BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capil...BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capillary network,and gastric pits.AIM To evaluate the effectiveness of a new one-dual(near)focus,NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification.METHODS During 2021 and 2022,68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid(AA).The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa.At the time of the endoscopy,the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy(WLE),near focus(NF),NF-NBI,AA-NF,and AA-NF-NBI modes.RESULTS The WLE,NF and NF-NBI endoscopic modes for all patients(204 images)were classified in the same order into three groups.Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order.According to all three observers who completed the work independently,NF magnification was significantly superior to WLE(P<0.01),and the NF-NBI mode was significantly superior to NF magnification(P<0.01).After applying AA,the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF(P<0.01).Interobserver kappa values for WLE were 0.609,0.704,and 0.598,respectively and were 0.600,0.721,and 0.637,respectively,for NF magnification.For the NF-NBI mode,the values were 0.378,0.471,and 0.553,respectively.For AA-NF,they were 0.453,0.603,and 0.480,respectively,and for AA-NF-NBI,they were 0.643,0.506,and 0.354,respectively.CONCLUSION When investigating gastric mucosa in microscopic detail,NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules,subepithelial capillary network,and gastric pits among the five endoscopic modalities investigated in this study.AA-NF-NBI was the most powerful endoscopic mode for analyzing crypt opening and intervening part.展开更多
BACKGROUND In recent years,two new narrow-band imaging(NBI)classifications have been proposed:The NBI international colorectal endoscopic(NICE)classification and Japanese NBI expert team(JNET)classification.Most valid...BACKGROUND In recent years,two new narrow-band imaging(NBI)classifications have been proposed:The NBI international colorectal endoscopic(NICE)classification and Japanese NBI expert team(JNET)classification.Most validation studies of the two new NBI classifications were conducted in classification setting units by experienced endoscopists,and the application of use in different centers among endoscopists with different endoscopy skills remains unknown.AIM To evaluate clinical application and possible problems of NICE and JNET classification for the differential diagnosis of colorectal cancer and precancerous lesions.METHODS Six endoscopists with varying levels of experience participated in this study.Eighty-seven consecutive patients with a total of 125 lesions were photographed during non-magnifying conventional white-light colonoscopy,non-magnifying NBI,and magnifying NBI.The three groups of endoscopic pictures of each lesion were evaluated by the six endoscopists in randomized order using the NICE and JENT classifications separately.Then we calculated the six endoscopists’sensitivity,specificity,accuracy,positive predictive value,and negative predictive value for each category of the two classifications.RESULTS The sensitivity,specificity,and accuracy of JNET classification type 1 and 3 were similar to NICE classification type 1 and 3 in both the highly experienced endoscopist(HEE)and less-experienced endoscopist(LEE)groups.The specificity of JNET classification type 1 and 3 and NICE classification type 3 in both the HEE and LEE groups was>95%,and the overall interobserver agreement was good in both groups.The sensitivity of NICE classification type 3 lesions for diagnosis of SM-d carcinoma in the HEE group was significantly superior to that in the LEE group(91.7%vs 83.3%;P=0.042).The sensitivity of JNET classification type 2B lesions for the diagnosis of high-grade dysplasia or superficial submucosal invasive carcinoma in the HEE and LEE groups was 53.8%and 51.3%,respectively.Compared with other types of JNET classification,the diagnostic ability of type 2B was the weakest.CONCLUSION The treatment strategy of the two classification type 1 and 3 lesions can be based on the results of endoscopic examination.JNET type 2B lesions need further examination.展开更多
AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).
