The usefulness of magnifying endoscopy with narrow-band imaging to distinguish carcinoma in flat elevated lesions in the stomach diagnosed as adenoma by using biopsy samples.
BACKGROUND
Therapeutic strategies for flat elevated (0-IIa) lesions in the stomach diagnosed as adenoma by biopsy are currently not established, because some difficulties have previously been reported in the evaluation of vascular patterns alone for the differential diagnosis between adenoma and carcinoma.


OBJECTIVE
We attempted to evaluate the 0-IIa lesions diagnosed as adenoma by using magnifying endoscopy with narrow-band imaging (MENBI) to distinguish them as either adenoma or carcinoma.


METHODS
Department of Gastroenterology, Fujita Health University.


METHODS
Fourteen adenomatous lesions (6 adenomas and 8 carcinomas confirmed postoperatively) diagnosed with preoperative biopsies from patients who had undergone endoscopic submucosal dissection were evaluated.


METHODS
We selected 5 sites per lesion for MENBI. Selected sites were divided into superficial structures (SSs) and irregular microvascular patterns (IMVPs).


METHODS
The rate of SSs and IMVPs in adenoma and carcinoma.


RESULTS
Significant SSs were tubular in the adenoma and unclear in the carcinoma. Regarding IMVP subcategories, (1) slight intrastructual irregular microvascular patterns (ISIMVPs) accounted for 97%, (2) severe ISIMVPs accounted for 0%, (3) fine networks accounted for 3%, and (4) corkscrews accounted for 0% of cases in the adenomas. The corresponding proportions in the carcinomas were (1) 40%, (2) 15%, (3) 45%, and (4) 0%. Severe ISIMVPs and fine networks were significant findings for carcinomas.


CONCLUSIONS
The number of cases was limited.


CONCLUSIONS
Our combined evaluation method using MENBI offers the ability to establish proper therapeutic strategies for lesions that are difficult to identify as adenoma or carcinoma.
Nakamura
Masakatsu
M
Department of Gastroenterology, Fujita Health University, Toyoake, Japan.
Shibata
Tomoyuki
T
Tahara
Tomomitsu
T
Yoshioka
Daisuke
D
Okubo
Masaaki
M
Mizoguchi
Yoshikazu
Y
Kuroda
Makoto
M
Arisawa
Tomiyasu
T
Hirata
Ichiro
I
D000236:Adenoma / Q000175:diagnosis*; D001706:Biopsy; D003937:Diagnosis, Differential; D004210:Dissection; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007089:Image Enhancement; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000601:surgery