[ Objective] The aim of this study was to solve the problem of photographing small flowers and fruits with a common digital camera in field. [Method] Firstly, the photographic mode of a common digital camera was set ...[ Objective] The aim of this study was to solve the problem of photographing small flowers and fruits with a common digital camera in field. [Method] Firstly, the photographic mode of a common digital camera was set as "macro" (or "soft snap" ) and "flash off". Secondly, the small flower or fruit was magnified with a magnifying glass, and then the magnified flower or fruit was automatically focused with the digital camera lens. After automatic focusing, the shutter button was pressed and the photograph finished. [Result] With this method, the clear inflo- rescence or floral photographs of Eragrostis pilosa ( Gramineae ) , Bidens biternata (Compositae) and Tribulus terrester (Zygophllaceae) were obtained in field. [ Conclusion] The optical system of a digital camera has been changed by the magnifying glass, which improves the photographic function of a common digital camera to small flowers and fruits, and also easily gets their clear photographs.展开更多
AIM:To elucidate the colonoscopic features of serrated lesions of the colorectum using magnifying colonoscopy.METHODS:Broad division of serrated lesions of the colorectum into hyperplastic polyps(HPs),traditional serr...AIM:To elucidate the colonoscopic features of serrated lesions of the colorectum using magnifying colonoscopy.METHODS:Broad division of serrated lesions of the colorectum into hyperplastic polyps(HPs),traditional serrated adenomas(TSAs),and sessile serrated adenomas/polyps(SSA/Ps) has been proposed on the basis of recent molecular biological studies.However,few reports have examined the colonoscopic features of these divisions,including magnified colonoscopic findings.This study examined 118 lesions excised in our hospital as suspected serrated lesions after magnified observation between January 2008 and September 2011.Patient characteristics(sex,age),conventional colonoscopic findings(location,size,morphology,color,mucin) and magnified colonoscopic findings(pit pattern diagnosis) were interpreted by five colonoscopists with experience in over 1000 colonoscopies,and were compared with histopathological diagnoses.The pit patterns were categorized according to Kudo's classification,but a more detailed investigation was also performed using the subclassification [type Ⅱ-Open(type Ⅱ-O),type Ⅱ-Long(type Ⅱ-L),or type Ⅳ-Serrated(type Ⅳ-S)] proposed by Kimura T and Yamano H.RESULTS:Lesions comprised 23 HPs(23/118:19.5%),39 TSAs(39/118:33.1%:with cancer in one case),50 SSA/Ps(50/118:42.4%:complicated with cancer in three cases),and six others(6/118:5.1%).We excluded six others,including three regular adenomas,one hamartoma,one inflammatory polyp,and one juvenile polyp for further analysis.Conventional colonoscopy showed that SSA/Ps were characterized as larger in diameter than TSAs and HPs(SSA/P vs HP,13.62 ± 8.62 mm vs 7.74 ± 3.24 mm,P < 0.001;SSA/Ps vs TSA,13.62 ± 8.62 mm vs 9.89 ± 5.73 mm,P < 0.01);common in the right side of the colon [HPs,30.4%(7/23):TSAs,20.5%(8/39):SSA/P,84.0%(42/50),P < 0.001];flat-elevated lesion [HPs,30.4%(7/23):TSAs,5.1%(2/39):SSA/Ps,90.0%(45/50),P < 0.001];normal-colored or pale imucosa [HPs,34.8%(8/23):TSAs,10.3%(4/39):SSA/Ps,80%(40/50),P < 0.001];and with large amounts of mucin [HPs,21.7%(5/23):TSAs,17.9%(7/39):SSA/Ps,72.0%(36/50),P < 0.001].In magnified colonoscopic findings,17 lesions showed either type Ⅱ pit pattern alone or partial type Ⅱ pit pattern as the basic architecture,with 14 HPs(14/17,70.0%) and 3 SSA/Ps.Magnified colonoscopy showed the type Ⅱ-O pit pattern as characteristic of SSA/Ps [sensitivity 83.7%(41/49),specificity 85.7%(54/63)].Cancer was also present in three lesions,in all of which a type Ⅵ pit pattern was also present within the same lesion.There were four HPs and four TSAs each.The type Ⅳ-S pit pattern was characteristic of TSAs [sensitivity 96.7%(30/31),specificity 89.9%(72/81)].Cancer was present in one lesion,in which a type Ⅵ pit pattern was also present within the same lesion.In our study,serrated lesions of the colorectum also possessed the features described in previous reports of conventional colonoscopic findings.The pit pattern diagnosis using magnifying colonoscopy,particularly magnified colonoscopic findings using subclassifications of surface architecture,reflected the pathological characteristics of SSA/Ps and TSAs,and will be useful for colonoscopic diagnosis.CONCLUSION:We suggest that this system could be a good diagnostic tool for SSA/Ps using magnifying colonoscopy.展开更多
