A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis

Recently, we reported a case of gastric mucosaassociated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestonelike mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.

Application of novel magnified single balloon enteroscopy for a patient with Cronkhite-Canada syndrome

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.

Conventional colonoscopy and magnified chromoendoscopy for the endoscopic histological prediction of diminutive colorectal polyps: A single operator study

AIM： To accurately differentiate the adenomatous from the non-adenomatous polyps by colonoscopy. METHODS： All lesions detected by colonoscopy were first diagnosed using the conventional view followed by chromoendoscopy with magnification. The diagnosis at each step was recorded consecutively. All polyps were completely removed endoscopically for histological evaluation. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as gold standard. RESULTS： A total of 240 lesions were identified, of which 158 （65.8%） were non-neoplastic and 82 （34.2%） were adenomatous. The overall diagnostic accuracy of conventional view, and chromoendoscopy with magnification was 76.3% （183/240） and 95.4% （229/240）, respectively （P〈 0.001） CONCLUSION： The combination of colonoscopy and magnified chromoendoscopy is the most reliable nonbiopsy method for distinguishing the non-neoplastic from the neoplastic lesions.

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.

Microvascular structural changes in esophageal squamous cell carcinoma pathology according to intrapapillary capillary loop types under magnifying endoscopy

BACKGROUND The intrapapillary capillary loop(IPCL)characteristics,visualized using magnifying endoscopy,are commonly assessed for preoperative evaluation of the infiltration depth of esophageal squamous cell carcinoma(ESCC).Japan Esophageal Society(JES)classification is the most widely used classification.Microvascular structural changes are evaluated by magnifying endoscopy for the presence or absence of each morphological factor:tortuosity,dilatation,irregular caliber,and different shapes.However,the pathological characteristics of IPCLs have not been thoroughly investigated,especially the microvascular structures corresponding to the deepest parts of the lesions'infiltration.AIM To investigate differences in pathological microvascular structures of ESCC,which correspond to the deepest parts of the lesions'infiltration.METHODS Patients with ESCC and precancerous lesions diagnosed at Peking University Third Hospital were enrolled between January 2019 and April 2023.Patients first underwent magnified endoscopic examination,followed by endoscopic submucosal dissection or surgical treatment.Pathological images were scanned using a threedimensional slice scanner,and the pathological structural differences in different types,according to the JES classification,were analyzed using nonparametric tests and t-tests.RESULTS The 35 lesions were divided into four groups according to the JES classification:A,B1,B2,and B3.Statistical analyses revealed significant differences(aP<0.05)in the short and long calibers,area,location,and density between types A and B.Notably,there were no significant differences in these parameters between types B1 and B2 and between types B2 and B3(P>0.05).However,significant differences in the short calibers,long calibers,and area of IPCL were observed between types B1 and B3(aP<0.05);no significant differences were found in the density or location(P>0.05).CONCLUSION Pathological structures of IPCLs in the deepest infiltrating regions differ among various IPCL types classified by the JES classification under magnifying endoscopy,especially between the types A and B.

Could near focus endoscopy,narrow-band imaging,and acetic acid improve the visualization of microscopic features of stomach mucosa?

BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capillary network,and gastric pits.AIM To evaluate the effectiveness of a new one-dual(near)focus,NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification.METHODS During 2021 and 2022,68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid(AA).The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa.At the time of the endoscopy,the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy(WLE),near focus(NF),NF-NBI,AA-NF,and AA-NF-NBI modes.RESULTS The WLE,NF and NF-NBI endoscopic modes for all patients(204 images)were classified in the same order into three groups.Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order.According to all three observers who completed the work independently,NF magnification was significantly superior to WLE(P<0.01),and the NF-NBI mode was significantly superior to NF magnification(P<0.01).After applying AA,the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF(P<0.01).Interobserver kappa values for WLE were 0.609,0.704,and 0.598,respectively and were 0.600,0.721,and 0.637,respectively,for NF magnification.For the NF-NBI mode,the values were 0.378,0.471,and 0.553,respectively.For AA-NF,they were 0.453,0.603,and 0.480,respectively,and for AA-NF-NBI,they were 0.643,0.506,and 0.354,respectively.CONCLUSION When investigating gastric mucosa in microscopic detail,NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules,subepithelial capillary network,and gastric pits among the five endoscopic modalities investigated in this study.AA-NF-NBI was the most powerful endoscopic mode for analyzing crypt opening and intervening part.

Experimental study on the desulfurization and evaporation characteristics of Ca(OH)_(2) droplets

The experiments were conducted to focus on the desulfurization and evaporation characteristics of lime slurry droplets at 298-383 K. We designed an evaporation-reaction chamber with quartz glass windows.The monodisperse slurry droplet stream was injected into the evaporation reaction chamber, and the inlet gas components(air, air + SO_(2)) were introduced into the chamber. We applied the magnified digital in-line holography to measure the droplet parameters and calculated the evaporation rate. The effects of temperature, droplet concentration, and SO_(2) concentration on the evaporation rate of Ca(OH)_(2) droplets were discussed. Moreover, the Ca(OH)_(2) droplets under different experimental conditions were sampled,and the droplets were observed and analyzed using an off-line microscope. The evaporation rate of the Ca(OH)_(2) droplet increased at first, and then decreased during the falling process, and remained constant at last. The average evaporation rate of the Ca(OH)_(2) droplets increased significantly with the temperature increasing.

Update on diagnosis and treatment of early signet-ring cell gastric carcinoma: A literature review

Gastric signet-ring cell gastric carcinoma(GSRC)is an unfavorable subtype of gastric cancer(GC)that presents with greater invasiveness and poorer prognosis in advanced stage than other types of GC.However,GSRC in early stage is often considered an indicator of less lymph node metastasis and more satisfying clinical outcome compared to poorly differentiated GC.Therefore,the detection and diagnosis of GSRC at early stage undoubtedly play a crucial role in the management of GSRC patients.In recent years,technological advancement in endoscopy including narrow-band imaging and magnifying endoscopy has significantly improved the accuracy and sensitivity of the diagnosis under endoscopy for GSRC patients.Researches have confirmed that early stage GSRC that meets the expanded criteria of endoscopic resection showed comparable outcomes to surgery after receiving endoscopic submucosal dissection(ESD),indicating that ESD could be considered standard treatment for GSRC after thorough selection and evaluation.This article summarizes the current knowledge and updates pertaining to the endoscopic diagnosis and treatment of early stage signet-ring cell gastric carcinoma.

Diagnosis of extent of early gastric cancer using flexible spectral imaging color enhancement

The demarcation line between the cancerous lesion and the surrounding area could be easily recognized with flexible spectral imaging color enhancement (FICE) system compared with conventional white light images. The characteristic f inding of depressed-type early gastric cancer (EGC) in most cases was revealed as reddish lesions distinct from the surrounding yellowish non-cancerous area without magnification. Conventional endoscopic images provide little information regarding depressed lesions located in the tangential line, but FICE produces higher color contrast of such cancers. Histological f indings in depressed area with reddish col- or changes show a high density of glandular structure and an apparently irregular microvessel in intervening parts between crypts, resulting in the higher color con- trast of FICE image between cancer and surrounding area. Some depressed cancers are shown as whitish lesion by conventional endoscopy. FICE also can pro- duce higher color contrast between whitish cancerous lesions and surrounding atrophic mucosa. For nearly flat cancer, FICE can produce an irregular structuralpattern of cancer distinct from that of the surrounding mucosa, leading to a clear demarcation. Most elevated-type EGCs are detected easily as yellowish lesions with clearly contrasting demarcation. In some cases, a partially reddish change is accompanied on the tumor surface similar to depressed type cancer. In addition, the FICE system is quite useful for the detection of minute gastric cancer, even without magnif ication. These new contrasting images with the FICE system may have the potential to increase the rate of detection of gastric cancers and screen for them more effectively as well as to determine the extent of EGC.

Diagnostic utility of narrow-band imaging endoscopy for pharyngeal superfi cial carcinoma

