Expansion of the indications for endoscopic mucosal resection in patients with superficial esophageal carcinoma

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection (EMR) is a minimally invasive local treatment for superficial esophageal carcinoma (SEC). The use of EMR in patients with m3 or sm1 SEC remains controversial, however. The aim of this retrospective study was to evaluate the histopathological risk factors for lymph-node metastasis and recurrence in patients with m3 or sm1 SEC. PATIENTS AND METHODS: The study subjects were 43 patients with m3 or sm1 esophageal squamous-cell carcinomas: 23 patients were treated surgically (the surgery group), and 20 were treated by EMR (the EMR group). We assessed the following variables of the specimens resected by surgery or EMR: tumor depth, maximal surface diameter of the tumor (superficial size), maximum diameter of tumor invasion at the lamina muscularis mucosae (LMM invasion width), and lymphatic invasion. The relationships of these variables to lymph-node metastasis and recurrence were examined. RESULTS: In the surgery group, lymph-node metastasis was found in four patients, all of whom had tumors with lymphatic invasion, a superficial size of at least 25 mm, and an LMM invasion width of at least 2500 microm. In the EMR group, no patient met all three of these criteria, and there was no evidence of lymph-node metastasis or distant metastasis on follow-up after EMR (median follow-up 39 months). CONCLUSIONS: In patients with m3 or sm1 SEC, tumors that have lymphatic invasion, larger superficial size, and wider LMM invasion are associated with a high risk for lymph-node metastasis. EMR might be indicated for the treatment of patients with m3 or sm1 SECs without these characteristics.     

Quantitative analysis of the microvascular architecture observed on magnification endoscopy in cancerous and benign gastric lesions

BACKGROUND AND STUDY AIMS: Gastric cancer remains a common malignant tumor in Japan. The aim of this study was to attempt a quantitative evaluation of the microvascular architecture observed by magnification endoscopy using image analysis, and to investigate whether this method is able to distinguish between gastric cancers and benign lesions. PATIENTS AND METHODS: A total of 132 patients were studied using magnification endoscopy, and image analysis was performed in 71 patients (32 patients with early gastric cancer, 39 patients with benign lesions). Analysis was not possible in the other 61 patients because the quality of the image was not good enough. A square region of interest was selected from the magnified images of the gastric mucosa. From this we extracted the vascular images corresponding to microvessels and calculated the mean caliber of vessels in the region of interest. RESULTS: Image analysis provided good-quality images of microvessels and enabled evaluation of the microvascular architecture. The mean caliber of vessels was 4.454 pixels in 17 differentiated adenocarcinomas, 4.319 pixels in 15 undifferentiated adenocarcinomas, and 4.034 pixels in the 39 benign lesions. This represented a significant difference between gastric cancers and benign lesions (P<0.0001). Histopathological investigation of surgically resected tumors demonstrated the mean caliber of microvessels in cancerous lesions to be greater than that of microvessels in the surrounding mucosa. CONCLUSIONS: Image analysis was useful for evaluating the microvascular architecture of the gastric mucosa, and calculation of the mean caliber of the vessels may prove helpful in the differential diagnosis of gastric cancers. However, analysis was not possible in 61 of the 132 patients studied because of inadequate image quality, and this represents a significant limitation of this diagnostic method.     