To assess the accuracy of a new magnifying endoscopy (ME) classification for predicting depth of invasion of superficial esophageal squamous cell carcinoma (SESCC). METHODSThis study included a total of 70 lesions in ...To assess the accuracy of a new magnifying endoscopy (ME) classification for predicting depth of invasion of superficial esophageal squamous cell carcinoma (SESCC). METHODSThis study included a total of 70 lesions in 69 patients with SESCC who underwent ME with narrow-band imaging (ME-NBI) before resection from August 2010 to July 2016. Accuracy of ME-NBI for predicting depth of invasion of SESCC was analyzed by using a new ME classification proposed by the Japan Esophageal Society (JES), and interobserver agreement was assessed. RESULTSOverall accuracy of ME-NBI for estimating depth of invasion of SESCC was 78.6%. Sensitivity and specificity of type B1 for tumors limited to the epithelial layer (m1) or invading into the lamina propria (m2) were 71.4% and 100%, respectively. Sensitivity and specificity of type B2 for tumors invading into the muscularis mucosa (m3) or superficial submucosa (≤ 200 μm, sm1) were 94.4% and 73.1%, respectively, while those of type B3 for tumors invading into the deep submucosa (> 200 μm, sm2) were 75.0% and 97.8%, respectively. Interobserver agreement was excellent (κ = 0.86, 95%CI: 0.76-0.95). CONCLUSIONThe recently developed JES ME classification is useful for predicting depth of invasion of SESCC, with reliable interobserver agreement.展开更多
We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointesti...We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointestinal polyposis with ectodermal abnormalities. To our knowledge, this is the first report showing magnified intestinal lesions of CCS. A 73-year-old female visited our hospital with complaints of diarrhea and dysgeusia. The blood test showed mild anemia and hypoalbuminemia. The esophagogastroduodenoscopy and colonoscopy revealed diffuse and reddened sessile to semi-pedunculated polyps, resulting in the diagnosis of CCS. In addition to the findings of conventional balloon-assisted enteroscopy or capsule endoscopy, magnifying observation revealed tiny granular structures, non-uniformity of the villus, irregular caliber of the loop-like capillaries, scattered white spots in the villous tip, and patchy redness of the villus. Histologically, the scattered white spots and patchy redness of the villus reflect lymphangiectasia and bleeding to interstitium, respectively.展开更多
AIM:To evaluate the diagnostic efficacies of narrowband imaging(NBI) endoscopy with and without high magnification in distinguishing neoplasia from nonneoplasia colorectal lesions.METHODS:A total of 118 patients with ...AIM:To evaluate the diagnostic efficacies of narrowband imaging(NBI) endoscopy with and without high magnification in distinguishing neoplasia from nonneoplasia colorectal lesions.METHODS:A total of 118 patients with 123 colorectal lesions examined by NBI endoscopy in the Zhejiang Provincial People's Hospital from September 2008 to April 2010 were enrolled in this study.These lesions were classified by pit pattern and capillary pattern,and then assessed by histopathology.RESULTS:Ten lesions not meeting the diagnostic criteria were excuded,the overall diagnostic accuracy of NBI endoscopy in distinguishing neoplasia from non-neoplasia colorectal lesions was 91.2%(103/113),and that of NBI endoscopy with and without high magnification was 93.0%(40/43) and 90.0%(63/70),respectively.Both were significantly higher than that of conventional colonoscopy reported in the literature(P < 0.05),but there was no significant difference between the two groups(P > 0.05).CONCLUSION:Besides NBI magnifying endoscopy,NBI endoscopy without magnification may also be used to distinguish neoplasia from non-neoplasia colorectal lesions.展开更多
Gastric fundic gland polyps(FGPs) are common nonadenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori(H. pylori) infection. Although systemic FGPs associated with familial adenomatou...Gastric fundic gland polyps(FGPs) are common nonadenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori(H. pylori) infection. Although systemic FGPs associated with familial adenomatous polyposis(FAP) often have dysplasia, there are few reports of dysplasia occurring in sporadic F G P s, e s p e c i a l l y w h e n d e t e c t e d b y m a g n i f y i n g endoscopy with narrow band imaging(ME-NBI). We experienced two cases of adenocarcinoma occurring in sporadic FGPs, and their ME-NBI findings were very useful for differentiating FGP with cancer from nondysplastic FGP. A 68-year-old man and a 63-year-old woman were referred to our institution for medical checkup. H. pylori was negative in both patients. Endoscopic examination revealed a small reddishpolypoid lesion on the anterior wall of the upper gastric body and several FGPs. ME-NBI showed an irregular microvascular architecture composed of closed loop- or open loop-type vascular components, plus an irregular microsurface structure composed of oval-type surface components which was different from that of FGPs. FAP was denied because of the absence of colon polyps and no familial history of FAP. Pathological diagnosis was adenocarcinoma occurring in sporadic FGP.展开更多
AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:...AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear visualization of the vascular microsurface patterns and microvascular structures of the gastric mucosa. The accuracy of the CLE and the ME-NBI diagnosis was 88% (95% CI:78%-98%) and 81% (95% CI: 69%-93%), respectively. The kappa coefficient of agreement between the histopathology and the in vivo CLE imaging was 0.755; between the histopathology and the in vivo CLE imaging was 0.615. McNemar's test (binomial distribution used) indicated that the agreement was significant (P < 0.05). When patients were diagnosed by MENBI with CLE, the overall accuracy of the diagnosis was 86.21% (95% CI:73%-96%), and the kappa coefficient of agreement was 0.713, according to McNemar's test (P < 0.05). CONCLUSION:Higher diagnostic accuracy, sensitivityand specificity of CLE over ME-NBI indicate the feasibility of these two techniques for the efficacious diagnostic classification of gastric IN.展开更多
