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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1233-E1242
DOI: 10.1055/a-1220-6389
Original article

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

Kohei Matsumoto
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Hiroya Ueyama
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Takashi Yao
2   Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan
,
Daiki Abe
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Shotaro Oki
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Nobuyuki Suzuki
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Atsushi Ikeda
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Noboru Yatagai
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Yoichi Akazawa
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Hiroyuki Komori
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Tsutomu Takeda
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Kenshi Matsumoto
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Mariko Hojo
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
,
Akihito Nagahara
1   Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan
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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.



Publication History

Received: 19 February 2020

Accepted: 08 May 2020

Article published online:
21 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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