title: 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.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Fujita Health University, Toyoake, Japan.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Nakamura
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Shibata
authors.forename: Tomomitsu
authors.initials: T
authors.lastname: Tahara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshioka
authors.forename: Masaaki
authors.initials: M
authors.lastname: Okubo
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Mizoguchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Kuroda
authors.forename: Tomiyasu
authors.initials: T
authors.lastname: Arisawa
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hirata
mesh_terms: 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