It is well known that angiogenesis is critical in the transition from premalignant to malignant lesions.Consequently,early detection and diagnosis based on morphological changes to the microvessels are crucial.In the ...It is well known that angiogenesis is critical in the transition from premalignant to malignant lesions.Consequently,early detection and diagnosis based on morphological changes to the microvessels are crucial.In the last few years,new imaging techniques which utilize the properties of light-tissue interaction have been developed to increase early diagnosis of gastrointestinal(GI) tract neoplasia.We analyzed several "red-flag" endoscopic techniques used to enhance visualization of the vascular pattern of preneoplastic and neoplastic lesions(e.g.trimodal imaging including autofluorescence imaging,magnifying endoscopy and narrow band imaging).These new endoscopic techniques provide better visualization of mucosal microsurface structure and microvascular architecture and may enhance the diagnosis and characterization of mucosal lesions in the GI tract.In the near future,it is expected that trimodal imaging endoscopy will be practiced as a standard endoscopy technique as it is quick,safe and accurate for making a precise diagnosis of gastrointestinal pathology,with an emphasis on the diagnosis of early GI tract cancers.Further large-scale randomized controlled trials comparing these modalities in different patient subpopulations are warranted before their endorsement in the routine practice of GI endoscopy.展开更多
AIM To examine usefulness of virtual biopsy using endocytoscopy by comparing the in vivo endocytoscopic and histopathological images of gastric cancers.METHODS Endocytoscopy was performed in 30 patients with early gas...AIM To examine usefulness of virtual biopsy using endocytoscopy by comparing the in vivo endocytoscopic and histopathological images of gastric cancers.METHODS Endocytoscopy was performed in 30 patients with early gastric cancer. Of these, 26 patients showed well differentiated adenocarcinomas, while 4 patients showed poorly differentiated adenocarcinomas(including one signet ring cell carcinoma). Cancerous and non-cancerous areas were observed after double staining with 0.05% crystal violet and 0.1% methylene blue. The endocytoscopic images obtained were evaluated by an expert endoscopist and an expert pathologist without knowledge of patient clinical data, and endocytoscopic and histopathological diagnoses were compared.RESULTS The endocytoscopic images of the cancerous area were assessed as evaluable in 25(83.3%) and 27(90%) patients by endoscopist A and pathologist B, respectively, and those of the non-cancerous area as evaluable in 28(93.3%) and 23(76.7%) patients by the endoscopist and pathologist, respectively. The sensitivity, specificity, and diagnostic accuracy of gastric cancer diagnosis using evaluable endocytoscopic images were 88.0% and 92.9%, and 90.6% by endoscopist A, and 88.9% and 91.3%, and 90.0% by pathologist B, respectively. Evaluation of the diagnostic concordance rate between the endoscopist and the pathologist by inter-observer agreement calculation revealed no significant difference between the two observers. The inter-observer agreement(κ-value) for endocytoscopic diagnosis was 0.745. CONCLUSION Endocytoscopy is useful for the differentiation of cancerous from non-cancerous gastric mucosa, making it a promising tool for virtual biopsy.展开更多
AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis...AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis of a randomized controlled trial. We performed NBI-ME for 147 patients with present or a history of squamous cell carcinoma in the head and neck, or esophagus between January 2009 and June 2011. Two expert endoscopistsdetected 89 lesions that were suspicious for SESCC lesions, which had been prospectively evaluated for the following 6 NBI-ME findings in real time: "intervascular background coloration"; "proliferation of intrapapillary capillary loops(IPCL)"; and "dilation", "tortuosity", "change in caliber", and "various shapes(VS)" of IPCLs(i.e., Inoue's tetrad criteria). The histologic examination of specimens was defined as the gold standard for diagnosis. A stepwise logistic regression analysis was used to identify candidates for the simplified criteria from among the 6 NBI-ME findings for diagnosing SESCCs. We evaluated diagnostic performance of the simplified criteria compared with that of Inoue's criteria.RESULTS Fifty-four lesions(65%) were histologically diagnosed as SESCCs and the others as low-grade intraepithelial neoplasia or inflammation. In the univariate analysis, proliferation, tortuosity, change in caliber, and VS were significantly associated with SESCC(P < 0.01). The combination of VS and proliferation was statistically extracted from the 6 NBI-ME findings by using the stepwise logistic regression model. We defined the combination of VS and proliferation as simplified dyad criteria for SESCC. The areas under the curve of the simplified dyad criteria and Inoue's tetrad criteria were 0.70 and 0.73, respectively. No significant difference was shown between them. The sensitivity, specificity, and accuracy of diagnosis for SESCC were 77.8%, 57.1%, 69.7% and 51.9%, 80.0%, 62.9% for the simplified dyad criteria and Inoue's tetrad criteria, respectively.CONCLUSION The combination of proliferation and VS may serve as simplified criteria for the diagnosis of SESCC using NBIME.展开更多
Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by exacerbations and remissions. The degree of inflammation as assessed by conventional colonoscopy is a reliable parameter of disease act...Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by exacerbations and remissions. The degree of inflammation as assessed by conventional colonoscopy is a reliable parameter of disease activity. However, even when conventional colonoscopy suggests remission and normal mucosal findings, microscopic abnormalities may persist, and relapse may occur later. Patients with long-standing, extensive ulcerative colitis have an increased risk of developing colorectal cancer. Ulcerative colitis-associated colorectal cancer is characterized by an early age at onset, poorly differentiated tumor cells, mucinous carcinoma, and multiple lesions. Early detection of dysplasia and colitic cancer is thus a prerequisite for survival. A relatively new method, magnifying chromoscopy, is thought to be useful for the early detection and diagnosis of dysplasia and colitic cancer, as well as the prediction of relapse.展开更多
Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis.Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as cu...Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis.Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years.The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens.However,before engaging in endoscopic therapy,an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ.For the past few years,many new types of endoscopic techniques,including magnifying endoscopy with narrow-band imaging (MENBI),have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR.However,to date,there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon",for the upper GI,there is still no clear internationally accepted classification system of magnifying endoscopy.Therefore,in order to help unify some viewpoints,here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI,describe the accurate relationship between them and the pathological diagnosis,and their clinical applications prior to ESD or en bloc EMR.We will also discuss assessing the differentiation and depth of invasion,defying the lateral spread of involvement and targeting biopsy in real time.展开更多
The patient was a 33-year-old man with hematochezia. Colonoscopy revealed a Iobulated peduncular polyp with bleeding, about 40 mm in diameter, in the ascending colon. The polyp had both red and white components and a ...The patient was a 33-year-old man with hematochezia. Colonoscopy revealed a Iobulated peduncular polyp with bleeding, about 40 mm in diameter, in the ascending colon. The polyp had both red and white components and a mosaic pattern. Magnifying observation revealed a red rugged surface component, and smooth white nodules with enlarged round or oval crypt openings. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with cystic change. This polyp was diagnosed as inflammatory myoglandular polyp (IMGP). Lobulated-type IMGP in the ascending colon is rare.展开更多
For thermal conduction cases,one can detect the size of an object explicitly by measuring the temperature distribution around it.If the temperature is the only signature we can obtain,we will give an incorrect judgmen...For thermal conduction cases,one can detect the size of an object explicitly by measuring the temperature distribution around it.If the temperature is the only signature we can obtain,we will give an incorrect judgment on the shape or size of the object by disturbing the distribution of it.According to this principle,in this article,we develop a transformation method and design a dual-functional thermal device,which can create a thermal illusion that the object inside it "seems" to appear bigger or smaller than its original size.This device can functionally switch among magnifier and miniGer at will The proposed device consists of two layers:the cloak and the complementary material.A thermal cloak can make the internal region thermally "invisible" while the complementary layer offsets this effect.The combination leads to the illusion of magnification and minification.As a result of finite element simulations,the performances of the illusions are confirmed.展开更多
基金Supported by National Natural Science Foundation(30770124)~~
文摘[ Objective] The aim of this study was to solve the problem of photographing small flowers and fruits with a common digital camera in field. [Method] Firstly, the photographic mode of a common digital camera was set as "macro" (or "soft snap" ) and "flash off". Secondly, the small flower or fruit was magnified with a magnifying glass, and then the magnified flower or fruit was automatically focused with the digital camera lens. After automatic focusing, the shutter button was pressed and the photograph finished. [Result] With this method, the clear inflo- rescence or floral photographs of Eragrostis pilosa ( Gramineae ) , Bidens biternata (Compositae) and Tribulus terrester (Zygophllaceae) were obtained in field. [ Conclusion] The optical system of a digital camera has been changed by the magnifying glass, which improves the photographic function of a common digital camera to small flowers and fruits, and also easily gets their clear photographs.