Early esophageal carcinoma: endoscopic ultrasonography using the sonoprobe

Background: Almost all cases of superficial esophageal carcinoma are curable by endoscopic mucosal resection (EMR), but a precise diagnosis of the depth of tumor invasion is necessary to assess the indication for EMR. Although endoscopy has a high rate of accuracy for diagnosing the depth of tumor invasion, it depends on the experience of the examiner in interpreting surface information of the lesions. Today, endoscopic ultrasonography (EUS) is one of the most powerful techniques for obtaining objective tomographic images of a tumor. The high-frequency ultrasound probe is appropriate for EUS in cases of superficial esophageal carcinoma because of its excellent near-field resolution that provides precise ultrasound images under direct control of the endoscope. Methods: We performed EUS with the Sonoprobe System in 85 cases of superficial esophageal carcinoma before treatment and evaluated the resected specimens histopathologically. We interpreted the depth of tumor invasion based on our fundamental studies of ultrasonograms taken with a 20-MHz probe. Results: The clinical usefulness of the Sonoprobe with linear and radial scanning modes is due to its capacity to differentiate between mucosal and submucosal carcinoma by means of analyses of the muscularis mucosae. Although a clear assessment of microinvasion and lymphoid hyperplasia surrounding the tumor of interest remains speculative, the diagnostic accuracy rate for 96 lesions of superficial esophageal carcinoma reached 93% in terms of differentiating between mucosal from submucosal carcinoma. Conclusion: EUS with the Sonoprobe can play an important role in the pretreatment diagnosis of superficial esophageal carcinomas.     

Clinical pathological analysis of surgically resected superficial esophageal carcinoma to determine criteria for deciding on treatment strategy

We performed a clinical pathological study of conventionally resected superficial esophageal carcinomas since this type of lesion has been increasing, in order to develop criteria of determination for therapeutic strategies. Pathological studies were performed on specimens obtained by radical surgical resection in 133 cases of superficial esophageal cancer. Evaluation was performed in terms of the gross classification of the lesion type, depth of invasion, lymph node metastasis, vascular invasion, size of the lesion, outcome, etc. In 0-I, 0-IIc+0-IIa, and 0-III type submucosal cancer lesions the rate of metastasis to lymph nodes was more than 40%, but in 0-IIa and 0-IIb mucosal cancer cases no lymph node metastasis was observed. 0-IIc type lesions showed a wide range of invasiveness, ranging from m1 to sm3. In cases with m1 or m2 invasion, no lymph node or lymph-vessel invasion was recognized, but in m3, sm1, sm2, and sm3 cases lymph node metastasis was recognized in 12.5%, 22.2%, 44.0% and 47.4%, respectively. In 47% of lesions with a greatest dimension of less than 30 mm invasion was limited to the mucosa. Seventy-two percent of m1 and m2 cases were 30 mm in size or less. Lymph node metastasis was recognized in only 16.7% of cases less than 30 mm in size, but in cases of lesions 30 mm or more the rate of lymph node metastasis was 35.8%. 0-IIb and 0-IIa type lesions are indications for endoscopic esophageal mucosal resection (EEMR), while 0-I, 0-IIc+0-IIa, and 0-III lesions should be candidates for radical surgical resection. In the 0-IIc category, lesions in which the depression is relatively flat and with a finely granular surface are indications for EEMR, but those cases in which the surface of depression shows granules of varying sizes should be treated with radical surgical resection. Cases of 0-IIa type 30 mm or larger in greatest dimension which have a gently sloping protruding margin shoulder or reddening should be treated with caution, but EEMR can be performed first and subsequent therapeutic strategy decided on, based on the pathological findings of the specimen.     

窄带谱成像放大内镜技术对早期食管癌及其癌前病变诊断的临床应用价值*

目的探讨窄带谱成像放大内镜(NBI-ME)观察下食道病变上皮乳头内血管袢(IPCL)分型对早期食管癌(EEC)及癌前病变诊断的临床价值。方法回顾该院内镜诊治中心2013年7月-2016年12月发现的食管黏膜表面异常的102例(共132处病变)患者内镜表现和临床病理资料,分析IPCL分型对食道病变性质及浸润深度的预判作用。结果 IPCL为A型的病变中95.0%(38/40)病理诊断为食管炎,IPCL为B型的病变中96.7%(89/92)病理诊断为EEC及癌前病变;NBI-ME观察后,术前活检病理与术后完整病理一致性尚可(Kappa=0.4850.4,P 0.01);B1、B2、B3型IPCL预判食道病变浸润深度的准确率分别为68.0%(34/50)、73.3%(11/15)及100.0%(4/4)。结论 NBI-ME观察下对食道病变的IPCL进行AB分型,有助于对食管病变性质及浸润深度的预判,同时结合病理结果及超声内镜(EUS)等技术,可实现对病变病情的综合评估,从而可以为患者制定最佳的治疗策略。     

