title: Diagnosis of small intramucosal signet ring cell carcinoma of the stomach by non-magnifying narrow-band imaging: A pilot study.
abstract: OBJECTIVE
  To examine the efficacy of non-magnifying narrow-band imaging (NM-NBI) imaging for small signet ring cell carcinoma (SRC).
  
  
  METHODS
  We retrospectively analyzed 14 consecutive small intramucosal SRCs that had been treated with endoscopic submucosal dissection (ESD) and 14 randomly selected whitish gastric ulcer scars (control). The strength and shape of the SRCs and whitish scars by NM-NBI and white-light imaging (WLI) were assessed with Image J (NIH, Bethesda).
  
  
  RESULTS
  NM-NBI findings of SRC showed a clearly isolated whitish area amid the brown color of the surrounding normal mucosa. The NBI index, which indicates the potency of NBI for visualizing SRC, was significantly higher than the WLI index (P = 0.001), indicating SRC was more clearly identified by NM-NBI. Although the NBI index was not significantly different between SRCs and controls, the circle (C)-index, as an index of circularity of tumor shape, was significantly higher in SRCs (P = 0.001). According to the receiver-operating characteristic analysis, the resulting cut-off value of the circularity index (C-index) for SRC was 0.60 (85.7% sensitivity, 85.7% specificity). Thus a lesion with a C-index ≥ 0.6 was significantly more likely to be an SRC than a gastric ulcer scar (OR = 36.0; 95%CI: 4.33-299.09; P = 0.0009).
  
  
  CONCLUSIONS
  Small isolated whitish round area by NM-NBI endoscopy is a useful finding of SRCs which is the indication for ESD.
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Watari
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Tomita
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Hisatomo
authors.initials: H
authors.lastname: Ikehara
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Taki
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Ogawa
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamasaki
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Toyoshima
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Sakurai
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kono
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Tozawa
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ohda
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Oshima
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Fukui
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hirota
authors.affiliation: Jiro Watari, Toshihiko Tomita, Hisatomo Ikehara, Masato Taki, Tomohiro Ogawa, Takahisa Yamasaki, Takashi Kondo, Fumihiko Toyoshima, Jun Sakurai, Tomoaki Kono, Katsuyuki Tozawa, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Miwa
keywords: Endoscopic submucosal dissection; Gastric cancer; Intramucosal cancer; Narrow-band imaging; Signet ring cell carcinoma