基金Supported by The Japanese Foundation for Research and Promotion of Endoscopy (JFE),in partThe Japanese Society of Gastroenterology (JSGE),to Watanabe Y+1 种基金The Princess Takamatsu Cancer Research FundA Generous Gift from both the JFE and the JSGE
文摘AIM:To elucidate the colonoscopic features of serrated lesions of the colorectum using magnifying colonoscopy.METHODS:Broad division of serrated lesions of the colorectum into hyperplastic polyps(HPs),traditional serrated adenomas(TSAs),and sessile serrated adenomas/polyps(SSA/Ps) has been proposed on the basis of recent molecular biological studies.However,few reports have examined the colonoscopic features of these divisions,including magnified colonoscopic findings.This study examined 118 lesions excised in our hospital as suspected serrated lesions after magnified observation between January 2008 and September 2011.Patient characteristics(sex,age),conventional colonoscopic findings(location,size,morphology,color,mucin) and magnified colonoscopic findings(pit pattern diagnosis) were interpreted by five colonoscopists with experience in over 1000 colonoscopies,and were compared with histopathological diagnoses.The pit patterns were categorized according to Kudo's classification,but a more detailed investigation was also performed using the subclassification [type Ⅱ-Open(type Ⅱ-O),type Ⅱ-Long(type Ⅱ-L),or type Ⅳ-Serrated(type Ⅳ-S)] proposed by Kimura T and Yamano H.RESULTS:Lesions comprised 23 HPs(23/118:19.5%),39 TSAs(39/118:33.1%:with cancer in one case),50 SSA/Ps(50/118:42.4%:complicated with cancer in three cases),and six others(6/118:5.1%).We excluded six others,including three regular adenomas,one hamartoma,one inflammatory polyp,and one juvenile polyp for further analysis.Conventional colonoscopy showed that SSA/Ps were characterized as larger in diameter than TSAs and HPs(SSA/P vs HP,13.62 ± 8.62 mm vs 7.74 ± 3.24 mm,P < 0.001;SSA/Ps vs TSA,13.62 ± 8.62 mm vs 9.89 ± 5.73 mm,P < 0.01);common in the right side of the colon [HPs,30.4%(7/23):TSAs,20.5%(8/39):SSA/P,84.0%(42/50),P < 0.001];flat-elevated lesion [HPs,30.4%(7/23):TSAs,5.1%(2/39):SSA/Ps,90.0%(45/50),P < 0.001];normal-colored or pale imucosa [HPs,34.8%(8/23):TSAs,10.3%(4/39):SSA/Ps,80%(40/50),P < 0.001];and with large amounts of mucin [HPs,21.7%(5/23):TSAs,17.9%(7/39):SSA/Ps,72.0%(36/50),P < 0.001].In magnified colonoscopic findings,17 lesions showed either type Ⅱ pit pattern alone or partial type Ⅱ pit pattern as the basic architecture,with 14 HPs(14/17,70.0%) and 3 SSA/Ps.Magnified colonoscopy showed the type Ⅱ-O pit pattern as characteristic of SSA/Ps [sensitivity 83.7%(41/49),specificity 85.7%(54/63)].Cancer was also present in three lesions,in all of which a type Ⅵ pit pattern was also present within the same lesion.There were four HPs and four TSAs each.The type Ⅳ-S pit pattern was characteristic of TSAs [sensitivity 96.7%(30/31),specificity 89.9%(72/81)].Cancer was present in one lesion,in which a type Ⅵ pit pattern was also present within the same lesion.In our study,serrated lesions of the colorectum also possessed the features described in previous reports of conventional colonoscopic findings.The pit pattern diagnosis using magnifying colonoscopy,particularly magnified colonoscopic findings using subclassifications of surface architecture,reflected the pathological characteristics of SSA/Ps and TSAs,and will be useful for colonoscopic diagnosis.CONCLUSION:We suggest that this system could be a good diagnostic tool for SSA/Ps using magnifying colonoscopy.
