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DOI: 10.1055/s-0043-121267
Multiple convex demarcation line for prediction of benign depressed gastric lesions in magnifying narrow-band imaging
Publication History
submitted 11 March 2017
accepted after revision 08 September 2017
Publication Date:
01 February 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201802/lookinside/thumbnails/859_10-1055-s-0043-121267-1.jpg)
Abstract
Background and study aims With magnifying narrow-band imaging (M-NBI) of the gastric mucosa, a characteristic demarcation line (DL) is occasionally found in non-cancerous depressed lesions. This DL forms multiple convex shapes along the edge of the epithelia of surrounding mucosa. We have termed this novel finding a multiple convex DL (MCDL). In this study, we clarified the prevalence of an MCDL in depressed gastric lesions detected in patients at high risk for gastric cancer and determined the diagnostic yield necessary to distinguish between cancer and non-cancer.
Patients and methods This was a post hoc analysis of a multicenter prospective trial. In total, 362 small (≤ 10 mm) depressed lesions were detected in 1353 patients. Presence or absence of a DL in target lesions was evaluated on M-NBI images. The proportion of MCDLs among lesions with a DL was evaluated.
Results Images of 347 lesions (39 cancerous and 308 non-cancerous) were evaluable. A DL was present in 252/347 lesions (73 %). When the cutoff value for the proportion of MCDLs needed to distinguish non-cancer from cancer was set at two-thirds, an MCDL was observed in 86/252 lesions (34 %). In 86 lesions with an MCDL, 83 (97 %) were non-cancerous. The sensitivity, specificity, positive predictive value, and negative predictive value of an MCDL for non-cancerous lesions were 38 %, 91 %, 97 %, and 19 %, respectively.
Conclusions Presence of an MCDL had high specificity and positive predictive value for non-cancerous lesions. Evaluating the shape of the DL is useful for differentiation between cancer and non-cancerous lesions.
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References
- 1 Allum WH, Blazeby JM, Griffin SM. et al. Guidelines for the management of oesophageal and gastric cancer. Gut 2011; 60: 1449-1472
- 2 Thrumurthy SG, Chaudry MA, Hochhauser D. et al. The diagnosis and management of gastric cancer. BMJ 2013; 347: f6367
- 3 Gotoda T, Yanagisawa A, Sasako M. et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000; 3: 219-225
- 4 Everett SM, Axon AT. Early gastric cancer in Europe. Gut 1997; 41: 142-150
- 5 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
- 6 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
- 7 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: S16-20
- 8 Yao K, Anagnostopoulos GK, Ragunath K. Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy 2009; 41: 462-467
- 9 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
- 10 Yao K, Iwashita A, Kikuchi Y. et al. Novel zoom endoscopy technique for visualizing the microvascular architecture in gastric mucosa. Clin Gastroenterol Hepatol 2005; 3: S23-26
- 11 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
- 12 Yao K, Doyama H, Gotoda T. et al. Diagnostic performance and limitations of magnifying narrow-band imaging in screening endoscopy of early gastric cancer: a prospective multicenter feasibility study. Gastric Cancer 2014; 17: 669-679
- 13 Yoo CH, Park MI, Park SJ. et al. Observer variability in gastric neoplasm assessment using the vessel plus surface classification for magnifying endoscopy with narrow band imaging. Clin Endosc 2014; 47: 74-78
- 14 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
- 15 Kanesaka T, Uedo N, Yao K. et al. A significant feature of microvessels in magnifying narrow-band imaging for diagnosis of early gastric cancer. Endosc Int Open 2015; 3: E590-596
- 16 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
- 17 Yao K. Zoom gastroscopy: Magnifying endoscopy in the stomach. Tokyo: Springer; 2014. 12.4: 91-92
- 18 Dixon MF, Genta RM, Yardley JH. et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181
- 19 Yamada S, Doyama H, Yao K. et al. An efficient diagnostic strategy for small, depressed early gastric cancer with magnifying narrow-band imaging: a post-hoc analysis of a prospective randomized controlled trial. Gastrointest Endosc 2014; 79: 55-63
- 20 Muto M, Yao K, Kaise M. et al. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Dig Endosc 2016; 28: 379-393
- 21 Kanzaki H, Uedo N, Ishihara R. et al. Comprehensive investigation of areae gastricae pattern in gastric corpus using magnifying narrow band imaging endoscopy in patients with chronic atrophic fundic gastritis. Helicobacter 2012; 17: 224-231
- 22 Kato M, Nishida T, Yamamoto K. et al. Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer: a multicenter retrospective cohort study by Osaka University ESD study group. Gut 2013; 62: 1425-32
- 23 Yoshida T, Kato J, Inoue I. et al. Cancer development based on chronic active gastritis and resulting gastric atrophy as assessed by serum levels of pepsinogen and Helicobacter pylori antibody titer. Int J Cancer 2014; 134: 1445-1457
- 24 Yao K. Zoom gastroscopy: Magnifying endoscopy in the stomach. Tokyo: Springer; 2014. 8.3: 61-69
- 25 Yagi K, Nozawa Y, Endou S. et al. Diagnosis of early gastric cancer by magnifying endoscopy with NBI from viewpoint of histological imaging: mucosal patterning in terms of white zone visibility and its relationship to histology. Diagn Ther Endosc 2012; 2012: 954809
- 26 Yao K. Zoom gastroscopy: Magnifying endoscopy in the stomach. Tokyo: Springer; 2014. 13.1: 100-125