AIM: To investigate the endoscopic features of pharyngeal superfi cial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwen...AIM: To investigate the endoscopic features of pharyngeal superfi cial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwent conventional white light (CWL) en-doscopy and non-magnifi ed/magnifi ed NBI endoscopy, followed by an endoscopic biopsy, for 445 superfi cial lesions in the oropharynx and hypopharynx. The macroscopic appearance of superfi cial lesions was categorized as either elevated (< 5 mm in height), flat, or depressed (not ulcerous). Superficial carcinoma (SC) was defi ned as a superfi cial lesion showing high-grade dysplasia or squamous cell carcinoma on histology. The color, delineation, and macroscopic appearances of the lesions were evaluated by CWL endoscopy. The ratio of the brownish area/intervascular brownish epithelium (IBE), as well as microvascular proliferation, dilation, and irregularities, was determined by non-magnifi ed/ magnifi ed NBI endoscopy. An experienced pathologist who was unaware of the endoscopic fi ndings made the histological diagnoses. By comparing endoscopic fi ndings with histology, we determined the endoscopic features of SC and evaluated the diagnostic utility of NBI. RESULTS: The 445 lesions were divided histologically into two groups: a non-SC group, including non-neoplasia and low-grade dysplasia cases, and an SC group. Of the 445 lesions examined, 333 were classified as non-SC and 112 were classif ied as SC. There were no significant differences in age, gender, or the location of the lesions between the patients in the two groups. The mean diameter of the SC lesions was signif icantly greater than that of non-SC lesions (11.0 ± 7.6 mm vs 4.6 ± 3.6 mm, respectively, P < 0.001). Comparisons of CWL endoscopy fi ndings for SC and non-SC lesions by univariate analysis revealed that the incidence of redness (72% vs 41%, respectively, P < 0.001) and a flat or depressed type of lesion (58% vs 44%, respectively, P = 0.013) was significantly higher in the SC group. Using non-magnifi ed NBI endoscopy, the incidence of a brownish area was signifi cantly higher for SC lesions (79% vs 57%, respectively, P < 0.001). On magnifi ed NBI endoscopy, the incidence of IBE (68% vs 33%, P < 0.001) and microvascular proliferation (82% vs 51%, P < 0.001), dilation (90% vs 76%, P =0.002), and irregularity (82% vs 31%, P < 0.001) was also signifi cantly higher for the SC compared with the non-SC lesions. Multivariate analysis revealed that the incidence of redness (P = 0.022) on CWL endoscopy and IBE (P < 0.001) and microvascular irregularities (P < 0.001) on magnif ied NBI endoscopy was signif icantly higher in SC than non-SC lesions. Redness alone exhibited signifi cantly higher sensitivity and signifi cantly lower specifi city for the diagnosis of SC compared with redness plus IBE and microvascular irregularities (72% vs 52%, P = 0.002; and 59% vs 92%, P < 0.001, respectively). The accuracy of redness plus IBE and irregularities for the diagnosis of SC was signifi cantly greater than using redness alone (82% vs 62%, respectively, P < 0.001). CONCLUSION: Redness, IBE, and microvascular irregularities appear to be closely related to SC lesions. Magnifi ed NBI endoscopy may increase the diagnostic accuracy of CWL endoscopy for SC.展开更多
Gastric cancer is the fifth most common cancer and in 2018,it was the third most common cause of cancer-related deaths worldwide.Endoscopic advances continue to be made for the diagnosis and management of both early g...Gastric cancer is the fifth most common cancer and in 2018,it was the third most common cause of cancer-related deaths worldwide.Endoscopic advances continue to be made for the diagnosis and management of both early gastric cancer and premalignant gastric conditions.In this review,we discuss the epidemiology and risk factors of gastric cancer and emphasize the differences in early vs latestage gastric cancer outcomes.We then discuss endoscopic advances in the diagnosis of early gastric cancer and premalignant gastric lesions.This includes the implementation of different imaging modalities such as narrow-band imaging,chromoendoscopy,confocal laser endomicroscopy,and other experimental techniques.We also discuss the use of endoscopic ultrasound in the diagnosis and staging of early gastric cancer.We then discuss the endoscopic advances made in the treatment of these conditions,including endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid techniques such as laparoscopic endoscopic cooperative surgery.Finally,we comment on the current suggested recommendations for surveillance of both gastric cancer and its premalignant conditions.展开更多
AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the "resect and discard" policy.METHODS: Patients who received colonoscopy and polypectomy were recruited in the retr...AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the "resect and discard" policy.METHODS: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancersand their endoscopic features were assessed. RESULTS: In total, we found 681 cases of diminutive(1-5 mm) lesions in 402 patients and 197 cases of small(6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal(SM) scanty invasive carcinomas, 1 and 1 were SM deeply invasive carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 endoscopically.CONCLUSION: The risk of failing to detect diminutive and small colorectal invasive cancer with the "resect and discard" strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.展开更多
Recently,a new disease entity termed gastric adenocarcinoma of fundic gland type(GA-FG) was proposed.We treated five cases of GA-FG with endoscopic submucosal dissection.All tumors were small and located in the upper ...Recently,a new disease entity termed gastric adenocarcinoma of fundic gland type(GA-FG) was proposed.We treated five cases of GA-FG with endoscopic submucosal dissection.All tumors were small and located in the upper third of the stomach.Four tumors were macroscopically identified as 0-IIa and one was identified as 0-Ⅱb.Narrow-band imaging with magnifying endoscopy showed an irregular microvascular pattern in 2 cases and a regular microvascular pattern in the remainder.All tumors arose from the deep layer of the lamina propria mucosae and showed submucosal invasion.Lymphatic invasion was seen only in one case,while no venous invasion was recognized.All tumors were positive for pepsinogen-Ⅰ and MUC6 by immunohistochemistry.None showed p53 overexpression,and the labeling index of Ki-67 was low in all cases.All cases have been free from recurrence or metastasis.Herein,we discussed the clinicopathological features of GA-FG in comparison with past reports.展开更多
BACKGROUND The undifferentiated-type(UDT)component profoundly affects the clinical course of early gastric cancers(EGCs).However,an accurate preoperative diagnosis of the histological types is unsatisfactory.To date,f...BACKGROUND The undifferentiated-type(UDT)component profoundly affects the clinical course of early gastric cancers(EGCs).However,an accurate preoperative diagnosis of the histological types is unsatisfactory.To date,few studies have investigated whether the UDT component within mixed-histological-type(MT)EGCs can be recognized preoperatively.AIM To clarify the histopathological characteristics of the endoscopically-resected MT EGCs for investigating whether the UDT component could be recognized preoperatively.METHODS This was a single-center retrospective study.First,we attempted to clarify the histopathological characteristics of the endoscopically-resected MT EGCs with emphasis on the UDT component.Histopathological examination investigated each lesion’s UDT component:(1)Whole mucosal layer occupation of the UDT component;(2)UDT component exposure to the surface of the mucosa;and(3)existence of a clear border between the differentiated-type and UDT components.Then,preoperative endoscopic images with magnifying endoscopy with narrowband imaging(ME-NBI)were examined to identify whether the endoscopic UDT component finding was recognizable within the area where it was present in the histopathological examination.The preoperative biopsy results and comparative relationships between endoscopic and histopathological findings were also examined.RESULTS In the histopathological examination,the whole mucosal layer occupation of the UDT component and exposure of the UDT component to the mucosal surface were observed in 67.3%(33/49)and 79.6%(39/49)of samples,respectively.A clear distinction of the border between the differentiated-type and UDT components could not be drawn in 65.3%(32/49)of MT lesions.In the endoscopic examination,the preoperative endoscopic images showed that only 24.5%(12/49)of MT EGCs revealed the UDT component within the area where it was present histopathologically.Histopathological UDT predominance was the single significant factor associated with the presence of the endoscopic UDT component finding(61.5%vs 11.1%,P=0.0009).Only 26.5%(13/49)of the lesions were diagnosed from the pretreatment biopsy as having a UDT component.Combined results of the pretreatment biopsy and ME-NBI showed the preoperative presence of the UDT component in 40.8%(20/49)of MT EGCs.CONCLUSION Recognition of a UDT component within MT EGCs is difficult even when pretreatment biopsy and ME-NBI are combined.Endoscopic resection plays a significant role in both treatment and diagnosis.展开更多