VEGF、CD44v6和MMP-9在食管癌组织中的表达及临床意义

目的:探讨血管内皮生长因子(VEGF)、CD44剪接变体6(CD44v6)和基质金属蛋白酶(MMP)-9在食管癌组织中的表达及其与临床病理特征之间的关系。方法:采用免疫组化方法检测VEGF、CD44v6、MMP-9在45例食管癌患者的手术切除癌组织中的表达。结果:VEGF、CD44v6、MMP-9在食管癌组织中的表达阳性率分别为62．2％、68．9％和42．2％;VEGF、CD44v6表达与肿瘤临床分期、淋巴结转移有关(均P<0．05),与浸润深度、肿瘤大小无关(P>0．05),MMP-9表达与肿瘤临床分期、浸润深度和肿瘤大小有关(P<0．05),与淋巴结转移无关(P>0．05)。结论:VEGF、CD44v6、MMP-9与食管癌临床分期、浸润深度、淋巴结转移关系密切,提示联合检测这3项指标有助于食管癌生物学行为的判断和预后的估计。     

Role of endoscopic ultrasonography in the diagnosis of early esophageal carcinoma

Endoscopic ultrasonography (EUS) for the diagnosis and staging of early esophageal carcinoma is discussed. Based on the nine-layered structure of esophageal wall, which is in good correspondence with histological layers, depth of carcinoma invasion can be investigated. Ultrasound endoscopes and probes are used for the examination. Ultrasound probes with 20 MHz and 30 MHz transducers can demonstrate the clear images of early esophageal carcinoma by using water filling method, which can discuss the change of the esophageal wall from the surface layer. Although the early esophageal carcinoma is detected by endoscopic findings with or without the dye spraying method by iodine, the diagnosis of depth of carcinoma invasion is not easy. EUS can assist in the diagnosis of depth of carcinoma invasion. Confirming the depth of carcinoma invasion by EUS and the lesion is limited to the mucosa. Endoscopists can decide the indication for endoscopic resection of the lesions.     

Histological analysis of endoscopic resection specimens from 326 patients with Barrett's esophagus and early neoplasia

BACKGROUND AND STUDY AIMS: Endoscopic resection has been recommended as a local curative approach for Barrett's neoplasia, but large series are still rare. In the present study we analyzed the histological characteristics of endoscopic resection specimens of Barrett's neoplasia. PATIENTS AND METHODS: 742 endoscopic resection specimens obtained from 326 patients were assessed. The following histological characteristics were evaluated: type of neoplasia, grade of differentiation, depth of infiltration, invasion into lymphatic and blood vessels, and resection status (tumor-free margins were regarded as indicating R0 status). RESULTS: 31 patients had no neoplasia and were excluded from the analysis. Among the remaining 295 patients (711 resection specimens), histological findings were: low-grade intraepithelial neoplasia, 1.0 %; high-grade intraepithelial neoplasia, 2.7 %; and mucosal carcinoma 80.3 %. Carcinomas infiltrating the submucosal layer were rare (sm1 7.5 %; sm2 3.7 %; sm3 4.8 %), as were those invading lymph vessels (3.5 %), and there were none with venous invasion. Most of the carcinomas were well-differentiated (72.2 %), and many of these (92.7 %) were limited to the mucosa, in contrast to moderately and poorly differentiated carcinomas (73.7 % and 22.7 %, respectively). R0 status was achieved in 74.5 % of patients; in 47.8 % this was after repeated endoscopic resection. In 26.8 % of patients, R0 resection was achieved at the first attempt. CONCLUSIONS: Our study demonstrates that early Barrett's neoplasms removed by endoscopic resection are mostly limited to the mucosa, are well to moderately differentiated, and very rarely show invasion of the lymph or blood vessels. Although these lesions seem to be low risk with regard to metastatic spread and therefore treatable endoscopically, improved endoscopic resection methods for achieving one-piece (en bloc) R0 resection should be developed.     