基金Supported by the National R&D Program for Cancer Control,Ministry for Health,Welfare and Family Affairs,South Korea,No.0920050the Medical Research Center Program through the National Research Foundation of Korea grant funded by the Korea government,No.NRF-2015R1A5A2009656
文摘To assess the accuracy of a new magnifying endoscopy (ME) classification for predicting depth of invasion of superficial esophageal squamous cell carcinoma (SESCC). METHODSThis study included a total of 70 lesions in 69 patients with SESCC who underwent ME with narrow-band imaging (ME-NBI) before resection from August 2010 to July 2016. Accuracy of ME-NBI for predicting depth of invasion of SESCC was analyzed by using a new ME classification proposed by the Japan Esophageal Society (JES), and interobserver agreement was assessed. RESULTSOverall accuracy of ME-NBI for estimating depth of invasion of SESCC was 78.6%. Sensitivity and specificity of type B1 for tumors limited to the epithelial layer (m1) or invading into the lamina propria (m2) were 71.4% and 100%, respectively. Sensitivity and specificity of type B2 for tumors invading into the muscularis mucosa (m3) or superficial submucosa (≤ 200 μm, sm1) were 94.4% and 73.1%, respectively, while those of type B3 for tumors invading into the deep submucosa (> 200 μm, sm2) were 75.0% and 97.8%, respectively. Interobserver agreement was excellent (κ = 0.86, 95%CI: 0.76-0.95). CONCLUSIONThe recently developed JES ME classification is useful for predicting depth of invasion of SESCC, with reliable interobserver agreement.
文摘We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointestinal polyposis with ectodermal abnormalities. To our knowledge, this is the first report showing magnified intestinal lesions of CCS. A 73-year-old female visited our hospital with complaints of diarrhea and dysgeusia. The blood test showed mild anemia and hypoalbuminemia. The esophagogastroduodenoscopy and colonoscopy revealed diffuse and reddened sessile to semi-pedunculated polyps, resulting in the diagnosis of CCS. In addition to the findings of conventional balloon-assisted enteroscopy or capsule endoscopy, magnifying observation revealed tiny granular structures, non-uniformity of the villus, irregular caliber of the loop-like capillaries, scattered white spots in the villous tip, and patchy redness of the villus. Histologically, the scattered white spots and patchy redness of the villus reflect lymphangiectasia and bleeding to interstitium, respectively.
文摘AIM:To evaluate the diagnostic efficacies of narrowband imaging(NBI) endoscopy with and without high magnification in distinguishing neoplasia from nonneoplasia colorectal lesions.METHODS:A total of 118 patients with 123 colorectal lesions examined by NBI endoscopy in the Zhejiang Provincial People's Hospital from September 2008 to April 2010 were enrolled in this study.These lesions were classified by pit pattern and capillary pattern,and then assessed by histopathology.RESULTS:Ten lesions not meeting the diagnostic criteria were excuded,the overall diagnostic accuracy of NBI endoscopy in distinguishing neoplasia from non-neoplasia colorectal lesions was 91.2%(103/113),and that of NBI endoscopy with and without high magnification was 93.0%(40/43) and 90.0%(63/70),respectively.Both were significantly higher than that of conventional colonoscopy reported in the literature(P < 0.05),but there was no significant difference between the two groups(P > 0.05).CONCLUSION:Besides NBI magnifying endoscopy,NBI endoscopy without magnification may also be used to distinguish neoplasia from non-neoplasia colorectal lesions.
