Multiple convex demarcation line for prediction of benign depressed gastric lesions in magnifying narrow-band imaging

Takashi Kanesaka; Noriya Uedo; Kenshi Yao; Yasumasa Ezoe; Hisashi Doyama; Ichiro Oda; Kazuhiro Kaneko; Yoshiro Kawahara; Chizu Yokoi; Yasushi Sugiura; Hideki Ishikawa; Yoji Takeuchi; Masamichi Arao; Taro Iwatsubo; Hiroyoshi Iwagami; Kenji Matsuno; Manabu Muto; Yutaka Saito; Yasuhiko Tomita

doi:10.1055/s-0043-121267

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endoscopy 2018; 06(02): E145-E155
DOI: 10.1055/s-0043-121267

Original article

Multiple convex demarcation line for prediction of benign depressed gastric lesions in magnifying narrow-band imaging

Takashi Kanesaka

¹Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Noriya Uedo

¹Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Kenshi Yao

²Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan

,

Yasumasa Ezoe

³Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

,

Hisashi Doyama

⁴Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan

,

Ichiro Oda

⁵Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

,

Kazuhiro Kaneko

⁶Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Chiba, Japan

,

Yoshiro Kawahara

⁷Division of Endoscopy, Okayama University, Okayama, Japan

,

Chizu Yokoi

⁸Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan

,

Yasushi Sugiura

⁹Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan

,

Hideki Ishikawa

¹⁰Department of Molecular Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan

,

Yoji Takeuchi

¹Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Masamichi Arao

¹Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Taro Iwatsubo

¹Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Hiroyoshi Iwagami

¹Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Kenji Matsuno

¹Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Manabu Muto

³Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

,

Yutaka Saito

⁵Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

,

Yasuhiko Tomita

¹¹Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan

› Institutsangaben

Abstract

Background and study aims With magnifying narrow-band imaging (M-NBI) of the gastric mucosa, a characteristic demarcation line (DL) is occasionally found in non-cancerous depressed lesions. This DL forms multiple convex shapes along the edge of the epithelia of surrounding mucosa. We have termed this novel finding a multiple convex DL (MCDL). In this study, we clarified the prevalence of an MCDL in depressed gastric lesions detected in patients at high risk for gastric cancer and determined the diagnostic yield necessary to distinguish between cancer and non-cancer.

Patients and methods This was a post hoc analysis of a multicenter prospective trial. In total, 362 small (≤ 10 mm) depressed lesions were detected in 1353 patients. Presence or absence of a DL in target lesions was evaluated on M-NBI images. The proportion of MCDLs among lesions with a DL was evaluated.

Results Images of 347 lesions (39 cancerous and 308 non-cancerous) were evaluable. A DL was present in 252/347 lesions (73 %). When the cutoff value for the proportion of MCDLs needed to distinguish non-cancer from cancer was set at two-thirds, an MCDL was observed in 86/252 lesions (34 %). In 86 lesions with an MCDL, 83 (97 %) were non-cancerous. The sensitivity, specificity, positive predictive value, and negative predictive value of an MCDL for non-cancerous lesions were 38 %, 91 %, 97 %, and 19 %, respectively.

Conclusions Presence of an MCDL had high specificity and positive predictive value for non-cancerous lesions. Evaluating the shape of the DL is useful for differentiation between cancer and non-cancerous lesions.

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