title: Prospective study of the evaluation of the usefulness of tumor typing by narrow band imaging for the differential diagnosis of gastric adenoma and well-differentiated adenocarcinoma.
abstract: OBJECTIVE
  Presently, the differential diagnosis of gastric adenoma and well-differentiated adenocarcinoma by endoscopy is very difficult. We carried out magnifying endoscopy with narrow band imaging (NBI) in lesions that required discrimination between gastric adenoma and well-differentiated adenocarcinoma, and prospectively evaluated whether the tumor typing that we propose is useful for their differential diagnosis.
  
  
  METHODS
  The materials were 93 lesions that required differential diagnosis between gastric adenoma and well-differentiated adenocarcinoma among the gastric epithelial tumors for which endoscopic treatment was planned at three facilities during the 14 months between November 2008 and December 2009. According to the typing method proposed by our facility based on images of the mucosal ultrastructure and microvessels obtained by magnified endoscopy combined with NBI, type I-II and type III-V lesions were diagnosed as gastric adenoma and well-differentiated adenocarcinoma, respectively, before endoscopic treatment, and the accuracy of the diagnoses were prospectively examined by comparing them with the postoperative pathological findings.
  
  
  RESULTS
  Of the 93 lesions, 87 could be typed into the five types of our typing method, but six lesions could not be classified. The 87 lesions consisted of 16 type I, 12 type II, 29 type III, 27 type IV, and three type V lesions. The percentages of accurate preoperative diagnoses of types I-II as adenoma and types III-V as well-differentiated adenocarcinoma were 79% and 93%, respectively.
  
  
  CONCLUSIONS
  The tumor typing based on NBI was useful for the endoscopic differentiation of gastric adenoma and well-differentiated adenocarcinoma.
authors.affiliation: Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Nonaka
authors.forename: Shin
authors.initials: S
authors.lastname: Arai
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ban
authors.forename: Hideki
authors.initials: H
authors.lastname: Kitada
authors.forename: Masaaki
authors.initials: M
authors.lastname: Namoto
authors.forename: Koji
authors.initials: K
authors.lastname: Nagata
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Ochiai
authors.forename: Osamu
authors.initials: O
authors.lastname: Togawa
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Nakao
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishimura
authors.forename: Keiko
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kita
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology*; D000236:Adenoma / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply / Q000473:pathology; D020699:Gastroscopes; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation; D008297:Male; D008853:Microscopy / Q000295:instrumentation*; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology*