White opaque substance within superficial elevated gastric neoplasia as visualized by magnification endoscopy with narrow-band imaging: a new optical sign for differentiating between adenoma and carcinoma.
BACKGROUND
The microvascular pattern (MVP) as visualized by magnification endoscopy (ME) is a reliable marker for differentiating between benign and malignant gastric flat lesions. However, in cases of gastric neoplasia of 0-IIa type, it is sometimes impossible to visualize the MVP because a white opaque substance (WOS) obscures the subepithelial MVP.


OBJECTIVE
To investigate whether the morphology of the WOS could be a useful optical sign for discriminating between adenoma and carcinoma.


METHODS
Single tertiary referral center.


METHODS
Forty-six gastric neoplasias of only 0-IIa type (18 adenomas and 28 early carcinomas) were evaluated.


METHODS
The prevalence and the morphology of the WOS as visualized by ME with narrow-band imaging (NBI) according to histologic type (adenoma vs carcinoma).


METHODS
The WOS is more frequently present in adenomas than in carcinomas. With regard to the morphology of the WOS, 100% of the examples of WOS within adenomas demonstrated a regular distribution; in contrast, 83% of the examples of WOS within carcinomas showed an irregular distribution.


RESULTS
In cases in which a neoplasia of 0-IIa type showed either WOS with a regular distribution or a regular MVP, the sensitivity and specificity for discriminating adenoma from carcinoma were 94% and 96%, respectively.


CONCLUSIONS
The number of cases was limited. The WOS has not yet been characterized by chemical analysis.


CONCLUSIONS
In cases in which the WOS is observed, rather than assessing the MVP, morphologic analysis of the WOS could be an alternative new optical sign for discriminating adenoma from carcinoma when using ME with NBI.
Yao
Kenshi
K
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Iwashita
Akinori
A
Tanabe
Hiroshi
H
Nishimata
Nobuaki
N
Nagahama
Takashi
T
Maki
Shinichiro
S
Takaki
Yasuhiro
Y
Hirai
Fumihito
F
Hisabe
Takashi
T
Nishimura
Taku
T
Matsui
Toshiyuki
T
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000236:Adenoma / Q000175:diagnosis / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply / Q000473:pathology; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007150:Immunohistochemistry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D011858:Radiographic Magnification; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*