AIM: To investigate the endoscopic features of pharyngeal superfi cial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwent conventional white light (CWL) en-doscopy and non-magnifi ed/magnifi ed NBI endoscopy, followed by an endoscopic biopsy, for 445 superfi cial lesions in the oropharynx and hypopharynx. The macroscopic appearance of superfi cial lesions was categorized as either elevated (< 5 mm in height), flat, or depressed (not ulcerous). Superficial carcinoma (SC) was defi ned as a superfi cial lesion showing high-grade dysplasia or squamous cell carcinoma on histology. The color, delineation, and macroscopic appearances of the lesions were evaluated by CWL endoscopy. The ratio of the brownish area/intervascular brownish epithelium (IBE), as well as microvascular proliferation, dilation, and irregularities, was determined by non-magnifi ed/ magnifi ed NBI endoscopy. An experienced pathologist who was unaware of the endoscopic fi ndings made the histological diagnoses. By comparing endoscopic fi ndings with histology, we determined the endoscopic features of SC and evaluated the diagnostic utility of NBI. RESULTS: The 445 lesions were divided histologically into two groups: a non-SC group, including non-neoplasia and low-grade dysplasia cases, and an SC group. Of the 445 lesions examined, 333 were classified as non-SC and 112 were classif ied as SC. There were no significant differences in age, gender, or the location of the lesions between the patients in the two groups. The mean diameter of the SC lesions was signif icantly greater than that of non-SC lesions (11.0 ± 7.6 mm vs 4.6 ± 3.6 mm, respectively, P < 0.001). Comparisons of CWL endoscopy fi ndings for SC and non-SC lesions by univariate analysis revealed that the incidence of redness (72% vs 41%, respectively, P < 0.001) and a flat or depressed type of lesion (58% vs 44%, respectively, P = 0.013) was significantly higher in the SC group. Using non-magnifi ed NBI endoscopy, the incidence of a brownish area was signifi cantly higher for SC lesions (79% vs 57%, respectively, P < 0.001). On magnifi ed NBI endoscopy, the incidence of IBE (68% vs 33%, P < 0.001) and microvascular proliferation (82% vs 51%, P < 0.001), dilation (90% vs 76%, P =0.002), and irregularity (82% vs 31%, P < 0.001) was also signifi cantly higher for the SC compared with the non-SC lesions. Multivariate analysis revealed that the incidence of redness (P = 0.022) on CWL endoscopy and IBE (P < 0.001) and microvascular irregularities (P < 0.001) on magnif ied NBI endoscopy was signif icantly higher in SC than non-SC lesions. Redness alone exhibited signifi cantly higher sensitivity and signifi cantly lower specifi city for the diagnosis of SC compared with redness plus IBE and microvascular irregularities (72% vs 52%, P = 0.002; and 59% vs 92%, P < 0.001, respectively). The accuracy of redness plus IBE and irregularities for the diagnosis of SC was signifi cantly greater than using redness alone (82% vs 62%, respectively, P < 0.001). CONCLUSION: Redness, IBE, and microvascular irregularities appear to be closely related to SC lesions. Magnifi ed NBI endoscopy may increase the diagnostic accuracy of CWL endoscopy for SC.

Endocytoscopic narrow-band imaging efficiency for evaluation of inflammatory activity in ulcerative colitis

AIM:To assess the efficacy of endocytoscopic narrowband imaging(EC-NBI)for evaluating the severity of inflammation in ulcerative colitis(UC).METHODS:This retrospective study was conducted at a single tertiary care referral center.We included UC patients who underwent colonoscopy with endocytoscopy from July 2010 to December 2013.ECNBI was performed,and the images were evaluated by assessing visibility,increased vascularization,and the increased calibers of capillaries and were classified as Obscure,Visible or Dilated.Obscure was indicative of inactive disease,while Visible and Dilated were indicative of acute inflammation.This study received Institutional Review Board approval.The primary outcome measures included the diagnostic ability of EC-NBI to distinguish between active and inactive UC on the basis of histological activity.The conventional endoscopic images were classified according to the Mayo endoscopic score.A score of 0 or 1 indicated inactive disease,whereas a score of 2 indicated active disease.RESULTS:Fifty-two patients were enrolled.There was a strong correlation between the EC-NBI findings and the histological assessment(r=0.871,P<0.01).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of EC-NBI for diagnosing acute inflammation were 84.0%,100%,87.1%,100%,and 92.3%,respectively,while those for the Mayo endoscopic score were 100%,40.7%,100%,61.0%,and 69.2%,respectively.Compared with conventional endoscopy,EC-NBI was superior in diagnostic specificity,negative predictive value,and accuracy(P<0.001,P=0.001 and P=0.047,respectively).CONCLUSION:The EC-NBI finding of capillaries in the rectal mucosa was strongly correlated with histological inflammation and aided in the differential diagnosis between active and inactive UC.

Diagnosis of boundary in early gastric cancer

Endoscopic submucosal dissection (ESD) is an advanced therapeutic endoscopic technique,which allowsresection of larger superficial tumors in the esophagus,stomach,and colon.Precise diagnosis of the boundary between tumor and the non-tumorous surrounding portion is especially important before starting ESD,because too much resection can potentially take more time and can induce a higher complication rate,while too little resection can result in a non-curative resection.The boundary diagnosis is often difficult for early gastric cancer,mainly because of the underlying condition of chronic gastritis.Due to recent developments in endoscopy,including magnified endoscopy and narrow band endoscopy,the boundary diagnosis is becoming easy and more accurate.We have also applied magnified endoscopy combined with narrow band imaging to fresh specimens immediately after resection using thetiling method and XY stage.