Endoscopic diagnosis of pharyngeal carcinoma by NBI

Head and neck cancer, especially pharyngeal cancer, frequently co-exist with esophageal cancer, but pharyngeal cancer has proven difficult to detect in such cases before its progression to an advanced stage. Several recent reports have indicated that narrow-band imaging (NBI) endoscopy with magnification is able to improve the detection of superficial pharyngeal cancer. NBI is a relatively new optical technology based on limiting the depth of light penetration into the mucosa. The recognition of these lesions is dramatically improved and the microvascular structure of the mucosal surface is significantly enhanced by NBI. As a result, NBI enables more accurate diagnosis and increases the detection rate of superficial pharyngeal cancer. This particular field has only been developed in recent years, however, and there are still a number of problems that need to be addressed in the future. It will be necessary to accumulate and evaluate resected specimens and follow up patients in order to establish the appropriate criteria for curative endoscopic treatment in these patients. The ease in using NBI in combination with this new diagnostic concept based on microvascular changes makes NBI suitable for worldwide use in the future.     

放大内镜结合窄带成像对早期食管癌诊断的临床意义

目的 探讨放大内镜结合窄带成像（magnifying endoscopy with narrow band imaging,ME NBI）及镜下分型对诊断早期食管癌的临床意义。方法 回顾性分析2015年1月至2017年1月于郑州大学第二附属医院消化内科病区住院且符合纳入标准的早期食管癌及癌前病变患者79例,观察符合纳入标准患者的年龄、性别、病变部位、内镜下形态分型、ME和ME NBI的微结构和微细血管形态、内镜下诊断结果和病理诊断结果。结果 ME NBI对食管病变部位、微结构和微血管形态的观察比普通内镜更有优势(P<0.01)。运用KAPPA一致性检验判断内镜下诊断与术后病理诊断关系,KAPPA系数为0.47,提示内镜下诊断与术后病理结果有良好的一致性。结论 ME NBI及其井上分型对早期食管肿瘤性疾病有良好的预测价值,其内镜下诊断与术后病理结果有较好的一致性。     

体表超声对腹段食管癌浸润深度的诊断价值

目的　分析总结腹段食管癌壁层结构形态变化的声像图表现 ,并与手术病理对照 ,探讨经体表超声对腹段食管癌浸润深度的诊断价值。方法　根据体表超声显示的胸下段及腹段食管 (以下简称食管 )肿瘤的壁层结构及外膜强回声线的连续性、与邻近脏器的分界 ,以及患者深呼吸运动状态食管移动性的附加方法等 ,判断食管肿瘤的浸润深度。超声诊断标准为 :肿瘤区食管外膜强回声线显示连续、平整 ,食管随呼吸移动良好为外膜未受侵 (S1) ;外膜强回声线不平整或中断 ,食管移动尚可为食管外膜受侵 (S2 ) ;肿瘤与邻近脏器组织分界不清 ,呼吸运动受限或消失为邻近脏器受侵 (S3 )。对 89例食管癌及食管贲门癌进行超声与手术病理的对比研究。结果　病理诊断S1、S2、S3者 ,超声测量食管壁厚度分别为 0 .4～ 4.3cm、0 .5～ 2 .1cm、0 .9～ 3 .2cm ;壁厚测量与浸润深度密切相关 (P <0 .0 0 5 ;列联系数 =0 .8)。超声诊断S1、S2、S3的灵敏性分别为 46.2 %(6/13例 )、 80 .0 %(4 8/60例 )、62 .5 %(10 /16例 ) ,诊断困难占 5 .6%(5 /89例 ) ,诊断正确率达 71.9%(64 /89例 )。结论　体表超声对食管癌壁浸润深度可作出一定程度的判断 ,尤其对肿瘤侵及食管外膜及邻近肝脏受侵的诊断率较高 ,可作为食管癌术前的辅助诊断方法。     

