title: Magnifying endoscopy with narrow-band imaging helps determine the management of gastric adenomas.
abstract: BACKGROUND
  There are no clear clinical criteria for the management of gastric lesions diagnosed as adenomas (Vienna classification category 3) by pre-treatment biopsy. In the present study, we examined the feasibility of magnifying endoscopy with narrow-band imaging (ME-NBI) in discriminating early gastric cancers (Vienna classification category 4 or 5) from adenomas in lesions diagnosed as adenomas by pre-treatment biopsy.
  
  
  METHODS
  This was a single-center cross-sectional retrospective study at a tertiary referral center. One hundred thirty-seven consecutive cases of gastric lesions diagnosed as adenomas in pre-treatment forceps biopsy were examined with conventional non-magnifying endoscopy under white light, non-magnifying chromoendoscopy, and ME-NBI. We investigated the association between the final pathological diagnoses (carcinoma or adenoma) and the following factors: lesion size (mm), color (red or white), macroscopic type (depressed or others), presence of ulceration, and positive ME-NBI finding. The presence of an irregular microvascular pattern or an irregular microsurface pattern with a demarcation line between the lesion and the surrounding area was regarded as a positive ME-NBI finding.
  
  
  RESULTS
  Lesion size was significantly larger in carcinomas than adenomas (P = 0.005). Depressed lesion (P = 0.011), red color (P < 0.001), and positive ME-NBI finding (P < 0.001) were significant predictive factors for carcinoma. Multivariate logistic regression confirmed that red color (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.26-7.34, P = 0.14) and a positive ME-NBI finding (OR 13.68, 95% CI 5.69-32.88, P < 0.001) were independent predictive factors for carcinomas. A positive ME-NBI finding was the strongest predictive factor.
  
  
  CONCLUSIONS
  ME-NBI is useful in planning the management of lesions diagnosed as adenomas by pre-treatment forceps biopsy.
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuji
authors.forename: Ken
authors.initials: K
authors.lastname: Ohata
authors.forename: Masau
authors.initials: M
authors.lastname: Sekiguchi
authors.forename: Akiko
authors.initials: A
authors.lastname: Ohno
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ito
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Chiba
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Gunji
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Fukushima
authors.forename: Nobutake
authors.initials: N
authors.lastname: Yamamichi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Matsuhashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000368:Aged; D001706:Biopsy; D003430:Cross-Sectional Studies; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery