Usefulness of Magnifying Endoscopy in the Diagnosis of Early Gastric Cancer

Background and Study Aims: We investigated the characteristic findings of early gastric cancer revealed by magnifying endoscopy, and clarified their relationship with histopathological features.
Patients and Methods: A total of 74 patients with early gastric cancer underwent magnifying endoscopy ( × 80) between March 2000 and December 2001. The endoscopic findings demonstrated 11 elevated-type carcinomas and 63 depressed-type, and histological examination showed 56 differentiated carcinomas and 18 undifferentiated carcinomas. The histopathological results were compared with findings from magnifying endoscopy regarding minute surface structure and microvessels.
Results: We were able to roughly classify the minute surface structure of early gastric cancer as shown by magnifying endoscopy into three patterns, as follows: (i) a small regular pattern of sulci and ridges; (ii) an irregular pattern of sulci and ridges; and (iii) a lack of visible structure. Abnormal microvessels observed in cancerous lesions were classified according to two patterns: irregular minute vessels and variation of vessel caliber. The small regular pattern of sulci and ridges was significantly more frequently observed in differentiated carcinoma (30/56, 53.6 %) than in undifferentiated carcinoma (2/18, 11.1 %). Lack of visible structure and irregular minute vessels were significantly more frequently observed in undifferentiated carcinoma (44.4 % and 77.7 %) than in differentiated carcinomas (5.4 % and 51.8 %).
Conclusion: The minute surface structure and microvessels observed by magnifying endoscopy were related to histopathological findings. Magnifying endoscopy is valuable for predicting the histological nature in the diagnosis of early gastric cancer.

References

• 1 Salem S N, Truelove S C. Dissecting microscope appearance of the gastric mucosa.  Br Med J. 1964;  2 1503-1504
• 2 Sakaki N, Iida Y, Okazaki Y. et al . Magnifying endoscopic observation of the gastric mucosa, particularly in patients with atrophic gastritis.  Endoscopy. 1978;  10 269-274
• 3 Nishizawa M, Okada T, Sato F. et al . A clinicopathological study of minute polypoid lesions of the colon based on magnifying fiber-colonoscopy and dissecting microscopy.  Endoscopy. 1980;  12 124-129
• 4 Okada T, Nishizawa M. Magnified observation of elevated lesions of the stomach based on magnifying fiberoptic endoscopy and dissecting microscopy.  Endoscopy. 1981;  13 192-196
• 5 Takemoto T, Sakaki N. Magnification endoscopy. In: Sivak M Jr (ed) Gastroenterologic endoscopy. 2nd edn. Philadelphia; WB Saunders 2000: 165-175
• 6 Kudo S, Tamura S, Nakajima T. et al . Diagnosis of colorectal tumorous lesions by magnifying endoscopy.  Gastrointest Endosc. 1996;  44 8-14
• 7 Tung S Y, Wu C S, Su M Y. et al . Magnifying colonoscopy in differentiating neoplastic from nonneoplastic colorectal lesions.  Am J Gastroenterol. 2001;  96 2628-2632
• 8 Tada M, Murakami A, Karita M. et al . Endoscopic resection of early gastric cancer.  Endoscopy. 1993;  25 445-450
• 9 Takeshita K, Tani M, Inoue H. et al . A new method of endoscopic mucosal resection of neoplastic lesions in the stomach: its technical features and results.  Hepatogastroenterology. 1997;  44 1602-1611
• 10 Ono H, Kondo H, Gotoda T. et al . Endoscopic mucosal resection for treatment of early gastric cancer.  Gut. 2001;  48 225-229
• 11 Shiraishi N, Adachi Y, Kitano S. et al . Indication for and outcome of laparoscopy-assisted Billroth I gastrectomy.  Br J Surg. 1999;  86 541-544
• 12 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
• 13 Tobita K. Study on minute surface structures of the depressed type early gastric cancer with magnifying endoscopy.  Dig Endosc. 2001;  13 121-126
• 14 Yagi K, Nakamura A, Sekine A. Comparison between magnifying endoscopy and histological, culture and urease test findings from the gastric mucosa of the corpus.  Endoscopy. 2002;  34 376-381