Irregular Microvascular Patterns Research Articles

Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection

BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract, and endoscopic submucosal dissection (ESD) is the preferred treatment for early-stage gastric cancer. The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD. AIM To analyze the features of gastric mucosal tumors at different differentiation levels, and to explore the prognostic factors of ESD. METHODS We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021, according to the latest Japanese guidelines (sixth edition), and divided them into low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and differentiated and undifferentiated early carcinoma. They are followed up by endoscopy, chest and abdominal computed tomography at 3, 6 and 12 months after ESD. We compared clinicopathologic characteristics, ESD efficacy, and complications with different degrees of differentiation, and analyzed the related factors associated with ESD. RESULTS HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients (P < 0.001) and accounted for more 0-IIc (P < 0.001), atrophic gastritis was common (P < 0.001), and irregular microvascular patterns (IMVPs) and demarcation lines (DLs) were more obvious (P < 0.001). There was more infiltration in the undifferentiated carcinoma tissue (P < 0.001), more abnormal folds and poorer mucosal peristalsis (P < 0.001), and more obvious IMVPs, irregular microsurface patterns and DLs (P < 0.05) than in the LGIN and HGIN tissues. The disease-free survival rates at 2, 5, and 8 years after ESD were 95.0%, 90.1%, and 86.9%, respectively. Undifferentiated lesions (HR 5.066), white moss (HR 7.187), incomplete resection (HR 3.658), and multiple primary cancers (HR 2.462) were significantly associated with poor prognosis. CONCLUSION Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics, which are closely related to the safety and efficacy of ESD.

Usefulness of magnifying endoscopy with acetic acid and narrow-band imaging for the diagnosis of duodenal neoplasms: proposal of a diagnostic algorithm.

This study aimed to clarify the features of superficial non-ampullary duodenal epithelial tumors (SNADETs) on magnifying endoscopy with narrow-band imaging (M-NBI) and magnifying endoscopy with acetic acid and narrow-band imaging (M-AANBI), and evaluate the efficacy of M-NBI/M-AANBI to distinguish high-grade adenomas or adenocarcinomas (HGA/AC) from low-grade adenomas (LGA). Clinicopathological data on 62 SNADETs in 58 patients who underwent preoperative M-NBI/M-AANBI and endoscopic resection were retrospectively reviewed. The pathological results were classified into two categories, LGA and HGA/AC. We evaluated microvascular patterns (MVPs) and microsurface patterns (MSPs) observed by M-NBI and MSPs observed by M-AANBI for characterizing LGA and HGA/AC. The kappa value was calculated to assess the interobserver and intraobserver agreements of evaluation of M-AANBI images. Pathologically, 38 lesions (61.3%) were LGA and 24 lesions (38.7%) were HGA/AC. HGA/AC tended to have irregular MVP and/or MSP on M-NBI. M-NBI diagnostic performance to distinguish HGA/AC from LGA showed 62.5% sensitivity, 68.4% specificity, and 66.1% accuracy. SNADETs had irregular MSP on M-AANBI. Three irregularity grades (iG) of MSP were observed by M-AANBI as follows: iG1, mild; iG2, moderate; iG3, significant. HGA/AC lesions had a significantly higher rate of iG3 than LGA lesions (p < 0.001). The iG2 was associated with HGA/AC in elevated lesions and LGA in depressed lesions. The diagnostic performance of M-AANBI was as follows: 95.8% sensitivity, 97.4% specificity, and 96.8% accuracy. The diagnostic accuracy of M-AANBI was significantly higher than that of M-NBI (p < 0.001). The kappa value for interobserver agreement on the diagnosis and irregularity grading of M-AANBI images was 0.742 and 0.719, respectively. These data indicate substantial interobserver agreement. Based on the above-mentioned results, we developed a M-AANBI diagnostic algorithm for SNADETs. The diagnostic algorithm for SNADETs using M-AANBI may be useful for differentiating between LGA and HGA/AC.

Taking the Next Steps in Endoscopic Visual Assessment of Barrett's Esophagus: A Pilot Study.

PurposePatients with Barrett’s esophagus (BE) undergo surveillance endoscopies to assess for pre-cancerous changes. We developed a simple endoscopic classification method for predicting non-dysplastic BE (NDBE), low-grade dysplasia (LGD)/indefinite for dysplasia (ID) and high-grade dysplasia (HGD)/early esophageal adenocarcinoma (EAC).Patients and MethodsTwenty-two patients with BE underwent endoscopy using the PENTAX Medical MagniView gastroscope and OPTIVISTA processor. Sixty-six video-still images were analyzed to characterize the microsurface, microvasculature and the presence of a demarcation line. Class A was characterized by regular microvascular and microsurface patterns and absence of a demarcation line, class B by changes in the microvascular and/or microsurface patterns compared to the background mucosa with presence of a demarcation line, and class C by irregular microvascular and/or irregular microsurface patterns with presence of a demarcation line.ResultsOf the class A images, 97.9% were NDBE. For class B, 69.2% were LGD/ID and 30.8% NDBE. One hundred percent of the class C samples were HGD/EAC. The sensitivity of our classification system was 93.8%, specificity 92%, positive predictive value 78.9%, negative predictive value 97.9% and an accuracy 92.4%.ConclusionIn this study, we developed a simple classification system for the prediction of NDBE, LGD/ID and HGD/EAC. Its real-time clinical applicability will be validated prospectively.

