Endoscopic detection and diagnostic strategies for minute gastric cancer:A real-world observational study

BACKGROUND Minute gastric cancers(MGCs)have a favorable prognosis,but they are too small to be detected by endoscopy,with a maximum diameter≤5 mm.AIM To explore endoscopic detection and diagnostic strategies for MGCs.METHODS This was a real-world observational study.The endoscopic and clinicopathological parameters of 191 MGCs between January 2015 and December 2022 were retrospectively analyzed.Endoscopic discoverable opportunity and typical neoplastic features were emphatically reviewed.RESULTS All MGCs in our study were of a single pathological type,97.38%(186/191)of which were differentiated-type tumors.White light endoscopy(WLE)detected 84.29%(161/191)of MGCs,and the most common morphology of MGCs found by WLE was protruding.Narrow-band imaging(NBI)secondary observation detected 14.14%(27/191)of MGCs,and the most common morphology of MGCs found by NBI was flat.Another three MGCs were detected by indigo carmine third observation.If a well-demarcated border lesion exhibited a typical neoplastic color,such as yellowish-red or whitish under WLE and brownish under NBI,MGCs should be diagnosed.The proportion with high diagnostic confidence by magnifying endoscopy with NBI(ME-NBI)was significantly higher than the proportion with low diagnostic confidence and the only visible groups(94.19%>56.92%>32.50%,P<0.001).CONCLUSION WLE combined with NBI and indigo carmine are helpful for detection of MGCs.A clear demarcation line combined with a typical neoplastic color using nonmagnifying observation is sufficient for diagnosis of MGCs.MENBI improves the endoscopic diagnostic confidence of MGCs.

Biochemical metabolic changes assessed by ^(31)P magnetic resonance spectroscopy after radiation-induced hepatic injury in rabbits

AIM:To compare the features of biochemical metabolic changes detected by hepatic phosphorus-31 magnetic resonance spectroscopy(31P MRS) with the liver damage score(LDS) and pathologic changes in rabbits and to investigate the diagnostic value of 31P MRS in acute hepatic radiation injury.METHODS:A total of 30 rabbits received different radiation doses(ranging 5-20 Gy) to establish acute hepatic injury models.Blood biochemical tests,31P MRS and pathological examinations were carried out 24 h after irradiation.The degree of injury was evaluated according to LDS and pathology.Ten healthy rabbits served as controls.The MR examination was performed on a 1.5 T imager using a 1H/31P surface coil by the 2D chemical shift imaging technique.The relative quantities of phosphomonoesters(PME),phosphodiesters(PDE),inorganic phosphate(Pi) and adenosine triphosphate(ATP) were measured.The data were statistically analyzed.RESULTS:(1) Relative quantification of phosphorus metabolites:(a) ATP:there were signif icant differences(P<0.05)(LDS-groups:control group vs mild group vs moderate group vs severe group,1.83±0.33 vs 1.55±0.24 vs 1.27±0.09 vs 0.98±0.18;pathological groups:control group vs mild group vs moderate group vs severe group,1.83±0.33 vs 1.58±0.25 vs 1.32±0.07 vs 1.02±0.18) of ATP relative quantifi cation among control group,mild injured group,moderate injured group,and severe injured group according to both LDS grading and pathological grading,respectively,and it decreased progressively with the increased degree of injury(r=-0.723,P=0.000).(b) PME and Pi;the relative quantifi cation of PME and Pi decreased signif icantly in the severe injured group,and the difference between the control group and severe injured group was signifi cant(P<0.05)(PME:LDS-control group vs LDS-severe group,0.86±0.23 vs 0.58±0.22,P=0.031;pathological control group vs pathological severe group,0.86±0.23 vs 0.60±0.21,P=0.037;Pi:LDS-control group vs LDS-severe group,0.74±0.18 vs 0.43±0.14,P=0.013;pathological control group vs pathological severe group,0.74±0.18 vs 0.43±0.14,P=0.005) according to LDS grading and pathological grading,respectively.(c) PDE;there were no significant differences among groups according to LDS grading,and no signifi cant differences between the control group and experimental groups according to pathological grading.(2) The ratio of relative quantifi cation of phosphorus metabolites:significant differences(P<0.05)(LDS-moderate group and LDS-severe group vs LDS-control group and LDS-mild group,1.94±0.50 and 1.96±0.72 vs 1.43±0.31 and 1.40±0.38) were only found in PDE/ATP between the moderate injured group,the severe injured group and the control group,the mild injured group.No signifi cant difference was found in other ratios of relative quantification of phosphorus metabolites.CONCLUSION:31P MRS is a useful method to evaluate early acute hepatic radiation injury.The relative quantification of hepatic ATP levels,which can reflect the pathological severity of acute hepatic radiation injury,is correlated with LDS.