Radiographic microstructures of early esophageal carcinoma: Correlation of specimen radiography with pathologic findings and clinical radiography

To clarify the exact radiologic features of mucosal carcinoma of the esophagus with a favorable prognosis, contact radiography was performed on 8 surgical specimens diagnosed preoperatively as showing early or superficial carcinoma. Mucosal carcinoma appeared as a well-defined smooth or nodular protrusion or as a feathered flat mucosa with tiny nodulations and barium poolings. Submucosal carcinoma showed a mound-like defect. The size of tumor was not a good index for estimating the depth of invasion. Protruded lesions were easily demonstrated on clinical radiographs and their profile was useful in determining the depth of invasion. Flat lesions were not easy to recognize; attention must therefore be paid not only to mucosal patterns but also to the contour of the esophageal wall.     

食管鳞癌神经浸润的临床病理学意义及其与COX-2蛋白关系

目的研究食管鳞状细胞癌发生神经组织浸润的临床病理意义及其与环氧合酶-2（COX-2）蛋白表达的关系。方法复习91例食管鳞状细胞癌的组织常规切片,并通过免疫组织化学染色检测肿瘤组织中COX-2蛋白的表达,研究食管鳞状细胞癌的神经组织浸润与性别、组织学分化程度、肿瘤浸润深度、淋巴结转移和临床分期等生物学行为以及COX-2蛋白表达的关系。结果食管鳞状细胞癌神经组织浸润的发生率为45%。神经组织的浸润与肿瘤的浸润深度、淋巴结转移和临床分期均呈正相关（P分别为0.013、0.000和0.004,r分别为0.29、0.41和0.30）,与性别、组织学分化程度和COX-2蛋白的表达均无关（P分别为0.119、0.097和0.861）。结论食管鳞状细胞癌的神经组织浸润与肿瘤的浸润深度、淋巴结转移和临床分期等生物学行为密切关系,可能与COX-2蛋白的表达无关。     

A Clinical Study of Photodynamic Therapy for Superficial Esophageal Carcinoma by YAG-OPO Laser

A cooperative clinical study of photodynamic therapy (PDT) for superficial esophageal carcinoma was conducted at 6 medical institution. PHE (2mg/kg) with high tumor affinity was used as the oncotropic compound. The light source was a pulse wave YAG-OPO laser with high penetration into the tissue. Irradiation was performed at an energy density of 60-180 J/cm(2) 48-72 h after PHE administration. Eight lesions in 6 patients were treated. All were type 0-II superficial carcinomas. The depth of invasion was EP-MM for 6 lesions and SM for 2 lesions. A complete response (CR) was achieved in all patients after one session of PDT. Five adverse events, including anemia and fever, were reported by 4 patients, but all were WHO grade 2 or lower and transient. PDT using PHE and YAG-OPO laser was therefore considered effective as a curative therapy for superficial esophageal carcinoma.     

