Accuracy of diagnostic demarcation of undifferentiated-type early gastric cancer for magnifying endoscopy with narrow-band imaging: surgical cases
- 508 Downloads
Background and aim
The usefulness of magnifying endoscopy with narrow-band imaging (ME-NBI) in undifferentiated-type early gastric cancers (UD-type EGCs) is unclear. This study investigated the accuracy of ME-NBI in the diagnostic demarcation.
Among UD-type EGCs that were initially surgically resected between June 2011 and August 2014 in this hospital, 74 lesions were studied that were preoperatively diagnosed with white-light imaging (WLI) or endoscopic ultrasonography as lesions for which endoscopic treatment was not indicated and found to be early gastric cancers by postoperative pathology. The demarcation line was marked on the most oral and anal sides with argon plasma coagulation using WLI and ME-NBI, and the diagnostic demarcation of cancer was defined as correct, if consistent with the results of postoperative pathology. The length of extension into the proliferative zone, distance between crypts and inflammatory cell infiltration (updated Sydney classification: USC) were compared between the correctly diagnosed and the misdiagnosed cases.
The diagnosis was correct in 62 cases (83.8 %). The average distance between crypts in correctly diagnosed and misdiagnosed cases was approximately 1.9 and 1.3 times, respectively, that in normal mucosa (p < 0.0001). The accuracy of diagnosis was higher when atrophy and neutrophil and monocyte infiltration were mild according to the USC (p < 0.05). The additional use of ME-NBI improved the accuracy of diagnosis by 36.5 % compared with the use of WLI alone.
The use of ME-NBI in the preoperative diagnosis of the demarcation of cancer is useful to prevent postoperative positive surgical margins.
KeywordsGastric cancer Surgery Endoscopy Endoscopic surgical procedure Laparoscopic surgery Carcinoma
Compliance with ethical standards
Drs. Yusuke Horiuchi, Junko Fujisaki, Noriko Yamamoto, Tomoki Shimizu, Masami Omae, Akiyoshi Ishiyama, Toshiyuki Yoshio, Toshiaki Hirasawa, Yorimasa Yamamoto, Tomohiro Tsuchida, Masahiro Igarashi and Hiroshi Takahashi have no conflicts of interest or financial ties to disclose.
- 7.Okada K, Fujisaki J, Kasuga A, Omae M, Hirasawa T, Ishiyama A, Inamori M, Chino A, Yamamoto Y, Nakajima A, Hoshino E, Igarashi M (2011) Diagnosis of undifferentiated-type early gastric cancers by magnification endoscopy with narrow-band imaging. J Gastroenterol Hepatol 26:1262–1269CrossRefPubMedGoogle Scholar
- 8.Horiuchi Y, Fujisaki J, Yamamoto N, Shimizu T, Miyamoto Y, Tomida H, Omae M, Ishiyama A, Yoshio T, Hirasawa T, Yamamoto Y, Tsuchida T, Igarashi M, Takahashi H (2016) Accuracy of diagnostic demarcation of undifferentiated-type early gastric cancers for magnifying endoscopy with narrow-band imaging: endoscopic submucosal dissection cases. Gastric Cancer 19:515–523CrossRefPubMedGoogle Scholar
- 9.Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244CrossRefPubMedGoogle Scholar
- 10.Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report–a phase III multicenter, prospective, randomized trial (KLASS Trial). Ann Surg 251(3):417–420CrossRefPubMedGoogle Scholar
- 19.Okada K, Fujisaki J, Yoshida T, Ishikawa H, Suganuma T, Kasuga A, Omae M, Kubota M, Ishiyama A, Hirasawa T, Chino A, Inamori M, Yamamoto Y, Yamamoto N, Tsuchida T, Tamegai Y, Nakajima A, Hoshino E, Igarashi M (2012) Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy 44:122–127CrossRefPubMedGoogle Scholar
- 21.Yamamoto Y, Fujisaki J, Hirasawa T, Ishiyama A, Yoshimoto K, Ueki N, Chino A, Tsuchida T, Hoshino E, Hiki N, Fukunaga T, Sano T, Yamaguchi T, Takahashi H, Miyata S, Yamamoto N, Kato Y, Igarashi M (2010) Therapeutic outcomes of endoscopic submucosal dissection of undifferentiated-type intramucosal gastric cancer without ulceration and preoperatively diagnosed as 20 mm or less in diameter. Dig Endosc 22:112–118CrossRefPubMedGoogle Scholar
- 22.Kim YY, Jeon SW, Kim J, Park JC, Cho KB, Park KS, Kim E, Chung YJ, Kwon JG, Jung JT, Kim EY, Kim KO, Jang B, Lee SH, Yang CH (2013) Endoscopic submucosal dissection for early gastric cancer with undifferentiated histology: could we extend the criteria beyond? Surg Endosc 12:4656–4662CrossRefGoogle Scholar