title: Magnifying endoscopy with narrow-band imaging in the differential diagnosis of gastric adenoma and carcinoma and identification of a simple indicator.
abstract: OBJECTIVE
  Discrimination of gastric adenomas from adenocarcinomas by conventional endoscopy is difficult. Therefore, we evaluated the usefulness of magnifying endoscopy combined with narrow-band imaging for this differential diagnosis.
  
  
  METHODS
  Forty-nine consecutive gastric lesions were diagnosed as adenomas by conventional endoscopy with forceps biopsy and finally resected by endoscopic submucosal dissection. The findings from magnifying endoscopy with narrow-band imaging were retrospectively classified into five types according to the marginal crypt epithelium and microvascular pattern: Types I and II (clear marginal crypt epithelium combined with regular or unclear microvascular pattern) and Types III, IV, and V (unclear marginal crypt epithelium combined with regular, irregular, or unclear microvascular pattern).
  
  
  RESULTS
  Conventional endoscopy showed 39 flat elevated-type lesions (0-IIa) and 10 flat elevated-type lesions with depression (0-IIa+IIc). The patterns on magnifying endoscopy with narrow-band imaging were Type I (n = 8), Type II (n = 8), Type III (n = 2), Type IV (n = 30), and Type V (n = 1). The final histological diagnoses after endoscopic submucosal dissection were adenoma (n = 20), adenocarcinoma in adenoma (n = 22), and adenocarcinoma (n = 7). The cancer-bearing rates were Type I (0%), Type II (0%), Type III (100%), Type IV (89.7%), and Type V (100%). Among the expert endoscopists, intra- and interobserver κ values for each type were 0.85 each, with 92.0% and 88.0% consensus of diagnoses, respectively.
  
  
  CONCLUSIONS
  Magnifying endoscopy with narrow-band imaging is a powerful tool for diagnosing gastric borderline lesions.
authors.affiliation: Division of Digestive Endoscopy, University of Medical Science Seta-Tukinowa, Otsu, Japan. yousuke@belle.shiga-med.ac.jp
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Mochizuki
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Saito
authors.forename: Ayako
authors.initials: A
authors.lastname: Kobori
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Ban
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Ishida
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Fujiyama
authors.forename: Akira
authors.initials: A
authors.lastname: Andoh
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods; D015588:Observer Variation; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology