Peroral cholangioscopic diagnosis of biliary-tract diseases by using narrow-band imaging (with videos)

BACKGROUND: Narrow-band imaging (NBI) makes it possible to emphasize the imaging of certain features, such as mucosal structures and mucosal microvessels in GI-tract diseases. Recently, video peroral cholangioscopy (POCS) was developed as a diagnostic modality for better visualization of bile-duct lesions; however, there is no report on POCS by using NBI. OBJECTIVE: To evaluate the clinical usefulness of POCS by using NBI for the diagnosis of biliary-tract diseases. DESIGN: Prospective case study. SETTING: This procedure was performed at Tokyo Medical University Hospital. PATIENTS: Twelve consecutive patients with biliary-tract diseases, including 7 bile-duct cancers and 5 benign biliary diseases, which revealed 6 bile-duct strictures and 6 filling defects by ERCP. INTERVENTION: All patients underwent POCS by using NBI. MAIN OUTCOME MEASUREMENT: Efficacy and safety of this technique. RESULTS: Twenty-one lesions were evaluated by using POCS with conventional white light imaging and NBI. Although visualization of only 2 lesions (9.5%) was "excellent" by conventional observation, visualization of 12 lesions (57.4%) was "excellent" by NBI observation. Identification of the surface structure and vessels of the lesions by NBI observation was significantly better than with conventional observation (P < .01 and P < .05, respectively). LIMITATIONS: Maneuverability and fragility of POCS. The current POCS is not equipped with magnification. CONCLUSIONS: POCS by using NBI may be helpful for the observation of both fine mucosal structures and tumor vessels.     

Magnified endoscopy with narrow-band imaging for the differential diagnosis of superficial non-ampullary duodenal epithelial tumors

Background and aim: Differentiation of low-grade adenoma (Vienna category 3, C3) and high-grade adenoma/carcinoma (C4/5) among superficial non-ampullary duodenal epithelial tumors (SNADETs) using magnified endoscopy with narrow-band imaging (MNBI) is not established. The aim of this study is to clarify the diagnostic ability of MNBI to differentiate between C3 and C4/5 among SNADETs.

Methods: A total of 585 MNBI images taken from 156 SNADETs were evaluated in a test and validation phase. In the test phase, MNBI patterns were extracted based on the combination of surface structure and vasculature. Comparison between MNBI patterns and histology was performed to establish diagnostic criteria to differentiate between C3 and C4/5. In the validation phase, the accuracy and interobserver agreement of the diagnostic criteria were assessed.

Results: Four MNBI patterns (network, disappeared, white opaque substance and intrastructural vessels) with distinctive histological features were selected. The median number of MNBI patterns observed among C3 and C4/5 differed with significance (1 vs 2, p?<?.01). The pattern of disappeared was suggestive of C4/5. Diagnosis of C4/5 by using the criteria of 2 or more MNBI patterns or presence of disappeared pattern revealed a sensitivity of 76%, specificity of 63% and accuracy of 72%. Interobserver agreement of recognizing MNBI patterns was moderate (kappa 0.59).

Conclusion: Diagnosis based on MNBI patterns is useful to differentiate between C3 and C4/5 lesions among SNADETs.     

Initial experience of peroral pancreatoscopy combined with narrow-band imaging in the diagnosis of intraductal papillary mucinous neoplasms of the pancreas (with videos)

