Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1268-1274
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1268
Diagnosis of early gastric cancer using narrow band imaging and acetic acid
Ken Matsuo, Hidetoshi Takedatsu, Michita Mukasa, Hiroaki Sumie, Hikaru Yoshida, Yasutomo Watanabe, Jun Akiba, Keita Nakahara, Osamu Tsuruta, Takuji Torimura
Ken Matsuo, Hidetoshi Takedatsu, Michita Mukasa, Hiroaki Sumie, Hikaru Yoshida, Yasutomo Watanabe, Keita Nakahara, Osamu Tsuruta, Takuji Torimura, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
Jun Akiba, Department of Pathology, Kurume University School of Medicine, Fukuoka 830-0011, Japan
Author contributions: Matsuo K, Mukasa M, Sumie H, Yoshida H, Watanabe Y and Nakahara K performed the majority of the experiments; Akiba J analyzed the histopathology of gastric tube cancer; Takedatsu H, Tsuruta O and Torimura T designed the study and wrote the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hidetoshi Takedatsu, MD, PhD, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan. takedatsu_hidetoshi@kurume-u.ac.jp
Telephone: +81-942-353311 Fax: +81-942-342623
Received: April 30, 2014
Peer-review started: May 4, 2014
First decision: June 27, 2014
Revised: July 22, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 28, 2015
Processing time: 272 Days and 0.9 Hours
Abstract

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 depressed-type EGC.

Keywords: Narrow band imaging; Magnifying endoscopy; Acetic acid; Early gastric cancer; Diagnosis

Core tip: Prediction of the histological diagnosis of early gastric cancer (EGC) using endoscopy is important for determining the appropriate therapeutic approach. In the present study, we combined magnifying endoscopy (ME) with narrow-band imaging (NBI) and enhanced ME (EME) to determine the associations between microvascular (MV) and mucosal surface (MS) patterns of depressed-type EGCs and the histological type. Indeed, 82 of the 90 lesions (91.1%) were classified according to MV or MS pattern, and 76 of the 90 lesions (84.4%) were diagnosed according to histological type. Therefore, our study suggested that the NBI-EME combination was useful for diagnosing the histological type in depressed-type EGC.