title: Can magnifying endoscopy with narrow band imaging be useful for low grade adenomas in preoperative biopsy specimens?
abstract: BACKGROUND
  In biopsy specimens with low grade adenomas, it is often difficult to identify the presence of high grade adenomas or early carcinomas and low grade adenomas preoperatively, and clear guidelines have not yet been defined for the applicability of endoscopic treatment to low grade adenomas identified in biopsy specimens.
  
  
  METHODS
  We aimed to clarify the usefulness of magnifying endoscopy with narrow band imaging (NBI) compared to conventional white light endoscopy for diagnosing actual high grade adenomas or early carcinomas with low grade adenomas, using the VS (microvascular pattern [V] and microsurface pattern [S]) classification for low grade adenomas in biopsy specimens. The study cohort consisted of 135 patients who were diagnosed with low grade adenomas in preoperative biopsy specimens and received endoscopic submucosal dissection.
  
  
  RESULTS
  In the elevated type of lesion, magnifying endoscopy with NBI diagnosed high grade adenomas or early carcinomas at a higher sensitivity and specificity than conventional white light endoscopy (82.4 vs. 70.6%, P = 0.391, 97.3 vs. 54.7%, P < 0.0001). In the depressed macroscopic type of lesion, magnifying endoscopy with NBI also diagnosed high grade adenomas or early carcinomas at a higher sensitivity (95.5 vs. 68.2%, P = 0.0459) than conventional white light endoscopy. Although the specificity was high, at 100%, the difference when compared to conventional white light endoscopy was not significant (100 vs. 100%, P > 0.99).
  
  
  CONCLUSIONS
  For low grade adenomas in biopsy specimens, it is vital to take sufficient consideration of endoscopic findings and not take action based only on the biopsy results. If a decision is made using the VS classification with magnifying endoscopy with NBI, actual high grade adenomas or early carcinomas can be differentiated from low grade adenomas so that endoscopic treatment can be performed more strictly.
authors.affiliation: Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan. kzmiwatoureg@yahoo.co.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Miwa
authors.forename: Hisashi
authors.initials: H
authors.lastname: Doyama
authors.forename: Renma
authors.initials: R
authors.lastname: Ito
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Nakanishi
authors.forename: Katsura
authors.initials: K
authors.lastname: Hirano
authors.forename: Satoko
authors.initials: S
authors.lastname: Inagaki
authors.forename: Kei
authors.initials: K
authors.lastname: Tominaga
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yoshida
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takemura
authors.forename: Shinya
authors.initials: S
authors.lastname: Yamada
authors.forename: Yoshibumi
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Katayanagi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurumaya
authors.forename: Toshihide
authors.initials: T
authors.lastname: Okada
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
mesh_terms: D000236:Adenoma / Q000473:pathology*; D000368:Aged; D001706:Biopsy / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D060787:Neoplasm Grading / Q000379:methods*; D057234:Preoperative Period; D013274:Stomach Neoplasms / Q000473:pathology*