High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas

BACKGROUND AND STUDY AIMS: The application of endoscopic mucosectomy in early esophageal cancer is limited by the presence of lymph-node metastasis. The aim of this prospective study was to analyze the rate of lymph-node involvement relative to the depth of mucosal or submucosal tumor penetration, comparing squamous-cell carcinomas and adenocarcinomas. PATIENTS AND METHODS: A total of 60 patients with pT1 esophageal cancer--24 with squamous-cell carcinomas (SCCs) and 36 with adenocarcinomas--were treated with transthoracic en-bloc esophagectomy with two-field lymphadenectomy (n = 50) or transhiatal esophageal resection (n = 10). An average of 30 lymph nodes were examined, and the following characteristics were evaluated: histology, mucosal infiltration, depth of submucosal wall infiltration in three thirds (sm1, sm2, sm3), grading, resection category, ratio of metastatic to resected lymph nodes, and locations of metastatic nodes. RESULTS: The rates of lymph-node metastasis were 0% for the 16 mucosal carcinomas and 45% for the 44 submucosal carcinomas (P < 0.01). There were no significant differences in the extent of lymph-node involvement between submucosal adenocarcinomas (41%) and submucosal SCCs (50%). Sm1 carcinomas were associated with a lower rate of lymph-node metastasis (SCCs 33%, adenocarcinomas 22%) than sm3 carcinomas (SCCs 69%, adenocarcinomas 78%). Two patients (9%) with submucosal SCCs and five patients (23%) with submucosal adenocarcinomas were classified as having stage pM1 lymph. The average lymph-node ratio in patients with pN1 was 0.13 for adenocarcinomas and 0.1 for SCCs (difference not significant). In the multivariate analysis, the parameters mucosal vs. submucosal (P < 0.01) and G1/G2 vs. G3 (P < 0.05) showed a significant impact in relation to metastatic lymph nodes. CONCLUSIONS: The most important factor for predicting lymph-node metastasis in early esophageal cancer is the presence of submucosal infiltration. Early adenocarcinomas and SCCs do not differ with regard to their rate of lymphatic involvement. The rate of lymph-node metastasis increases with the depth of submucosal infiltration, but metastases can already occur in sm1 lesions. Submucosal infiltration is a contraindication for endoscopic mucosectomy. Limited surgical procedures without adequate lymphadenectomy do not appear to be appropriate in the treatment of patients with submucosal esophageal carcinomas.     

Roentgenographically occult bronchogenic squamous cell carcinoma: location in the bronchi, depth of invasion and length of axial involvement of the bronchus

Forty patients with roentgenographically occult lung cancer underwent surgical resection. In thirty-five, cancer was detected by mass screening and in five at outpatient clinic. Bronchoscopic localization was accomplished in all cases. Serial block-sections of bronchi of all surgical specimens were prepared and examined microscopically. Forty-two lesions of bronchogenic squamous cell carcinoma were found including two of concurrent occult carcinoma. The site of tumor in the bronchi, the depth of mural invasion and the axial length of involved portion were investigated microscopically. The depth was measured with a micrometer. Fifteen lesions occurred in a subsegmental or a sub-subsegmental bronchus and 27 in a segmental or a central bronchus. Based on the depth of invasion (DI), occult bronchogenic carcinomas were classified microscopically into six categories (DI0 to DI5). Of the 42 lesions, 6 were judged as carcinoma in situ (DI0), 4 as suspicious invasion (DI1), 7 as intramucosal invasion (DI2), 17 as extramuscular invasion (DI3), 5 as extracartilaginous invasion (DI4) and 3 as extrabronchial invasion (DI5). Microscopic analysis revealed the presence of at least two types of infiltration in the bronchial wall. One was the creeping type in which carcinoma extended flatly along the superficial layers of bronchus and was presumed to stay as an occult lung cancer for a long time. The other, the penetrating type in which carcinoma extended deeply into the wall, was presumed to advance within a short period.     

窄带成像联合放大内镜对早期食管癌的诊治价值

目的探讨窄带成像技术（NBI）联合放大内镜对早期食管癌的诊断及指导治疗中的作用。方法选择2006年3月至2010年5月82例同时经普通内镜、NBI联合放大内镜、卢戈氏碘染色后发现食管黏膜可疑病变患者,并进行上皮乳头内毛细血管袢（IPCL）分型,最后取标本作病理检查。结果NBI对病变的检出率高于普通内镜,差异有统计学意义（P〈0．05）;对早期癌及高度异型增生的检出率与碘染色相同（均为100％）,对低度恶性倾向的病变的检出率低于碘染色,差异有统计学意义（P〈0．05）;早期癌及高度异型增生IPCL分型多在Ⅳ～Ⅴ2型（占92．3％）,低度恶性倾向病变多在Ⅱ-Ⅲ型（占87．5％）。结论NBI与碘染色均可以提高早期食管癌及高糜异型增生的检出率;NBI与放大内镜联合可初步判断病变的良恶性质及病变的深度,对指导治疗有着重要的作用。     

