title: The vessels within epithelial circle (VEC) pattern as visualized by magnifying endoscopy with narrow-band imaging (ME-NBI) is a useful marker for the diagnosis of papillary adenocarcinoma: a case-controlled study.
abstract: OBJECTIVE
  Pathological studies indicate papillary adenocarcinomas are more aggressive than tubular adenocarcinomas, but a definitive diagnosis is difficult using conventional endoscopy alone. The vessels within an epithelial circle (VEC) pattern, visualized using magnifying endoscopy with narrow-band imaging (ME-NBI), may be a feature of papillary adenocarcinoma. The aims of our study were to investigate whether the VEC pattern is useful in the preoperative diagnosis of papillary adenocarcinoma and to determine whether VEC-positive adenocarcinomas are more malignant than VEC-negative lesions.
  
  
  METHODS
  From 395 consecutive early gastric cancers resected using the endoscopic submucosal dissection method, we analyzed 35 VEC-positive lesions and 70 VEC-negative control lesions matched for size and macroscopic type. We evaluated (1) the correlation between the incidence of VEC-positive cancers and the histological papillary structure and (2) differences in the incidence of coexisting undifferentiated carcinoma in VEC-positive and VEC-negative cancers and the incidence of submucosal and vascular invasion.
  
  
  RESULTS
  Histological papillary structure was seen in 94 % (33/35) of VEC-positive and 9 % (6/70) of VEC-negative cancers, a significant difference (P < 0.001). The incidence of coexisting undifferentiated carcinoma was 23 % (8/35) in VEC-positive and 3 % (2/70) in VEC-negative cancers (P = 0.002). The incidence of submucosal invasion by the carcinoma was 26 % (9/35) in VEC-positive cancers and 10 % (7/70) in VEC-negative cancers (P = 0.045).
  
  
  CONCLUSIONS
  The VEC pattern as visualized using ME-NBI is a promising preoperative diagnostic marker of papillary adenocarcinoma. Coexisting undifferentiated carcinoma and submucosal invasion were each seen in approximately one fourth of VEC-positive cancers.
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Kanemitsu
authors.forename: Kenshi
authors.initials: K
authors.lastname: Yao
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagahama
authors.forename: Shoko
authors.initials: S
authors.lastname: Fujiwara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takaki
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Ono
authors.forename: Yu
authors.initials: Y
authors.lastname: Matsushima
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsui
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanabe
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ota
authors.forename: Akinori
authors.initials: A
authors.lastname: Iwashita
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis; D016022:Case-Control Studies; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D009361:Neoplasm Invasiveness; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology
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