Can virtual chromoendoscopy measure up to histology in early gastric cancer?

Abstract

The prognosis of differentiated early gastric cancer is better han that of undifferentiated early gastric cancer, anddifferentiated arly gastric cancer can be removed from the stomach using endocopic submucosal dissection (ESD), regardless of the size of the esion, as long as it does not invade the submucosa. A preliminary iagnosis of undifferentiated early gastric cancer, however, results n the patient being referred directly to surgery for a gastrectomy ithout endoscopic dissection. Yao et al. [1] describe and classify the mucosal changes in icrovascular structure (V=vascular pattern) and microsurface tructure (S = surface pattern) visible with magnification and highesolution endoscopy (at least 8 m). Both V and S can be regular, rregular or absent; however, there is evidence that in early gasric cancer, both V and S are irregular and have a well-defined emarcation line. In the past, the combined use of magnification and chromoenoscopy allowed clear definition of the characteristics of gastric ancer tissue. Today, several types of endoscopes are equipped with techiques for enhancement, magnification and virtual staining, llowing them to correctly displaymicrovascular andmicrosurface tructures. (narrow-band imaging and autofluorescence – Olymus, FICE – Fuji and I-Scan – Pentax). Ezoe et al. [2] compared magnifying white light imaging (WLI) nd magnifying narrow-band imaging (NBI) for small, depressed astric lesions and found that the real-timediagnostic accuracy and ensitivity were significantly higher for NBI than for WLI (79% vs. 4%,P= .0001, and70%vs. 33%,P= .0005, respectively). Thediagnosic specificity of NBI (89%) was also higher than that of WLI (67%), ut this difference was not statistically significant. Nakamura et al. [3] demonstrated the ability to differeniate between adenomas and early gastric cancer in elevated, at lesions of the stomach using magnifying NBI. Notably, in 7% of cases, adenomas showed slight intrastructural irreguar microvascular patterns (ISIMVPs), whereas severe ISIMVPs ere not observed. A fine network pattern of the microvasulature was identified in 3% of cases, but none of the cases howed a corkscrew pattern. Carcinomas showed slight ISIMVPs n 40% of cases, severe ISIMVPs in 15% of cases and a fine netork pattern in 45% of cases, but none of the cases showed a orkscrew pattern. The authors of that study concluded that severe