A significant feature of microvessels in magnifying narrow-band imaging for diagnosis of early gastric cancer

Takashi Kanesaka; Noriya Uedo; Kenshi Yao; Yasumasa Ezoe; Hisashi Doyama; Ichiro Oda; Kazuhiro Kaneko; Yoshiro Kawahara; Chizu Yokoi; Yasushi Sugiura; Hideki Ishikawa; Minoru Kato; Yoji Takeuchi; Manabu Muto; Yutaka Saito

doi:10.1055/s-0034-1392608

Endoscopy International Open, Inhaltsverzeichnis

Endosc Int Open 2015; 03(06): E590-E596
DOI: 10.1055/s-0034-1392608

Original article

A significant feature of microvessels in magnifying narrow-band imaging for diagnosis of early gastric cancer

Takashi Kanesaka

¹Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

,

Noriya Uedo

¹Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

,

Kenshi Yao

²Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan

,

Yasumasa Ezoe

³Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

,

Hisashi Doyama

⁴Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan

,

Ichiro Oda

⁵Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

,

Kazuhiro Kaneko

⁶Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Chiba, Japan

,

Yoshiro Kawahara

⁷Division of Endoscopy, Okayama University, Okayama, Japan

,

Chizu Yokoi

⁸Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan

,

Yasushi Sugiura

⁹Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan

,

Hideki Ishikawa

¹⁰Department of Molecular Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan

,

Minoru Kato

¹Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

,

Yoji Takeuchi

¹Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

,

Manabu Muto

³Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

,

Yutaka Saito

⁵Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

› Institutsangaben

Abstract

Background and study aims: Magnifying narrow-band imaging (NBI) is more useful than conventional endoscopy for diagnosing early gastric cancer (EGC). However, evaluation of irregular microvascular patterns is subjective and is often difficult, even with expert eyes. The aim of this study was to clarify the most important microvascular patterns in magnifying NBI for diagnosis of EGC.

Patients and methods: This was a post-hoc analysis of a multicenter prospective trial among nine Japanese hospitals. A total of 1353 patients underwent screening with white-light endoscopy and 362 patients had small (≤ 10 mm) depressed lesions. They were randomly assigned to magnifying NBI or white-light endoscopy followed by magnifying NBI. During diagnosis, magnifying NBI images were recorded before biopsy. All magnifying NBI images were reviewed and evaluated for the association of four features of microvessels – that is, dilation, tortuosity, difference in caliber, and variation in shape – with cancer diagnosis.

Results: Images of 343 lesions (40 cancerous and 303 benign depression lesions) were evaluable. The diagnostic performance (sensitivity/specificity) of each finding was: dilation, 25/90 %; tortuosity, 55/24 %; difference in caliber, 13 /99 %; and variation in shape, 70/95 %. Multivariate analysis identified only variation in shape as being statistically significantly associated with diagnosis of cancer (odds ratio 38.0, 95 % confidence interval: 16.1 – 95.7, P < 0.001). All findings showed moderate agreement (κ values): dilation, 0.44; tortuosity, 0.33; difference in caliber, 0.26; and variation in shape, 0.48.

Conclusions: A variation in shape was the most significant feature of microvessels observed in magnifying NBI for diagnosis of small depressed-type EGC.

Study registration: UMIN-CTR000001072

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References
1 Thrumurthy SG, Chaudry MA, Hochhauser D et al. The diagnosis and management of gastric cancer. BMJ 2013; 347: f6367
2 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
3 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
4 Gono K, Obi T, Yamaguchi M et al. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt 2004; 9: 568-577
5 Muto M, Katada C, Sano Y et al. Narrow band imaging: a new diagnostic approach to visualize angiogenesis in the superficial neoplasia. Clin Gastroenterol Hepatol 2005; 3: 16-20
6 Yao K, Oishi T, Matsui T et al. Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer. Gastrointest Endosc 2002; 56: 279-284
7 Yao K, Iwashita A, Tanabe H et al. Novel zoom endoscopy technique for diagnosis of small flat gastric cancer: a prospective, blind study. Clin Gastroenterol Hepatol 2007; 5: 869-878
8 Yao K, Anagnostopoulos GK, Ragunath K. Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy 2009; 41: 462-467
9 Ezoe Y, Muto M, Uedo N et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology 2011; 141: 2017-2025
10 Yoshida T, Inoue H, Usui S et al. Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. Gastrointest Endosc 2004; 59: 288-295
11 Inoue H. Magnification endoscopy in the esophagus and stomach. Dig Endosc 2001; 13: 40-S41
12 Kaise M, Kato M, Urashima M et al. Magnifying endoscopy combined with narrow-band imaging for differential diagnosis of superficial depressed gastric lesions. Endoscopy 2009; 41: 310-315
13 Bossuyt PM, Reitsma JB, Bruns DE et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med 2003; 138: W1-12
14 Schlemper RJ, Riddell RH, Kato Y et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
15 Ishihara R, Inoue T, Uedo N et al. Significance of each narrow-band imaging finding in diagnosing squamous mucosal high-grade neoplasia of the esophagus. J Gastroenterol Hepatol 2010; 25: 1410-1415
16 Uedo N, Fujishiro M, Goda N et al. Role of narrow band imaging for diagnosis of early-stage esophagogastric cancer: current consensus of experienced endoscopists in Asia–Pacific region. Dig Endosc 2011; 23: 58-71
17 Yao K. Zoom gastroscopy: Magnifying endoscopy in the stomach. Tokyo: Springer; 2014
18 Gao Y, Zhong WX, Mu DB et al. Distributions of angiogenesis and lymphangiogenesis in gastrointestinal intramucosal tumors. Ann Surg Oncol 2008; 15: 1117-1123
19 Mabe K, Yao K, Nojima M et al. An educational intervention to improve the endoscopist’s ability to correctly diagnose small gastric lesions using magnifying endoscopy with narrow-band imaging. Ann Gastroenterol 2014; 27: 149-155