Gastric signet-ring cell gastric carcinoma(GSRC)is an unfavorable subtype of gastric cancer(GC)that presents with greater invasiveness and poorer prognosis in advanced stage than other types of GC.However,GSRC in earl...Gastric signet-ring cell gastric carcinoma(GSRC)is an unfavorable subtype of gastric cancer(GC)that presents with greater invasiveness and poorer prognosis in advanced stage than other types of GC.However,GSRC in early stage is often considered an indicator of less lymph node metastasis and more satisfying clinical outcome compared to poorly differentiated GC.Therefore,the detection and diagnosis of GSRC at early stage undoubtedly play a crucial role in the management of GSRC patients.In recent years,technological advancement in endoscopy including narrow-band imaging and magnifying endoscopy has significantly improved the accuracy and sensitivity of the diagnosis under endoscopy for GSRC patients.Researches have confirmed that early stage GSRC that meets the expanded criteria of endoscopic resection showed comparable outcomes to surgery after receiving endoscopic submucosal dissection(ESD),indicating that ESD could be considered standard treatment for GSRC after thorough selection and evaluation.This article summarizes the current knowledge and updates pertaining to the endoscopic diagnosis and treatment of early stage signet-ring cell gastric carcinoma.展开更多
文摘BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capillary network,and gastric pits.AIM To evaluate the effectiveness of a new one-dual(near)focus,NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification.METHODS During 2021 and 2022,68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid(AA).The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa.At the time of the endoscopy,the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy(WLE),near focus(NF),NF-NBI,AA-NF,and AA-NF-NBI modes.RESULTS The WLE,NF and NF-NBI endoscopic modes for all patients(204 images)were classified in the same order into three groups.Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order.According to all three observers who completed the work independently,NF magnification was significantly superior to WLE(P<0.01),and the NF-NBI mode was significantly superior to NF magnification(P<0.01).After applying AA,the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF(P<0.01).Interobserver kappa values for WLE were 0.609,0.704,and 0.598,respectively and were 0.600,0.721,and 0.637,respectively,for NF magnification.For the NF-NBI mode,the values were 0.378,0.471,and 0.553,respectively.For AA-NF,they were 0.453,0.603,and 0.480,respectively,and for AA-NF-NBI,they were 0.643,0.506,and 0.354,respectively.CONCLUSION When investigating gastric mucosa in microscopic detail,NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules,subepithelial capillary network,and gastric pits among the five endoscopic modalities investigated in this study.AA-NF-NBI was the most powerful endoscopic mode for analyzing crypt opening and intervening part.
基金Supported by Digestive Medical Coordinated Development Center of Beijing Hospitals Authority,No.XXZ015Capital Citizens Health Cultivation Project of Beijing Municipal Science&Technology Commission,No.Z161100000116084+1 种基金Medical and Health Public Foundation of Beijing,No.YWJKJJHKYJJ-B17262-067Science and Technology Development Project of China State Railway Group,No.N2019Z004.
文摘BACKGROUND In recent years,two new narrow-band imaging(NBI)classifications have been proposed:The NBI international colorectal endoscopic(NICE)classification and Japanese NBI expert team(JNET)classification.Most validation studies of the two new NBI classifications were conducted in classification setting units by experienced endoscopists,and the application of use in different centers among endoscopists with different endoscopy skills remains unknown.AIM To evaluate clinical application and possible problems of NICE and JNET classification for the differential diagnosis of colorectal cancer and precancerous lesions.METHODS Six endoscopists with varying levels of experience participated in this study.Eighty-seven consecutive patients with a total of 125 lesions were photographed during non-magnifying conventional white-light colonoscopy,non-magnifying NBI,and magnifying NBI.The three groups of endoscopic pictures of each lesion were evaluated by the six endoscopists in randomized order using the NICE and JENT classifications separately.Then we calculated the six endoscopists’sensitivity,specificity,accuracy,positive predictive value,and negative predictive value for each category of the two classifications.RESULTS The sensitivity,specificity,and accuracy of JNET classification type 1 and 3 were similar to NICE classification type 1 and 3 in both the highly experienced endoscopist(HEE)and less-experienced endoscopist(LEE)groups.The specificity of JNET classification type 1 and 3 and NICE classification type 3 in both the HEE and LEE groups was>95%,and the overall interobserver agreement was good in both groups.The sensitivity of NICE classification type 3 lesions for diagnosis of SM-d carcinoma in the HEE group was significantly superior to that in the LEE group(91.7%vs 83.3%;P=0.042).The sensitivity of JNET classification type 2B lesions for the diagnosis of high-grade dysplasia or superficial submucosal invasive carcinoma in the HEE and LEE groups was 53.8%and 51.3%,respectively.Compared with other types of JNET classification,the diagnostic ability of type 2B was the weakest.CONCLUSION The treatment strategy of the two classification type 1 and 3 lesions can be based on the results of endoscopic examination.JNET type 2B lesions need further examination.
文摘AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).