Gastric adenocarcinoma of the fundic gland type: clinicopathological features of eight patients treated with endoscopic submucosal dissection

BackgroundGastric adenocarcinoma of the fundic gland type (GA-FG) has been added to the 2019 edition of the World Health Organization’s list of digestive system-associated cancers. This lesion differentiates toward the fundic gland and mostly involves chief cell-predominant differentiation with low-grade cytology. Clinicians and pathologists are still unaware of this rare disease; consequently, some cases are incorrectly diagnosed. This study aimed to investigate the clinicopathological features of GA-FG using retrospective analyses of endoscopic and pathological findings.Materials and methodsSamples were collected from patients diagnosed with GA-FG. The clinical courses of all patients were monitored prospectively and reviewed retrospectively. Available clinical information, endoscopic features, pathological appearance, and follow-up data were assessed. Immunohistochemistry [mucin (MUC) 2, MUC5, MUC6, P53, CDX2, Ki67, SYN, CD56, CGA, β-catenin, and pepsinogen-I] was examined using Envision two-step method.ResultsEight cases of endoscopic submucosal dissection (ESD) were obtained from our institution. Patient age ranged from 48 to 80 years (mean, 65 years). Some patients were on acid-suppressing medication. Most lesions were located in the upper third (n = 7) and one was in the middle third of the stomach. Six lesions were of the superficial flat type, whereas two were of the superficial elevated type. Narrow-band imaging using magnifying endoscopy showed irregular microvascular patterns (MVPs) in four cases and regular MVPs in the remaining cases. All lesions were primarily solitary and ~ 6 mm in diameter (largest, 12 mm). The main body of the tumors were localized in the mucosal layer, of which six cases invade into the submucosal layer. Well-formed glands of chief cells were predominant. Tumor cells were positive for pepsinogen-I, MUC6, SYN, and CD56. Lymphatic and vascular infiltration and metastatic and recurrent disease were not observed in any case.ConclusionGA-FG, a well-differentiated adenocarcinoma with mild atypia, can be completely removed using ESD, with a favorable prognosis in patients.

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

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

Narrow Band Imaging Can Differentiate Type Iia Early Gastric Cancer From Adenoma: Correlations of Vascular Patterns With Histopathology

BACKGROUND/AIMS: Narrow band imaging (NBI) systems consist of sequential electronic endoscopes and light sources equipped with modern narrow band filters, and yield very clear images of microvessels on mucosal surfaces. The aim of this study was to assess the relationships between images obtained with an NBI system and histological findings, especially vascular patterns, to distinguish adenoma from early gastric cancer (EGC) type IIa. PATIENTS AND METHODS: We postoperatively confirmed and evaluated 39 elevated lesions, 32 adenomas and seven type IIa early gastric cancers (EGC IIa) in patients who had undergone endoscopic submucosal dissection. We selected three sites per adenoma and four sites per EGC IIa for NBI. The selected sites were classified as four conventional superficial structures (SSs) or irregular microvascular patterns (IMVPs). In addition, the selected sites were divided into two groups based on the presence of corkscrew (CS) vascular patterns over 10% of the field. RESULTS: Regarding IMVP subcategories, (1) slight intrastructural irregular microvascular patterns (ISIMVPs) accounted for 84%, (2) severe ISIMVPs accounted for 6%, (3) fine networks (FNs) accounted for 10%, and (4) corkscrews accounted for 0% of cases in the adenomas. The corresponding proportions in the EGC IIa were (1) 25%, (2) 25%, (3) 50%, and (4) 0%. Slight ISIMVPs, severe ISIMVPs, and FNs reliably distinguished the two diseases: P=0.000 for slight ISMVPs; P=0.010 for severe ISIMVPs; P=0.000 for FNs. Corkscrew vascular patterns were observed in 46% of EGC IIa and 7% of adenoma cases (P=0.000). CONCLUSIONS: NBI can be used to differentiate EGC IIa from gastric adenoma based on IMVP classifications and the presence of corkscrew vascular patterns. Irregular microvascular patterns of adenoma and EGC IIa

The Usefulness of Raman Spectroscopy for the Differential Diagnosis of Colonic Polyps