A Method to Improve Photographing Function of Common Digital Camera to Small Flowers and Fruits

[ 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.

Role of magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions:Few issues

Standard endoscopy with biopsy and narrow-band imaging with guided biopsy are techniques for the detection of Helicobacter pylori(H.pylori)-related gastritis and precancerous lesions.In this study,the authors compared standard endoscopy and magnified narrow-band imaging(commonly known as NBI-M)in the diagnosis of H.pylori infections,atrophic gastritis,and intestinal metaplasia.Although the sensitivity of NBI-M is better than standard endoscopy,the diagnostic accuracy did not differ substantially between the diagnostic modalities.Future prospective studies may guide endoscopists in difficult cases regarding which modality is more useful and cost-effective for the diagnosis of H.pylorirelated gastritis and precancerous conditions.

Magnifying narrow-band imaging endoscopy is superior in diagnosis of early gastric cancer

AIM:To evaluate the diagnostic effectiveness of white light endoscopy,magnifying endoscopy(ME),and magnifying narrow-band imaging endoscopy(ME-NBI) in detecting early gastric cancer(EGC).METHODS:From March 2010 to June 2012,a total of 3616 patients received screening for gastric cancer by magnifying endoscopy. There were 3675 focal gastric lesions detected using conventional high definition white light endoscopy(HD-WLE) in four different referentialhospitals that were recruited for further investigation using ME and ME-NBI. The images obtained from HD-WLE,ME,and ME-NBI were reviewed by four experienced endoscopists to evaluate their diagnostic effectiveness for EGC. The diagnosis of cancerous and non-cancerous lesions was conducted by evaluating the microvascular and microsurface patterns using the VS classification system. The final endoscopic diagnosis of each lesion was determined by consultation when a disagreement occurred. We used histopathological results as the gold standard for the diagnosis of EGC.RESULTS:Among the 3675 lesions found,1508 were validated by pathological findings as chronic gastritis,1279 as chronic gastritis with intestinal metaplasia,631 as low-grade neoplasia,and 257 as EGC. The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of HD-WLE for the diagnosis of EGC were 71.2%,99.1%,85.5%,97.9% and 97.1%,respectively. The results of ME for diagnosing EGC were 81.3%,98.8%,83.3%,98.6% and 97.6%,respectively. The results of ME-NBI for the diagnosis of EGC were 87.2%,98.6%,82.1%,99.0% and 97.8%,respectively. The diagnostic sensitivity and accuracy of paired ME and ME-NBI were significantly better than those of HD-WLE(P < 0.05).CONCLUSION:HD-WLE has a relatively high accuracy for diagnosing EGC and is an effective screening tool. Further investigations of ME and ME-NBI are required to achieve superior accuracy.

Magnifying colonoscopy as a non-biopsy technique for differential diagnosis of non-neoplastic and neoplastic lesions

AIM： To clarify whether mucosal crypt patterns observed with magnifying colonoscopy are feasible to distinguish non-neoplastic polyps from neoplastic polyps. METHODS： From June 1999 through March 2000, 180 consecutive patients with 210 lesions diagnosed with a magnifying colonoscope （CF-200Z, Olympus Optical Co., Ltd., Tokyo, Japan） were enrolled. Magnification and chromoendoscopy with 0.2% indigo-carmine dye was applied to each lesion for mucosal crypt observation. Lesions showing types Ⅰ and Ⅱ crypt patterns were considered non-neoplastic and examined histologically by biopsy, whereas lesions showing types Ⅲ to Ⅴ crypt patterns were removed endoscopically or surgically. The correlation of endoscopic diagnosis and histologic diagnosis was then investigated. RESULTS： At endoscopy, 24 lesions showed a type Ⅰ or Ⅱ pit pattern, and 186 lesions showed type Ⅲ to Ⅴ pit patterns. With histologic examination, 26 lesions were diagnosed as non-neoplastic polyps, and 184 lesions were diagnosed as neoplastic polyps. The overall diagnostic accuracy was 99.1% （208/210）. The sensitivity and specificity were 92.3% （24/26） and 99.8% （184/186）, respectively. CONCLUSION： Magnifying colonoscopy could be used as a non-biopsy technique for differentiating neoplastic and non-neoplastic polyps.