微探头超声内镜对食管癌的诊断价值

目的：探讨微探头超声内镜（ＭＰＳ）对食管癌的诊断价值。方法：食管癌病人３０例,ＭＰＳ检查作术前ＴＮ分期,并与手术后病理结果对照。结果：２７例手术病人中,ＭＰＳ对１例局限于膜层及２例局限于粘膜下层的早期癌均作出准确判断,对于进展期癌,癌肿浸润深度诊断准确率为８１．５％,食管邻近的给隔淋吉转移判断敏感性为８８．９％,特 性为７７．８％。结论：ＭＰＳ能对早期食管癌作出准确诊断,对于进展期癌能较准确地进行     

Long-Segment early squamous cell carcinoma of the proximal esophagus: curative treatment and long-term follow-up after 5-aminolevulinic acid (5-ALA)-photodynamic therapy

Photodynamic therapy (PDT) is an established treatment for the ablation of dysplastic Barrett's epithelium and early esophageal carcinoma, but no data have been published on curative 5-aminolevulinic acid (5-ALA)-PDT for long-segment early esophageal cancer with infiltration of the upper sphincter. We describe successful curative treatment of an unusual early long-segment squamous cell carcinoma (uT1a,N0) of the proximal esophagus (18 - 28 cm aborally), with three sessions of 5-ALA-PDT. Endoscopic and endosonographic follow-up macroscopically showed a complete remission of the tumor, proven by biopsy showing total histological ablation. After a follow-up period of 23 months, there has been no indication of tumor recurrence. Early superficial (< 3 mm) squamous cell carcinomas of the esophagus can be ablated completely by 5-ALA-PDT. However, long-term follow-up is required in order to prove the effectiveness of endoscopic ablation therapy for early esophageal cancer.     

Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video)

BACKGROUND AND STUDY AIMS: The narrow band imaging (NBI) system consists of a sequential electronic endoscope system and a source of light equipped with new narrow band filters, yielding very clear images of microvessels on mucosal surfaces. The aim of this prospective study was to measure the correlation between the magnified images obtained with the NBI system and the histological findings, especially with regard to the vascular pattern. In addition, three-dimensional images of microvessels were reconstructed using a laser scanning microscope. PATIENTS AND METHODS: Between July 2001 and August 2003, 165 patients with depressed-type early gastric cancer lesions were enrolled in the study. The lesions were carefully observed with magnification using the NBI system. The images, the pathological characteristics of the lesions, and three-dimensionally reconstructed images of the microvascular networks in biopsied specimens were carefully analyzed. The microvascular patterns were classified into three groups: A, fine network; B, corkscrew; and C, unclassified pattern. The endoscopic images were compared with the histological findings. RESULTS: Of the three types of filter available for use with the NBI system, microvascular formation was best enhanced in B mode images produced using short wavelengths, which focus on the superficial mucosal layer. Among 109 cases of differentiated adenocarcinoma, the group A microvascular pattern was observed in 72 cases (66.1 %). Among 56 cases of undifferentiated adenocarcinoma, the group B pattern was observed in 48 cases (85.7 %; P = 0.0011) The microvascular structure observed using the NBI system corresponded with the superficial mucosal layer in the three-dimensional images obtained using laser scanning microscopy and the resected specimens. CONCLUSIONS: Magnifying endoscopy performed in combination with the NBI system is not sufficient to replace conventional histology, but is capable of predicting the histological characteristics of gastric cancer lesions.