文摘Gastric fundic gland polyps(FGPs) are common nonadenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori(H. pylori) infection. Although systemic FGPs associated with familial adenomatous polyposis(FAP) often have dysplasia, there are few reports of dysplasia occurring in sporadic F G P s, e s p e c i a l l y w h e n d e t e c t e d b y m a g n i f y i n g endoscopy with narrow band imaging(ME-NBI). We experienced two cases of adenocarcinoma occurring in sporadic FGPs, and their ME-NBI findings were very useful for differentiating FGP with cancer from nondysplastic FGP. A 68-year-old man and a 63-year-old woman were referred to our institution for medical checkup. H. pylori was negative in both patients. Endoscopic examination revealed a small reddishpolypoid lesion on the anterior wall of the upper gastric body and several FGPs. ME-NBI showed an irregular microvascular architecture composed of closed loop- or open loop-type vascular components, plus an irregular microsurface structure composed of oval-type surface components which was different from that of FGPs. FAP was denied because of the absence of colon polyps and no familial history of FAP. Pathological diagnosis was adenocarcinoma occurring in sporadic FGP.
文摘AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear visualization of the vascular microsurface patterns and microvascular structures of the gastric mucosa. The accuracy of the CLE and the ME-NBI diagnosis was 88% (95% CI:78%-98%) and 81% (95% CI: 69%-93%), respectively. The kappa coefficient of agreement between the histopathology and the in vivo CLE imaging was 0.755; between the histopathology and the in vivo CLE imaging was 0.615. McNemar's test (binomial distribution used) indicated that the agreement was significant (P < 0.05). When patients were diagnosed by MENBI with CLE, the overall accuracy of the diagnosis was 86.21% (95% CI:73%-96%), and the kappa coefficient of agreement was 0.713, according to McNemar's test (P < 0.05). CONCLUSION:Higher diagnostic accuracy, sensitivityand specificity of CLE over ME-NBI indicate the feasibility of these two techniques for the efficacious diagnostic classification of gastric IN.
文摘It is well known that angiogenesis is critical in the transition from premalignant to malignant lesions.Consequently,early detection and diagnosis based on morphological changes to the microvessels are crucial.In the last few years,new imaging techniques which utilize the properties of light-tissue interaction have been developed to increase early diagnosis of gastrointestinal(GI) tract neoplasia.We analyzed several "red-flag" endoscopic techniques used to enhance visualization of the vascular pattern of preneoplastic and neoplastic lesions(e.g.trimodal imaging including autofluorescence imaging,magnifying endoscopy and narrow band imaging).These new endoscopic techniques provide better visualization of mucosal microsurface structure and microvascular architecture and may enhance the diagnosis and characterization of mucosal lesions in the GI tract.In the near future,it is expected that trimodal imaging endoscopy will be practiced as a standard endoscopy technique as it is quick,safe and accurate for making a precise diagnosis of gastrointestinal pathology,with an emphasis on the diagnosis of early GI tract cancers.Further large-scale randomized controlled trials comparing these modalities in different patient subpopulations are warranted before their endorsement in the routine practice of GI endoscopy.
文摘AIM To examine usefulness of virtual biopsy using endocytoscopy by comparing the in vivo endocytoscopic and histopathological images of gastric cancers.METHODS Endocytoscopy was performed in 30 patients with early gastric cancer. Of these, 26 patients showed well differentiated adenocarcinomas, while 4 patients showed poorly differentiated adenocarcinomas(including one signet ring cell carcinoma). Cancerous and non-cancerous areas were observed after double staining with 0.05% crystal violet and 0.1% methylene blue. The endocytoscopic images obtained were evaluated by an expert endoscopist and an expert pathologist without knowledge of patient clinical data, and endocytoscopic and histopathological diagnoses were compared.RESULTS The endocytoscopic images of the cancerous area were assessed as evaluable in 25(83.3%) and 27(90%) patients by endoscopist A and pathologist B, respectively, and those of the non-cancerous area as evaluable in 28(93.3%) and 23(76.7%) patients by the endoscopist and pathologist, respectively. The sensitivity, specificity, and diagnostic accuracy of gastric cancer diagnosis using evaluable endocytoscopic images were 88.0% and 92.9%, and 90.6% by endoscopist A, and 88.9% and 91.3%, and 90.0% by pathologist B, respectively. Evaluation of the diagnostic concordance rate between the endoscopist and the pathologist by inter-observer agreement calculation revealed no significant difference between the two observers. The inter-observer agreement(κ-value) for endocytoscopic diagnosis was 0.745. CONCLUSION Endocytoscopy is useful for the differentiation of cancerous from non-cancerous gastric mucosa, making it a promising tool for virtual biopsy.