BACKGROUND/AIMS: Narrow band imaging (NBI) systems consist of sequential electronic endoscopes and light sources equipped with modern narrow band filters, and yield very clear images of microvessels on mucosal surfaces. The aim of this study was to assess the relationships between images obtained with an NBI system and histological findings, especially vascular patterns, to distinguish adenoma from early gastric cancer (EGC) type IIa. PATIENTS AND METHODS: We postoperatively confirmed and evaluated 39 elevated lesions, 32 adenomas and seven type IIa early gastric cancers (EGC IIa) in patients who had undergone endoscopic submucosal dissection. We selected three sites per adenoma and four sites per EGC IIa for NBI. The selected sites were classified as four conventional superficial structures (SSs) or irregular microvascular patterns (IMVPs). In addition, the selected sites were divided into two groups based on the presence of corkscrew (CS) vascular patterns over 10% of the field. RESULTS: Regarding IMVP subcategories, (1) slight intrastructural irregular microvascular patterns (ISIMVPs) accounted for 84%, (2) severe ISIMVPs accounted for 6%, (3) fine networks (FNs) accounted for 10%, and (4) corkscrews accounted for 0% of cases in the adenomas. The corresponding proportions in the EGC IIa were (1) 25%, (2) 25%, (3) 50%, and (4) 0%. Slight ISIMVPs, severe ISIMVPs, and FNs reliably distinguished the two diseases: P=0.000 for slight ISMVPs; P=0.010 for severe ISIMVPs; P=0.000 for FNs. Corkscrew vascular patterns were observed in 46% of EGC IIa and 7% of adenoma cases (P=0.000). CONCLUSIONS: NBI can be used to differentiate EGC IIa from gastric adenoma based on IMVP classifications and the presence of corkscrew vascular patterns. Irregular microvascular patterns of adenoma and EGC IIa

Efficacy of Narrow Band Imaging System Combined With Magnifying Endoscopy for Differentiating Type IIa Early Gastric Cancer From Adenoma.

BackgroundIt is not always possible for endoscopists to differentiate early gastric cancer from adenoma in 0-IIa type neoplasia. The aim of this study was to assess the relationships between images obtained with a narrow band image system combined with magnifying endoscopy (MENBI) and histological findings, especially vascular patterns, to distinguish adenoma from type IIa early gastric cancer (EGC IIa).MethodsWe postoperatively confirmed and evaluated 46 elevated lesions, 32 adenomas and 14 EGC IIa in patients who had undergone endoscopic submucosal dissection. We randomly selected three sites from each neoplasm. The selected sites were classified as four irregular microvascular patterns (IMVPs). In addition, the selected sites were divided into two groups based on the presence of corkscrews.ResultsRegarding IMVP subcategories, (1) slight intrastructural irregular microvascular patterns (ISIMVPs) accounted for 84%, (2) severe ISIMVPs accounted for 6%, (3) fine networks (FNs) accounted for 10%, and (4) corkscrews accounted for 0 of cases in the adenomas. The corresponding proportions in the EGC IIa were (1) 24%, (2) 31%, (3) 45%, and (4) 0. Slight ISIMVPs, severe ISIMVPs, and FNs reliably distinguished the two diseases: P < 0.001 for slight ISMVPs; P < 0.001 for severe ISIMVPs; P < 0.001 for FNs. The presence of corkscrews was observed in 9.5% of EGC IIa and 0 of adenoma cases (P = 0.008).ConclusionsMENBI can be used to differentiate EGC IIa from gastric adenoma based on IMVPs classifications and the presence of corkscrews.

The usefulness of magnifying endoscopy with narrow-band imaging to distinguish carcinoma in flat elevated lesions in the stomach diagnosed as adenoma by using biopsy samples

Therapeutic strategies for flat elevated (0-IIa) lesions in the stomach diagnosed as adenoma by biopsy are currently not established, because some difficulties have previously been reported in the evaluation of vascular patterns alone for the differential diagnosis between adenoma and carcinoma. We attempted to evaluate the 0-IIa lesions diagnosed as adenoma by using magnifying endoscopy with narrow-band imaging (MENBI) to distinguish them as either adenoma or carcinoma. Department of Gastroenterology, Fujita Health University. Fourteen adenomatous lesions (6 adenomas and 8 carcinomas confirmed postoperatively) diagnosed with preoperative biopsies from patients who had undergone endoscopic submucosal dissection were evaluated. We selected 5 sites per lesion for MENBI. Selected sites were divided into superficial structures (SSs) and irregular microvascular patterns (IMVPs). The rate of SSs and IMVPs in adenoma and carcinoma. Significant SSs were tubular in the adenoma and unclear in the carcinoma. Regarding IMVP subcategories, (1) slight intrastructual irregular microvascular patterns (ISIMVPs) accounted for 97%, (2) severe ISIMVPs accounted for 0%, (3) fine networks accounted for 3%, and (4) corkscrews accounted for 0% of cases in the adenomas. The corresponding proportions in the carcinomas were (1) 40%, (2) 15%, (3) 45%, and (4) 0%. Severe ISIMVPs and fine networks were significant findings for carcinomas. The number of cases was limited. Our combined evaluation method using MENBI offers the ability to establish proper therapeutic strategies for lesions that are difficult to identify as adenoma or carcinoma.