基金Supported by A Grant-in-Aid for Cancer Research (18-8) from the Ministry of Health, Labour and Welfare of Japan
文摘AIM: To investigate the endoscopic features of pharyngeal superfi cial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwent conventional white light (CWL) en-doscopy and non-magnifi ed/magnifi ed NBI endoscopy, followed by an endoscopic biopsy, for 445 superfi cial lesions in the oropharynx and hypopharynx. The macroscopic appearance of superfi cial lesions was categorized as either elevated (< 5 mm in height), flat, or depressed (not ulcerous). Superficial carcinoma (SC) was defi ned as a superfi cial lesion showing high-grade dysplasia or squamous cell carcinoma on histology. The color, delineation, and macroscopic appearances of the lesions were evaluated by CWL endoscopy. The ratio of the brownish area/intervascular brownish epithelium (IBE), as well as microvascular proliferation, dilation, and irregularities, was determined by non-magnifi ed/ magnifi ed NBI endoscopy. An experienced pathologist who was unaware of the endoscopic fi ndings made the histological diagnoses. By comparing endoscopic fi ndings with histology, we determined the endoscopic features of SC and evaluated the diagnostic utility of NBI. RESULTS: The 445 lesions were divided histologically into two groups: a non-SC group, including non-neoplasia and low-grade dysplasia cases, and an SC group. Of the 445 lesions examined, 333 were classified as non-SC and 112 were classif ied as SC. There were no significant differences in age, gender, or the location of the lesions between the patients in the two groups. The mean diameter of the SC lesions was signif icantly greater than that of non-SC lesions (11.0 ± 7.6 mm vs 4.6 ± 3.6 mm, respectively, P < 0.001). Comparisons of CWL endoscopy fi ndings for SC and non-SC lesions by univariate analysis revealed that the incidence of redness (72% vs 41%, respectively, P < 0.001) and a flat or depressed type of lesion (58% vs 44%, respectively, P = 0.013) was significantly higher in the SC group. Using non-magnifi ed NBI endoscopy, the incidence of a brownish area was signifi cantly higher for SC lesions (79% vs 57%, respectively, P < 0.001). On magnifi ed NBI endoscopy, the incidence of IBE (68% vs 33%, P < 0.001) and microvascular proliferation (82% vs 51%, P < 0.001), dilation (90% vs 76%, P =0.002), and irregularity (82% vs 31%, P < 0.001) was also signifi cantly higher for the SC compared with the non-SC lesions. Multivariate analysis revealed that the incidence of redness (P = 0.022) on CWL endoscopy and IBE (P < 0.001) and microvascular irregularities (P < 0.001) on magnif ied NBI endoscopy was signif icantly higher in SC than non-SC lesions. Redness alone exhibited signifi cantly higher sensitivity and signifi cantly lower specifi city for the diagnosis of SC compared with redness plus IBE and microvascular irregularities (72% vs 52%, P = 0.002; and 59% vs 92%, P < 0.001, respectively). The accuracy of redness plus IBE and irregularities for the diagnosis of SC was signifi cantly greater than using redness alone (82% vs 62%, respectively, P < 0.001). CONCLUSION: Redness, IBE, and microvascular irregularities appear to be closely related to SC lesions. Magnifi ed NBI endoscopy may increase the diagnostic accuracy of CWL endoscopy for SC.
文摘Gastric cancer is the fifth most common cancer and in 2018,it was the third most common cause of cancer-related deaths worldwide.Endoscopic advances continue to be made for the diagnosis and management of both early gastric cancer and premalignant gastric conditions.In this review,we discuss the epidemiology and risk factors of gastric cancer and emphasize the differences in early vs latestage gastric cancer outcomes.We then discuss endoscopic advances in the diagnosis of early gastric cancer and premalignant gastric lesions.This includes the implementation of different imaging modalities such as narrow-band imaging,chromoendoscopy,confocal laser endomicroscopy,and other experimental techniques.We also discuss the use of endoscopic ultrasound in the diagnosis and staging of early gastric cancer.We then discuss the endoscopic advances made in the treatment of these conditions,including endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid techniques such as laparoscopic endoscopic cooperative surgery.Finally,we comment on the current suggested recommendations for surveillance of both gastric cancer and its premalignant conditions.
基金Supported by Institute of Minimally Invasive Endoscopic Care(iM EC),Sano Hospital,No.2014-02
文摘AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the "resect and discard" policy.METHODS: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancersand their endoscopic features were assessed. RESULTS: In total, we found 681 cases of diminutive(1-5 mm) lesions in 402 patients and 197 cases of small(6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal(SM) scanty invasive carcinomas, 1 and 1 were SM deeply invasive carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 endoscopically.CONCLUSION: The risk of failing to detect diminutive and small colorectal invasive cancer with the "resect and discard" strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.
