A new exploration of white globe appearance (WGA) in ulcerative lesions

Jinnian Cheng; Jie Xia; Qian Zhuang; Xianjun Xu; Xiaowan Wu; Xinjian Wan; Jing Wang; Hui Zhou

doi:10.1055/a-1200-2287

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2020; 58(08): 754-760
DOI: 10.1055/a-1200-2287

Originalarbeit

A new exploration of white globe appearance (WGA) in ulcerative lesions

Eine neue Studie zum White globe appearance (WGA) bei ulzerativen Läsionen

Jinnian Cheng‡

¹Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China

,

Jie Xia‡

¹Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China

,

Qian Zhuang

¹Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China

,

Xianjun Xu

²Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P. R. China

,

Xiaowan Wu

¹Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China

,

Xinjian Wan

²Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P. R. China

³Department of Gastroenterology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, P. R. China

,

Jing Wang

⁴Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P. R. China

,

Hui Zhou

¹Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China

²Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P. R. China

› Author Affiliations

Abstract

Aim White globe appearance (WGA), a small white lesion with a globular shape that can be clearly visualized by magnifying endoscopy with narrow-band imaging (ME-NBI), was reported to be a reliable marker of early gastric cancer (EGC). However, we found that this endoscopic presentation could also be seen in non-cancerous tissues, especially in ulcerative lesions. This study aimed to further investigate the diagnostic value of WGA in differentiating non-cancerous lesions from EGC in ulcer-type cases.

Materials and Methods We retrospectively reviewed 54 cases of EGC and 155 cases of non-cancerous lesions in this study, all of which had endoscopic imaging data of ME-NBI scanning and pathological data of biopsy or resected specimens. The correlation of the prevalence of WGA and ulcerative lesions, as well as the characteristics of WGA between the 2 groups were analyzed in this study.

Results WGA was more common in ulcerative lesions (27.6 %, 21/76) than in non-ulcerative lesions (3.8 %, 5/133) (p < 0.001) in our study. In the ulcerative cases, no significant difference in prevalence of WGA was observed between EGC and non-cancerous lesions (p = 0.532). Compared with WGA in EGC, WGA in non-cancerous lesions tended to show the characteristic of tree-branch-like vessels on globular shape (p < 0.001).

Conclusions WGA is more likely to occur in ulcerative lesions, and the presence of WGA alone cannot distinguish EGC from non-cancerous lesions in ulcer-type cases. In WGA-positive tissue, tree-branch-like vessels of globular shape may provide a certain clinical value in diagnosis of non-cancerous lesions or EGC.

Zusammenfassung

Ziele Das White Globe Appearance (WGA) ist eine kleine weiße Läsion mit einer Kugelform, die durch Vergrößerungsendoskopie mit Schmalband-Bildgebung (magnifying endoscopy with narrow-band imaging, ME-NBI) identifiziert werden kann. WGA wurde zuvor als zuverlässiger Marker für die Diagnose von frühem Magenkrebs (early gastric cancer, EGC) unter ME-NBI angesehen. Wir fanden jedoch heraus, dass diese Manifestation auch in nicht krebsartigen Geweben auftreten kann, insbesondere in ulzerativen Läsionen. Diese Studie zielt darauf, den diagnostischen Wert von WGA bei der Unterscheidung zwsichen nicht krebsartigen Läsionen und EGC in ulzerativen Läsionen weiter zu untersuchen.

Methode Retrospektiv analysierten wir 54 EGC-Fälle und 155 Nicht-Krebs-Läsionen. Alle Fälle wurden von ME-NBI untersucht und dazu liegen entsprechende pathologische Daten von Biopsie- oder Resektionsproben vor. Die Beziehung zwischen der Inzidenz von WGA und ulzerativen Läsionen und die Eigenschaften von WGA in den beiden Gruppen von Läsionen wurden weiter analysiert.

Ergebnisse Die Inzidenz von WGA bei ulzerativen Läsionen (27,6 %, 21/76) war signifikant höher als bei nicht ulzerativen Läsionen (3,8 %, 5/76) (P < 0,001). Bei ulzerativen Läsionen gab es keinen signifikanten statistisch Unterschied in der WGA-positiven Rate zwischen der EGC-Gruppe und der Nicht-Krebsläsionsgruppe (p = 0,532). Im Vergleich zu WGA bei EGC zeigte WGA tendenziell bei nicht krebsartigen Läsionen die Eigenschaften dendritischer Gefäße (p < 0,001).

Schlussfolgerungen WGA tritt tendenziell bei ulzerativen Läsionen auf, aber das Vorhandensein von WGA kann ulzerative EGC nicht von nicht krebsbedingten Läsionen unterscheiden. Bei WGA-positiven Läsionen hat das Auftreten dendritischer Gefäße in einer kugelförmigen Struktur einen bestimmten klinischen Wert für die Differentialdiagnose von EGC oder Nichtkrebsläsionen.

Key words

white globe appearance - ulcerative lesions - early gastric cancer - ME-NBI - stomach neoplasm

Schlüsselwörter

White Globe Appearance (WGA) - ulzerative Läsionen - früher Magenkrebs (early gastric cancer, EGC) - ME-NBI - Magenmasse

Full Text

References

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Supplementary Material

Supplementary Material