title: Accuracy of diagnostic demarcation of undifferentiated-type early gastric cancer for magnifying endoscopy with narrow-band imaging: surgical cases.
abstract: The usefulness of magnifying endoscopy with narrow-band imaging (ME-NBI) in undifferentiated-type early gastric cancers (UD-type EGCs) is unclear. This study investigated the accuracy of ME-NBI in the diagnostic demarcation.
  
  
  
  Among UD-type EGCs that were initially surgically resected between June 2011 and August 2014 in this hospital, 74 lesions were studied that were preoperatively diagnosed with white-light imaging (WLI) or endoscopic ultrasonography as lesions for which endoscopic treatment was not indicated and found to be early gastric cancers by postoperative pathology. The demarcation line was marked on the most oral and anal sides with argon plasma coagulation using WLI and ME-NBI, and the diagnostic demarcation of cancer was defined as correct, if consistent with the results of postoperative pathology. The length of extension into the proliferative zone, distance between crypts and inflammatory cell infiltration (updated Sydney classification: USC) were compared between the correctly diagnosed and the misdiagnosed cases.
  
  
  
  The diagnosis was correct in 62 cases (83.8 %). The average distance between crypts in correctly diagnosed and misdiagnosed cases was approximately 1.9 and 1.3 times, respectively, that in normal mucosa (p < 0.0001). The accuracy of diagnosis was higher when atrophy and neutrophil and monocyte infiltration were mild according to the USC (p < 0.05). The additional use of ME-NBI improved the accuracy of diagnosis by 36.5 % compared with the use of WLI alone.
  
  
  
  The use of ME-NBI in the preoperative diagnosis of the demarcation of cancer is useful to prevent postoperative positive surgical margins.
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan. yusuke.horiuchi@jfcr.or.jp.
authors: Yusuke
authors: Y
authors: Horiuchi
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors: Junko
authors: J
authors: Fujisaki
authors: Department of Pathology, Cancer Institute Hospital, Tokyo, Japan.
authors: Noriko
authors: N
authors: Yamamoto
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors: Tomoki
authors: T
authors: Shimizu
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors: Masami
authors: M
authors: Omae
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors: Akiyoshi
authors: A
authors: Ishiyama
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors: Toshiyuki
authors: T
authors: Yoshio
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors: Toshiaki
authors: T
authors: Hirasawa
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors: Yorimasa
authors: Y
authors: Yamamoto
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors: Tomohiro
authors: T
authors: Tsuchida
authors: Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors: Masahiro
authors: M
authors: Igarashi
authors: Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors: Hiroshi
authors: H
authors: Takahashi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D001284:Atrophy; D019160:Endosonography; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology; D062048:Narrow Band Imaging / Q000379:methods; D009504:Neutrophils / Q000473:pathology; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery
keywords: Carcinoma; Endoscopic surgical procedure; Endoscopy; Gastric cancer; Laparoscopic surgery; Surgery