Diagnostic limitations of magnifying endoscopy with narrow-band imaging in early gastric cancer.
Diagnostic limitations of magnifying endoscopy with narrow-band imaging in early gastric cancer.
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DOI：
10.1055/a-1220-6389
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发表时间：
2020-10
影响因子：
2.6
通讯作者：
Nagahara A
中科院分区：
文献类型：
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作者：
Matsumoto K;Ueyama H;Yao T;Abe D;Oki S;Suzuki N;Ikeda A;Yatagai N;Akazawa Y;Komori H;Takeda T;Matsumoto K;Hojo M;Nagahara A
背景和研究目的窄带成像放大内镜（M-NBI）在早期胃癌（EGC）的内镜诊断中发挥了重要作用。 然而，我们有时会遇到M-NBI诊断的假阴性病例（即， M-NBI诊断限制病变：M-NBI-DLL）。然而，M-NBI-DLL的临床病理特征尚未得到很好的阐明。我们的目的是阐明M-NBI-DLLs的临床病理特征和组织学原因。 患者和方法在这项单中心回顾性研究中，M-NBI-DLL从我们医院内镜下切除的456例EGCs中提取。 我们定义了M-NBI-DLLs的组织学类型，并进行了临床病理分析，以阐明M-NBI-DLLs的组织学原因。 结果456例EGC中，48例（10.5%）为M-NBI-DLLs。 M-NBI-DLLs分为4种组织学类型：胃底腺型胃腺癌（GA-FG，n = 25）、胃底腺粘膜型胃腺癌（GA-FGM，n = 1）、分化型胃腺癌（n = 14）和未分化型胃腺癌（n = 8）。 39个M-NBI-DLLs病灶为H。pylori阴性胃癌（39/47，82.9%）。 M-NBI-DLLs的组织学原因如下：1）完全被非肿瘤性粘膜覆盖（25/25 GA-FG，8/8未分化腺癌）; 2）高分化腺癌伴低度恶性淋巴瘤（1/1 GA-FGM，14/14分化腺癌）; 3）表面结构相似性（10/14分化腺癌）;和4）部分覆盖和/或混合有非肿瘤性粘膜（1/1 GA-FGM，6/14分化腺癌）。 结论M-NBI的诊断局限性取决于四个不同的组织学特征。 为了准确诊断M-NBI-DLL，可能需要使用白色光成像和基于这些组织学特征的M-NBI充分了解这些病变的内镜特征，并进行精确的活检。
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.