Histopathological validation of magnifying endoscopy for diagnosis of mixed-histological-type early gastric cancer

Figure 1 Patient recruitment. ESD: Endoscopic submucosal dissection; ME-NBI: Magnifying endoscopy with narrow-band imaging.

Figure 2 Evaluation of histopathological examination (hematoxylin-eosin staining). A schema of the three histopathological findings investigated in our study. The scale bars show 200 μm in (A) and (B), and 500 μm in (C). A: The whole mucosal layer occupation of undifferentiated-type (UDT) component (100 ×); B: Exposure of UDT component to the mucosal surface (100 ×); C: Clear border between differentiated-type and UDT components (40 ×). DT: Differentiated-type; UDT: Undifferentiated-type.

Figure 3 Correlation between pathology and endoscopic findings. Preoperative endoscopic images were reviewed to determine whether the endoscopic finding of undifferentiated-type (UDT) component was recognizable within the area where UDT component was present in the histopathological examination. A: Endoscopically resected specimen cut into 2-mm-thick slices with mapping according to the histological types. Blue lines indicate differentiated-type component, while yellow lines indicate UDT component; B: Endoscopic images upon white light imaging onto which the histological type is mapped; C: Endoscopic images upon narrow-band imaging onto which the histological type is mapped; D: Magnifying endoscopy with narrow-band imaging finding of the designated UDT area with the yellow square in Figure 3C. ME-NBI: Magnifying endoscopy with narrow-band imaging; DT: Differentiated-type; UDT: Undifferentiated-type.

Figure 4 A representative magnifying endoscopy with narrow-band imaging image of the undifferentiated-type component. Magnifying endoscopy with narrow-band imaging finding of undifferentiated-type. Component was defined as satisfying both a microvascular pattern, which has an isolated and disordered quality and a microstructure pattern, which lacks visibility or even disappears. It complied with the finding described as a corkscrew pattern.

Figure 5 Diagnostic accuracy of pretreatment biopsy examination for undifferentiated-type-component and possible additional effect of magnifying endoscopy with narrow-band imaging. DT: Differentiated-type; UDT: Undifferentiated-type; ME-NBI: Magnifying endoscopy with narrow-band imaging.