Surgical Endoscopy

, Volume 31, Issue 4, pp 1906–1913 | Cite as

Accuracy of diagnostic demarcation of undifferentiated-type early gastric cancer for magnifying endoscopy with narrow-band imaging: surgical cases

  • Yusuke HoriuchiEmail author
  • Junko Fujisaki
  • Noriko Yamamoto
  • Tomoki Shimizu
  • Masami Omae
  • Akiyoshi Ishiyama
  • Toshiyuki Yoshio
  • Toshiaki Hirasawa
  • Yorimasa Yamamoto
  • Tomohiro Tsuchida
  • Masahiro Igarashi
  • Hiroshi Takahashi


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.


Gastric 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.


  1. 1.
    Japanese gastric cancer treatment guidelines (2010) ver. 3) Japanese gastric cancer association (2011. Gastric Cancer 14:113–123CrossRefGoogle Scholar
  2. 2.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 4:219–225CrossRefGoogle Scholar
  3. 3.
    Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda Taniguchi H, Fujisaki J, Sano T, Yamaguchi T (2009) Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer 12:148–152CrossRefPubMedGoogle Scholar
  4. 4.
    Yao K, Iwashita A, Tanabe H, Nagahama T, Matsui T, Ueki T, Sou S, Kikuchi Y, Yorioka M (2007) Novel zoom endoscopy technique for diagnosis of small flat gastric cancer: a prospective, blind study. Clin Gastroenterol Hepatol 5:869–878CrossRefPubMedGoogle Scholar
  5. 5.
    Yao K, Iwashita A, Kikuchi Y, Yao T, Matsui T, Tanabe H, Nagahama T, Sou S (2005) Novel zoom endoscopy technique for visualizing the microvascular architecture in gastric mucosa. Clin Gastroenterol Hepatol 7:S23–S26CrossRefGoogle Scholar
  6. 6.
    Yao K, Anagnostopoulos GK, Ragunath K (2009) Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy 5:462–467CrossRefGoogle Scholar
  7. 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. 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. 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. 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
  11. 11.
    Nakayoshi T, Tajiri H, Matsuda K, Kaise M, Ikegami M, Sasaki H (2004) Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy 12:1080–1084CrossRefGoogle Scholar
  12. 12.
    Dixon MF, Genta RM, Yardley JH, Correa P (1996) Classification and Grading of Gastritis. The Updated Sydney system. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 20:1161–1181CrossRefPubMedGoogle Scholar
  13. 13.
    Koeda K, Nishizuka S, Wakabayashi G (2011) Minimally invasive surgery for gastric cancer: the future standard of care. World J Surg 35:1469–1477CrossRefPubMedGoogle Scholar
  14. 14.
    Songun I, Bonenkamp JJ, Hermans J, van Krieken JH, van de Velde CJ (1996) Prognostic value of resection-line involvement in patients undergoing curative resections for gastric cancer. Eur J Cancer 32:433–437CrossRefGoogle Scholar
  15. 15.
    Wang SY, Yeh CN, Lee HL, Liu YY, Chao TC, Hwang TL, Jan YY, Chen MF (2009) Clinical impact of positive surgical margin status on gastric cancer patients undergoing gastrectomy. Ann Surg Oncol 16:2738–2743CrossRefPubMedGoogle Scholar
  16. 16.
    Nagata T, Ichikawa D, Komatsu S, Inoue K, Shiozaki A, Fujiwara H, Okamoto K, Sakakura C, Otsuji E (2011) Prognostic impact of microscopic positive margin in gastric cancer patients. J Surg Oncol 104:592–597CrossRefPubMedGoogle Scholar
  17. 17.
    Ninomiya Y, Yanagisawa A, Kato Y, Tomimatsu H (2000) Unrecognizable intramucosal spread of diffuse-type mucosal gastric carcinomas of less than 20 mm in size. Endoscopy 8:604–608CrossRefGoogle Scholar
  18. 18.
    Kamada K, Tomatsuri N, Yoshida N (2012) Endoscopic submucosal dissection for undifferentiated early gastric cancer as the expanded indication lesion. Digestion 85:111–115CrossRefPubMedGoogle Scholar
  19. 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
  20. 20.
    Abe S, Oda I, Suzuki H, Nonaka S, Yoshinaga S, Odagaki T, Taniguchi H, Kushima R, Saito Y (2013) Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Endoscopy 45:703–707CrossRefPubMedGoogle Scholar
  21. 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. 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
  23. 23.
    Kang HY, Kim SG, Kim JS, Jung HC, Song IS (2010) Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg Endosc 24:509–516CrossRefPubMedGoogle Scholar
  24. 24.
    Kim JH, Lee YC, Kim H, Song KH, Lee SK, Cheon JH, Kim H, Hyung WJ, Noh SH, Kim CB, Chung JB (2009) Endoscopic resection for undifferentiated early gastric cancer. Gastrointest Endosc 69:e1–e9CrossRefPubMedGoogle Scholar
  25. 25.
    Park YD, Chung YJ, Chung HY, Yu W, Bae HI, Jeon SW, Cho CM, Tak WY, Kweon YO (2008) Factors related to lymph node metastasis and the feasibility of endoscopic mucosal resection for treating poorly differentiated adenocarcinoma of the stomach. Endoscopy 40:7–10CrossRefPubMedGoogle Scholar
  26. 26.
    Sun Z, Li DM, Wang ZN, Huang BJ, Xu Y, Li K, Xu HM (2009) Prognostic significance of microscopic positive margins for gastric cancer patients with potentially curative resection. Ann Surg Oncol 16:3028–3037CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Yusuke Horiuchi
    • 1
    Email author
  • Junko Fujisaki
    • 1
  • Noriko Yamamoto
    • 2
  • Tomoki Shimizu
    • 1
  • Masami Omae
    • 1
  • Akiyoshi Ishiyama
    • 1
  • Toshiyuki Yoshio
    • 1
  • Toshiaki Hirasawa
    • 1
  • Yorimasa Yamamoto
    • 1
  • Tomohiro Tsuchida
    • 1
  • Masahiro Igarashi
    • 1
  • Hiroshi Takahashi
    • 3
  1. 1.Department of GastroenterologyCancer Institute HospitalTokyoJapan
  2. 2.Department of PathologyCancer Institute HospitalTokyoJapan
  3. 3.Department of GastroenterologyShowa University Fujigaoka HospitalYokohamaJapan

Personalised recommendations