Routine endoscopy using a magnifying endoscope for gastric cancer diagnosis
Routine endoscopy using a magnifying endoscope for gastric cancer diagnosis
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DOI：
10.1055/s-2002-34267
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发表时间：
2002-10-01
期刊：
影响因子：
9.3
通讯作者：
Yagi, K
中科院分区：
文献类型：
--
作者：
Tajiri, H;Doi, T;Yagi, K
背景和研究目的：据报道，胃小凹的精细粘膜模式可以通过放大观察，这可能有助于组织学诊断前的初步评估。这项前瞻性研究的目的是阐明胃病变的精细粘膜模式和组织学检查结果之间的关系，并评估放大内镜在常规内镜检查中的作用。最近开发的放大视频内窥镜，可放大80倍，在2000年1月至2001年1月期间，在国立四国癌症中心对318名患者进行了胃肠内窥镜检查。总共检测到232处病变。然而，经常规内镜诊断为晚期胃癌、恶性淋巴瘤或粘膜下肿瘤的患者被排除在研究之外。结果：放大内镜下观察，隆起型癌的黏膜形态粗糙、不规则，凹陷型癌的黏膜形态较周围黏膜更细，黏膜微结构破坏或消失，毛细血管异常。放大内镜检查结果与解剖显微镜下观察到的粘膜微观结构及组织学特征密切相关。与传统内镜相比，使用放大内镜时小胃癌的推定诊断率明显较高。结论：放大内镜所显示的粘膜精细结构和毛细血管特征与病理诊断有较好的相关性，其敏感性为96.0%，特异性为95.5%。在常规内镜检查中，放大内镜对预测组织学诊断非常有用。
Background and Study Aims: It has been reported that the fine mucosal patterns of the gastric pits can be observed with magnification and this may assist in preliminary evaluation prior to histological diagnosis. The aim of this prospective study was to clarify the relationship between the fine mucosal patterns of gastric lesions and histological findings, and also to evaluate the usefulness of magnifying endoscopy during routine endoscopy.Patients and Methods: A recently developed magnifying video endoscope, which enables magnification up to 80 times, was used for gastrointestinal endoscopy in 318 patients between January 2000 and January 2001, at the National Shikoku Cancer Center. In total, 232 lesions were detected. However, patients diagnosed by conventional endoscopy as having advanced gastric cancer, malignant lymphoma, or submucosal tumor were excluded from the study. The endoscopic findings for 211 lesions included in this study were compared with the histological findings.Results: Coarse and irregular mucosal patterns were observed in elevated-type cancers by magnifying endoscopy, and in depressed-type cancers there was a finer pit pattern than in the Surrounding mucosa, destruction or disappearance of the mucosal microstructure, and abnormal capillary vessels. The magnifying endoscopy results were closely related to the mucosal microstructure observed by dissecting microscopy and to the histological features. The rate of presumptive diagnosis of small gastric cancers was significantly higher when a magnifying endoscope was used compared with conventional endoscopy. In this study, the sensitivity and specificity of magnifying endoscopy as a diagnostic method were 96.0% and 95.5%, respectively.Conclusions: The fine mucosal patterns and the features of capillary vessels, which were identified with the magnifying endoscope, correlated well with the pathological diagnosis. Magnifying endoscopy will be very useful in predicting the histological diagnosis during routine endoscopic procedures.