There are significant differences in the MS and VS pattern of EGC between antrum and corpus types. The antral EGC is less obvious than the corporal EGC, therefore, it is more likely to be missed in clinical gastroscopy.