文摘Recently,a new disease entity termed gastric adenocarcinoma of fundic gland type(GA-FG) was proposed.We treated five cases of GA-FG with endoscopic submucosal dissection.All tumors were small and located in the upper third of the stomach.Four tumors were macroscopically identified as 0-IIa and one was identified as 0-Ⅱb.Narrow-band imaging with magnifying endoscopy showed an irregular microvascular pattern in 2 cases and a regular microvascular pattern in the remainder.All tumors arose from the deep layer of the lamina propria mucosae and showed submucosal invasion.Lymphatic invasion was seen only in one case,while no venous invasion was recognized.All tumors were positive for pepsinogen-Ⅰ and MUC6 by immunohistochemistry.None showed p53 overexpression,and the labeling index of Ki-67 was low in all cases.All cases have been free from recurrence or metastasis.Herein,we discussed the clinicopathological features of GA-FG in comparison with past reports.
文摘BACKGROUND The undifferentiated-type(UDT)component profoundly affects the clinical course of early gastric cancers(EGCs).However,an accurate preoperative diagnosis of the histological types is unsatisfactory.To date,few studies have investigated whether the UDT component within mixed-histological-type(MT)EGCs can be recognized preoperatively.AIM To clarify the histopathological characteristics of the endoscopically-resected MT EGCs for investigating whether the UDT component could be recognized preoperatively.METHODS This was a single-center retrospective study.First,we attempted to clarify the histopathological characteristics of the endoscopically-resected MT EGCs with emphasis on the UDT component.Histopathological examination investigated each lesion’s UDT component:(1)Whole mucosal layer occupation of the UDT component;(2)UDT component exposure to the surface of the mucosa;and(3)existence of a clear border between the differentiated-type and UDT components.Then,preoperative endoscopic images with magnifying endoscopy with narrowband imaging(ME-NBI)were examined to identify whether the endoscopic UDT component finding was recognizable within the area where it was present in the histopathological examination.The preoperative biopsy results and comparative relationships between endoscopic and histopathological findings were also examined.RESULTS In the histopathological examination,the whole mucosal layer occupation of the UDT component and exposure of the UDT component to the mucosal surface were observed in 67.3%(33/49)and 79.6%(39/49)of samples,respectively.A clear distinction of the border between the differentiated-type and UDT components could not be drawn in 65.3%(32/49)of MT lesions.In the endoscopic examination,the preoperative endoscopic images showed that only 24.5%(12/49)of MT EGCs revealed the UDT component within the area where it was present histopathologically.Histopathological UDT predominance was the single significant factor associated with the presence of the endoscopic UDT component finding(61.5%vs 11.1%,P=0.0009).Only 26.5%(13/49)of the lesions were diagnosed from the pretreatment biopsy as having a UDT component.Combined results of the pretreatment biopsy and ME-NBI showed the preoperative presence of the UDT component in 40.8%(20/49)of MT EGCs.CONCLUSION Recognition of a UDT component within MT EGCs is difficult even when pretreatment biopsy and ME-NBI are combined.Endoscopic resection plays a significant role in both treatment and diagnosis.
文摘Gastric signet-ring cell gastric carcinoma(GSRC)is an unfavorable subtype of gastric cancer(GC)that presents with greater invasiveness and poorer prognosis in advanced stage than other types of GC.However,GSRC in early stage is often considered an indicator of less lymph node metastasis and more satisfying clinical outcome compared to poorly differentiated GC.Therefore,the detection and diagnosis of GSRC at early stage undoubtedly play a crucial role in the management of GSRC patients.In recent years,technological advancement in endoscopy including narrow-band imaging and magnifying endoscopy has significantly improved the accuracy and sensitivity of the diagnosis under endoscopy for GSRC patients.Researches have confirmed that early stage GSRC that meets the expanded criteria of endoscopic resection showed comparable outcomes to surgery after receiving endoscopic submucosal dissection(ESD),indicating that ESD could be considered standard treatment for GSRC after thorough selection and evaluation.This article summarizes the current knowledge and updates pertaining to the endoscopic diagnosis and treatment of early stage signet-ring cell gastric carcinoma.