BACKGROUND: It is very important to determine the extent of intraductal mucinous neoplasms (IPMNs), because this can greatly affect the determination of the indications of surgery. Peroral pancreatovideoscopy (POPS) has been recognized as a new diagnostic tool for clear imaging of IPMN. Recently, narrow-band imaging (NBI) has made it possible to emphasize certain image features, such as mucosal structures and capillary vessels. OBJECTIVE: To evaluate the clinical usefulness of POPS by using NBI for the diagnosis of IPMN. DESIGN: Case reports. SETTING: This procedure was performed at Tokyo Medical University Hospital. PATIENTS: Three patients with IPMN. INTERVENTION: All patients underwent POPS with NBI. MAIN OUTCOME MEASUREMENT: Efficacy and safety of this technique. RESULTS: POPS with NBI was performed in 3 patients, without procedure-related complications. Identification of the surface structure and the capillary vessels by NBI observation was better than by conventional observation. Furthermore, NBI identified skip tumor lesions in the tail of pancreas, which were not detected by conventional POPS. LIMITATIONS: Because none of the patients in the 3 cases underwent surgical resection, a comparison to clarify total agreement between the preoperative POPS findings and the resected specimen was not possible. CONCLUSIONS: POPS with NBI may facilitate the observation of both fine mucosal structures and capillary vessels in patients with IPMN, although further study is necessary to fully establish the clinical benefit.     

CD30 expression in de novo diffuse large B‐cell lymphoma: a population‐based study from British Columbia

Diffuse large B‐cell lymphoma (DLBCL) is a heterogeneous disease with variable therapeutic responses and alternative therapies are needed for patients with unfavourable treatment outcomes after standard treatment with R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). One promising candidate is brentuximab vedotin, an antibody‐drug conjugate targeting CD30‐expressing cells. However, CD30 (TNFRSF8) expression patterns in DLBCL are not well described thus far. Here, we examined CD30 expression in a population‐based cohort of immunocompetent patients from British Columbia with de novo DLBCL using immunohistochemistry. 385 cases of formalin‐fixed paraffin‐embedded DLBCL in tissue microarrays were evaluated. 95 cases (25%) harboured CD30+ tumour cells. Using a > 0% cut‐off, CD30 expression was predictive of superior 5‐year progression‐free survival within R‐CHOP treated germinal centre B‐cell‐like (GCB) DLBCL (86% vs. 64%, P = 0·020), which was independent of the International Prognostic Index. Epstein‐Barr virus (EBV) was identified in 11 (3%) cases, all of which were non‐GCB (P = 0·001) and almost exclusively positive for CD30 expression (10/11) (P < 0·001). We conclude CD30 is expressed in a substantial proportion of DLBCL and CD30 immunohistochemistry may be a useful prognostic marker in R‐CHOP treated GCB‐DLBCL. The significant association of CD30 with EBV‐positive non‐GCB DLBCL suggests a distinct pathobiology for these cases.     

Serum interleukin-18 level is associated with the outcome of patients with diffuse large B-cell lymphoma treated with CHOP or R-CHOP regimens

Background: We have previously reported that serum interleukin‐18 (IL‐18) concentration predicted the clinical outcome of patients with aggressive non‐Hodgkin’s lymphoma treated with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). When rituximab (R) was added to this regimen, the prognosis of diffuse large B‐cell lymphoma (DLBCL) was markedly improved. Patients and Methods: In this study, we re‐evaluated the prognostic significance of serum IL‐18 in 227 DLBCL patients. Seventy‐three patients received CHOP before R‐era, and 154 patients received rituximab‐cyclophosphamide, doxorubicin, vincristine, and prednisolone (R‐CHOP) recently. Result: Four‐year overall survival (4‐yr OS) rates for patients in CHOP group with IL‐18 ≥ 720 pg/mL and <720 pg/mL were 8.2% and 67.3% (P < 0.0001), respectively, and 4‐yr OS rates with IL‐18 ≥ 590 and <590 pg/mL in R‐CHOP group were 53.4% and 77.8% (P = 0.0008), respectively. Multivariate analysis revealed that serum IL‐18 correlated most significantly with OS and progression‐free survival (PFS) in both groups (OS: P < 0.0001, PFS: P < 0.0001, in CHOP group; OS: P = 0.0147, PFS: P = 0.0084 in R‐CHOP group). The high serum IL‐18 patients with poor prognostic group in revised IPI or with non‐germinal center B‐cell phenotype had a very poor prognosis. Conclusion: Serum IL‐18 might be a powerful prognostic factor for DLBCL in R‐era.