Diagnostic performance of magnifying narrow-band imaging for early gastric cancer: A meta-analysis

AIM: To investigate the performance of magnifying endoscopy with narrow-band imaging(ME-NBI) in the diagnosis of early gastric cancer(EGC).METHODS: Systematic literature searches were conducted until February 2014 in Pub Med, EMBASE, Web of Science, Ovid, Scopus and the Cochrane Library databases by two independent reviewers. Meta-analysis was performed to calculate the pooled sensitivity, specificity and diagnostic odds ratio and to construct a summary receiver operating characteristic(ROC) curve. Subgroup analyses were performed based on the morphology type of lesions, diagnostic standard, the size of lesions, type of assessment, country and sample size to explore possible sources of heterogeneity. A Deeks' asymmetry test was used to evaluate the publication bias.RESULTS: Fourteen studies enrolling 2171 patients were included. The pooled sensitivity, specificity and diagnostic odds ratio for ME-NBI diagnosis of EGC were 0.86(95%CI: 0.83-0.89), 0.96(95%CI: 0.95-0.97) and 102.75(95%CI: 48.14-219.32), respectively, with the area under ROC curve being 0.9623. Among the 14 studies, six also evaluated the diagnostic value of conventional white-light imaging, with a sensitivityof 0.57(95%CI: 0.50-0.64) and a specificity of 0.79(95%CI: 0.76-0.81). When using "VS"(vessel plus surface) ME-NBI diagnostic systems in gastric lesions of depressed macroscopic type, the pooled sensitivity and specificity were 0.64(95%CI: 0.52-0.75) and 0.96(95%CI: 0.95-0.98). For the lesions with a diameter less than 10 mm, the sensitivity and specificity were 0.74(95%CI: 0.65-0.82) and 0.98(95%CI: 0.97-0.98).CONCLUSION: ME-NBI is a promising endoscopic tool in the diagnosis of early gastric cancer and might be helpful in further target biopsy.

Gastric adenocarcinoma of fundic gland type: Five cases treated with endoscopic resection

Recently,a new disease entity termed gastric adenocarcinoma of fundic gland type(GA-FG) was proposed.We treated five cases of GA-FG with endoscopic submucosal dissection.All tumors were small and located in the upper third of the stomach.Four tumors were macroscopically identified as 0-IIa and one was identified as 0-Ⅱb.Narrow-band imaging with magnifying endoscopy showed an irregular microvascular pattern in 2 cases and a regular microvascular pattern in the remainder.All tumors arose from the deep layer of the lamina propria mucosae and showed submucosal invasion.Lymphatic invasion was seen only in one case,while no venous invasion was recognized.All tumors were positive for pepsinogen-Ⅰ and MUC6 by immunohistochemistry.None showed p53 overexpression,and the labeling index of Ki-67 was low in all cases.All cases have been free from recurrence or metastasis.Herein,we discussed the clinicopathological features of GA-FG in comparison with past reports.

Diagnosis of early gastric cancer using narrow band imaging and acetic acid

AIM: To determine whether the endoscopic findings of depressed-type early gastric cancers(EGCs) could precisely predict the histological type.METHODS: Ninety depressed-type EGCs in 72 patients were macroscopically and histologically identified. We evaluated the microvascular(MV) and mucosal surface(MS) patterns of depressed-type EGCs using magnifying endoscopy(ME) with narrow-band imaging(NBI)(NBI-ME) and ME enhanced by 1.5% acetic acid, respectively. First, depressed-type EGCs were classified according to MV pattern by NBI-ME. Subsequently, EGCs unclassified by MV pattern were classified according to MS pattern by enhanced ME(EME) images obtained from the same angle.RESULTS: We classified the depressed-type EGCs into the following 2 MV patterns using NBI-ME: a fine-network pattern that indicated differentiated adenocarcinoma(25/25, 100%) and a corkscrew pattern that likely indicated undifferentiated adenocarcinoma(18/23, 78.3%). However, 42 of the 90(46.7%) lesions could not be classified into MV patterns by NBI-ME. These unclassified lesions were then evaluated for MS patterns using EME, which classified 33(81.0%) lesions as MS patterns, diagnosed as differentiated adenocarcinoma. As a result, 76 of the 90(84.4%) lesions were matched with histological diagnoses using a combination of NBI-ME and EME.CONCLUSION: A combination of NBI-ME and EME was useful in predicting the histological type of depressedtype EGC.