title: Can magnifying endoscopy with narrow-band imaging discriminate between carcinomas and low grade adenomas in gastric superficial elevated lesions?
abstract: Background and study aims:The aim of this study was to investigate the capability of magnifying endoscopy with narrow-band imaging (ME-NBI) to discriminate between early carcinomas (EC) and low grade adenomas (LGA) in gastric superficial elevated epithelial neoplasias.Patients and methods:We investigated 100 consecutive cases of gastric superficial elevated epithelial neoplasias that were removed using endoscopic submucosal dissection. The pathological diagnostic criteria were based on the revised Vienna classification; category 4 (mucosal high grade neoplasia) and category 5 (submucosal invasion by carcinoma) lesions were diagnosed as EC, whereas category 3 (mucosal low grade neoplasia) lesions were diagnosed as LGA. The associations between the postoperative pathological diagnoses and the ME-NBI findings were analyzed, and included the shape, specification, and area of irregularity in the microvascular architecture (MV) and the microsurface structure (MS).Results:Seventy-nine EC and 21 LGA cases diagnosed postoperatively were evaluated retrospectively. The lesion size (median; range (mm)) was significantly larger in the EC group (14; 2 - 95) compared to the LGA group (5; 2 - 16) (P< 0.001). Wavy forms in the MV shapes (P= 0.031), extension in the MV specifications (P= 0.035), and area with MV irregularity (P= 0.001) were found to be statistically significant predictive findings for EC. Villous forms in the MS shapes (P= 0.026), enlargement in the MS specifications (P= 0.044), and area with MS irregularity (P= 0.021) were also found to be statistically significant predictive findings for EC. The rates of preoperative sensitivity, specificity, and diagnostic accuracy of ME-NBI for discriminating EC were 86.1 %, 38.9 %, and 75 %, respectively.Conclusions:The present study suggests that ME-NBI is useful for the differential diagnosis of EC and LGA in gastric superficial elevated epithelial neoplasias.
  
  
  BACKGROUND
  UMIN000012925.
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nonaka
authors.affiliation: Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inamori
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Honda
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kanoshima
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Inoh
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Mizue
authors.initials: M
authors.lastname: Matsuura
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Shiori
authors.initials: S
authors.lastname: Uchiyama
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Sakai
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Higurashi
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ohkubo
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iida
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Endo
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.affiliation: Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kusakabe
authors.affiliation: Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Atsukawa
authors.affiliation: Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Tateishi
authors.affiliation: Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Maeda
authors.affiliation: Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ohashi
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima