The usefulness of magnifying endoscopy with narrow-band imaging to distinguish carcinoma in flat elevated lesions in the stomach diagnosed as adenoma by using biopsy samples
The usefulness of magnifying endoscopy with narrow-band imaging to distinguish carcinoma in flat elevated lesions in the stomach diagnosed as adenoma by using biopsy samples
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DOI：
10.1016/j.gie.2009.12.032
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发表时间：
2010-05-01
影响因子：
7.7
通讯作者：
Hirata, Ichiro
中科院分区：
文献类型：
--
作者：
Nakamura, Masakatsu;Shibata, Tomoyuki;Hirata, Ichiro
背景资料：胃扁平隆起（0-IIa）病变经活检诊断为腺瘤的治疗策略目前尚未建立，因为以前曾报道过仅评估血管模式用于腺瘤和癌之间的鉴别诊断存在一些困难。目的：我们试图通过使用放大内镜窄带成像（MENBI）来评估诊断为腺瘤的0-IIa病变患者：14个腺瘤性病变（6个腺瘤和8个癌，术后证实），术前活检诊断，均来自接受内镜粘膜下剥离术的患者。干预措施：我们为MENBI选择5个病变部位。主要观察指标：腺瘤和腺癌中浅表结构（SS）和不规则微血管（IMVP）的检出率。关于IMVP亚类，腺瘤中（1）轻度结构内不规则微血管模式（ISIMVP）占97%，（2）重度ISIMVP占0%，（3）精细网络占3%，（4）螺旋状占0%。癌中相应比例分别为（1）40%、（2）15%、（3）45%、（4）0%。严重的ISIMVP和精细的网络是显着的发现为carcinoma.Limitations：病例数limited.Conclusions：我们的综合评价方法使用MENBI提供了建立适当的治疗策略，难以确定为腺瘤或癌病变的能力。
Background: Therapeutic strategies for flat elevated (0-IIa) lesions in the stomach diagnosed as adenoma by biopsy are currently not established, because some difficulties have previously been reported in the evaluation of vascular patterns alone for the differential diagnosis between adenoma and carcinoma.Objective: We attempted to evaluate the 0-IIa lesions diagnosed as adenoma by using magnifying endoscopy with narrow-band imaging (MENBI) to distinguish them as either adenoma or carcinoma.Setting: Department of Gastroenterology, Fujita Health University.Patients: Fourteen adenomatous lesions (6 adenomas and 8 carcinomas confirmed postoperatively) diagnosed with preoperative biopsies from patients who had undergone endoscopic submucosal dissection were evaluated.Interventions: We selected 5 sites per lesion for MENBI. Selected sites were divided into superficial structures (SSs) and irregular microvascular patterns (IMVPs).Main Outcome Measurements: The rate of SSs and IMVPs in adenoma and carcinoma.Results: Significant SSs were tubular in the adenoma and unclear in the carcinoma. Regarding IMVP subcategories, (1) slight intrastructual irregular microvascular patterns (ISIMVPs) accounted for 97%, (2) severe ISIMVPs accounted for 0%, (3) Fine networks accounted for 3%, and (4) corkscrews accounted for 0% of cases in the adenomas. The corresponding proportions in the carcinomas were (1) 40%, (2) 15%, (3) 45%, and (4) 0%. Severe ISIMVPs and fine networks were significant Findings for carcinomas.Limitations: The number of cases was limited.Conclusions: Our combined evaluation method using MENBI offers the ability to establish proper therapeutic strategies for lesions that are difficult to identify as adenoma or carcinoma.