文摘AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis of a randomized controlled trial. We performed NBI-ME for 147 patients with present or a history of squamous cell carcinoma in the head and neck, or esophagus between January 2009 and June 2011. Two expert endoscopistsdetected 89 lesions that were suspicious for SESCC lesions, which had been prospectively evaluated for the following 6 NBI-ME findings in real time: "intervascular background coloration"; "proliferation of intrapapillary capillary loops(IPCL)"; and "dilation", "tortuosity", "change in caliber", and "various shapes(VS)" of IPCLs(i.e., Inoue's tetrad criteria). The histologic examination of specimens was defined as the gold standard for diagnosis. A stepwise logistic regression analysis was used to identify candidates for the simplified criteria from among the 6 NBI-ME findings for diagnosing SESCCs. We evaluated diagnostic performance of the simplified criteria compared with that of Inoue's criteria.RESULTS Fifty-four lesions(65%) were histologically diagnosed as SESCCs and the others as low-grade intraepithelial neoplasia or inflammation. In the univariate analysis, proliferation, tortuosity, change in caliber, and VS were significantly associated with SESCC(P < 0.01). The combination of VS and proliferation was statistically extracted from the 6 NBI-ME findings by using the stepwise logistic regression model. We defined the combination of VS and proliferation as simplified dyad criteria for SESCC. The areas under the curve of the simplified dyad criteria and Inoue's tetrad criteria were 0.70 and 0.73, respectively. No significant difference was shown between them. The sensitivity, specificity, and accuracy of diagnosis for SESCC were 77.8%, 57.1%, 69.7% and 51.9%, 80.0%, 62.9% for the simplified dyad criteria and Inoue's tetrad criteria, respectively.CONCLUSION The combination of proliferation and VS may serve as simplified criteria for the diagnosis of SESCC using NBIME.
文摘Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by exacerbations and remissions. The degree of inflammation as assessed by conventional colonoscopy is a reliable parameter of disease activity. However, even when conventional colonoscopy suggests remission and normal mucosal findings, microscopic abnormalities may persist, and relapse may occur later. Patients with long-standing, extensive ulcerative colitis have an increased risk of developing colorectal cancer. Ulcerative colitis-associated colorectal cancer is characterized by an early age at onset, poorly differentiated tumor cells, mucinous carcinoma, and multiple lesions. Early detection of dysplasia and colitic cancer is thus a prerequisite for survival. A relatively new method, magnifying chromoscopy, is thought to be useful for the early detection and diagnosis of dysplasia and colitic cancer, as well as the prediction of relapse.
基金Supported by The fund of National Natural Science Foundation Financial of China,No. 81072913
文摘Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis.Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years.The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens.However,before engaging in endoscopic therapy,an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ.For the past few years,many new types of endoscopic techniques,including magnifying endoscopy with narrow-band imaging (MENBI),have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR.However,to date,there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon",for the upper GI,there is still no clear internationally accepted classification system of magnifying endoscopy.Therefore,in order to help unify some viewpoints,here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI,describe the accurate relationship between them and the pathological diagnosis,and their clinical applications prior to ESD or en bloc EMR.We will also discuss assessing the differentiation and depth of invasion,defying the lateral spread of involvement and targeting biopsy in real time.
文摘The patient was a 33-year-old man with hematochezia. Colonoscopy revealed a Iobulated peduncular polyp with bleeding, about 40 mm in diameter, in the ascending colon. The polyp had both red and white components and a mosaic pattern. Magnifying observation revealed a red rugged surface component, and smooth white nodules with enlarged round or oval crypt openings. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with cystic change. This polyp was diagnosed as inflammatory myoglandular polyp (IMGP). Lobulated-type IMGP in the ascending colon is rare.
基金Support by the National Natural Science Foundation of China under Grant No.11222544by the Fok Ying Tung Education Foundation under Grant No.131008+1 种基金by the Program for New Century Excellent Talents in University(NCET-12-0121)by the Chinese National Key Basic Research Special Fund under Grant No.2011CB922004
文摘For thermal conduction cases,one can detect the size of an object explicitly by measuring the temperature distribution around it.If the temperature is the only signature we can obtain,we will give an incorrect judgment on the shape or size of the object by disturbing the distribution of it.According to this principle,in this article,we develop a transformation method and design a dual-functional thermal device,which can create a thermal illusion that the object inside it "seems" to appear bigger or smaller than its original size.This device can functionally switch among magnifier and miniGer at will The proposed device consists of two layers:the cloak and the complementary material.A thermal cloak can make the internal region thermally "invisible" while the complementary layer offsets this effect.The combination leads to the illusion of magnification and minification.As a result of finite element simulations,the performances of the illusions are confirmed.