title: A significant feature of microvessels in magnifying narrow-band imaging for diagnosis of early gastric cancer.
abstract: OBJECTIVE
  Magnifying narrow-band imaging (NBI) is more useful than conventional endoscopy for diagnosing early gastric cancer (EGC). However, evaluation of irregular microvascular patterns is subjective and is often difficult, even with expert eyes. The aim of this study was to clarify the most important microvascular patterns in magnifying NBI for diagnosis of EGC.
  
  
  METHODS
  This was a post-hoc analysis of a multicenter prospective trial among nine Japanese hospitals. A total of 1353 patients underwent screening with white-light endoscopy and 362 patients had small (≤ 10 mm) depressed lesions. They were randomly assigned to magnifying NBI or white-light endoscopy followed by magnifying NBI. During diagnosis, magnifying NBI images were recorded before biopsy. All magnifying NBI images were reviewed and evaluated for the association of four features of microvessels - that is, dilation, tortuosity, difference in caliber, and variation in shape - with cancer diagnosis.
  
  
  RESULTS
  Images of 343 lesions (40 cancerous and 303 benign depression lesions) were evaluable. The diagnostic performance (sensitivity/specificity) of each finding was: dilation, 25/90 %; tortuosity, 55/24 %; difference in caliber, 13 /99 %; and variation in shape, 70/95 %. Multivariate analysis identified only variation in shape as being statistically significantly associated with diagnosis of cancer (odds ratio 38.0, 95 % confidence interval: 16.1 - 95.7, P < 0.001). All findings showed moderate agreement (κ values): dilation, 0.44; tortuosity, 0.33; difference in caliber, 0.26; and variation in shape, 0.48.
  
  
  CONCLUSIONS
  A variation in shape was the most significant feature of microvessels observed in magnifying NBI for diagnosis of small depressed-type EGC.
  
  
  BACKGROUND
  UMIN-CTR000001072.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanesaka
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.affiliation: Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Yao
authors.affiliation: Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Ezoe
authors.affiliation: Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Doyama
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.affiliation: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kaneko
authors.affiliation: Division of Endoscopy, Okayama University, Okayama, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kawahara
authors.affiliation: Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Chizu
authors.initials: C
authors.lastname: Yokoi
authors.affiliation: Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sugiura
authors.affiliation: Department of Molecular Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.affiliation: Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Muto
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito