Magnifying Narrow-band Imaging Research Articles

Investigation of mucosal pattern of gastric antrum using magnifying narrow-band imaging in patients with chronic atrophic fundic gastritis.

BackgroundMagnifying narrow-band imaging (M-NBI) can reportedly help predict the presence and distribution of atrophy and intestinal metaplasia in the gastric corpus. However, the micro-mucosal pattern of the antrum shown by M-NBI differs from that of the corpus. We studied the distribution and histology of the micro-mucosal pattern in the antrum based on magnifying endoscopy.MethodsEndoscopic images of the greater curvature of the antrum were evaluated in 50 patients with chronic atrophic fundic gastritis (CAFG). The extent of CAFG was evaluated by autofluorescence imaging. The micro-mucosal pattern was evaluated by M-NBI and classified into groove and white villiform types. The localization of white villiform type mucosa was classified into three types in relation to the areae gastricae: null, central, and segmental types. Biopsies were taken from regions showing different micro-mucosal patterns. Associations among the extent of CAFG, micro-mucosal pattern, and histology were examined.ResultsAs the extent of CAFG increased, the proportion of white villiform type mucosa increased, whereas that of groove type mucosa decreased (P=0.022). In patients with extensive CAFG, most of the areae gastricae was composed of the segmental or central type of white villiform type mucosa (P=0.044). The white villiform type mucosa had significantly higher grades of atrophy (P=0.002) and intestinal metaplasia (P<0.001) than did the groove type mucosa.ConclusionWhite villiform type mucosa is indicative of atrophy and intestinal metaplasia in the gastric antrum. It extends to the whole or central part of the areae gastricae as CAFG becomes more extensive.

Clinical usefulness of narrow band imaging magnifying colonoscopy for assessing ulcerative colitis-associated cancer/dysplasia.

Background and study aims: Colitis-associated cancer/dysplasia (CC/D) can affect the life expectancy of patients with ulcerative colitis (UC). Although the utility of magnifying chromocolonoscopy has been shown, the use of optical magnification with narrow band imaging (NBI) for distinguishing CC/D from non-neoplastic lesions in patients with UC has not been reported. We evaluated whether endoscopic findings are distinguishing and thus assessed the clinical usefulness of NBI magnification for differentiating UC-associated lesions. Patients and methods: The study involved 27 patients diagnosed and treated at Hiroshima University Hospital between September 2005 and March 2015: a neoplasia group (16 lesions) and a non-neoplasia group (17 lesions). The neoplasias comprised 9 dysplastic lesions, 5 intramucosal carcinomas, and 2 submucosal carcinomas, and 17 non-neoplastic lesions. Targeted biopsy samples of suspicious lesions detected by conventional colonoscopy were classified pathologically as neoplastic or non-neoplastic, and NBI magnifying colonoscopy findings (i. e., the surface [unclear/regular/irregular/amorphous] and vascular [same as the background mucosa/regular/irregular/avascular] patterns) of the 2 lesion types were compared. Results: Irregular/amorphous surface patterns were significantly more common in neoplastic lesions than in non-neoplastic lesions (81 % [13/16] vs. 18 % [3/17], respectively, P < 0.001). Irregular/avascular vessel pattern tended to be more common in neoplastic lesions (75 % [12/16] vs. 41 % [7/17], respectively). The surface pattern correctly predicted 82 % of neoplastic lesions, and the vessel pattern correctly predicted 67 % of non-neoplastic lesions. The 2 endoscopic findings together correctly predicted 91 % of neoplastic lesions. Conclusion: Surface pattern, determined by magnifying colonoscopy with NBI, is useful for differenting between UC-associated neoplastic and non-neoplastic lesions.

Diagnostic efficacy of magnifying endoscopy with narrow band imaging for gastric mucosal lesions

Objective To study the diagnostic value of magnifying endoscopy with narrow band imaging(NBI-ME) for gastric neoplastic lesion and its role in developing diagnostic skills of less experienced endoscopists. Methods White light images and magnifying endoscopic images with narrow band imaging of 20 cases of early gastric lesions were collected from published literature. Thirty-seven endoscopists with various experiences were invited to a diagnosis workshop to study these cases. After a short training course of diagnosis, real time vote was performed and data were analyzed. Results All thirty-seven endoscopists finished the diagnosis workshop. Fourteen endoscopists(37.8%) had work experience of less than five years, and 22(59.5%) had experience in either magnifying endoscopy or narrow band imaging. The diagnostic accuracy of NBI-ME was significantly higher than that of white light imaging [(62.6±21.7)% VS(49.8±28.7)%, P=0.005], but was consistent in the 3 cases with lowest diagnostic accuracy, which were all benign including two cases of localized gastritis and one metaplasia. Comparison between the diagnostic accuracy rates of first and last seven cases showed there was no statistical difference [(55.8±26.3)% VS(69.0±27.1)%, P=0.377], neither was there when 22 experienced endoscopists in NBI-ME were excluded [(56.5±23.2)% VS(67.4±25.3)%, P=0.356]. Conclusion Magnifying endoscopy with narrow band imaging is superior to white light imaging in diagnosis of early gastric mucosal lesions. It is also helpful to improve diagnostic skills of less experienced endoscopists. But it may be of lower diagnostic accuracy for such benign lesion as gastric atrophy and intraepithelial metaplasia. Key words: Magnifying endoscopy; Narrow band imaging; Early gastric neoplasm; Training

Clinicopathologic characteristics and management of minute esophageal lesions diagnosed by narrow-band imaging endoscopy.

Background and study aims: Magnifying narrow-band imaging (NBI) endoscopy enables the diagnosis of minute esophageal neoplasia. We aimed to evaluate clinicopathological diagnosis of minute esophageal neoplasia by using magnifying NBI endoscopy and biopsy. Patients and methods: In total, 309 patients (127 men and 182 women) with minute esophageal lesions of intrapapillary capillary loop (IPCL) type IV were enrolled. Of these patients, 249 underwent biopsy for histologic diagnosis and also for treatment. Of the 249 patients, 123 underwent follow-up with endoscopy. We analyzed the clinicopathologic characteristics and prognosis of these lesions after biopsy. Results: Of the 249 biopsied lesions, we histologically diagnosed 11 as high-grade intraepithelial neoplasia (HGIN), 41 as low-grade intraepithelial neoplasia (LGIN), and 197 as non-neoplasia (Non-N) including inflammation. Six of the 11 HGINs and 11 of the 41 LGINs showed slight elevation. Background coloration was observed in 9 of 11 HGINs, 34 of 41 LGINs, and 33 of 197 Non-Ns. Of the 249 biopsied lesions, 147 were microscopically measurable. The average diameter was 1.4 mm for HGINs and 0.8 mm for LGINs. Of the 123 patients who underwent post-biopsy follow-up, 93 (76 %) showed no lesions at the biopsied sites during the NBI examinations and were suspected to have undergone complete resection by biopsy. Conclusions: Biopsy was useful for diagnosis and treatment of minute esophageal lesions, diagnosed as IPCL type IV by magnifying NBI endoscopy.

Findings of the margin around lesions by magnifying endoscopy with narrow-band imaging in early gastric carcinoma and intestinal metaplasia.

Many endoscopists have reported their own classifications of early gastric carcinoma (EGC) using magnifying narrow-band imaging (M-NBI). However, few reports on classifying the margin around lesions by M-NBI have been published. The aim of this study was to advocate the usefulness of the demarcation area classification for the diagnosis of EGC. Altogether 197 lesions that could be investigated by M-NBI were included in this study, consisting of 115 EGC and 82 intestinal metaplasias (IM). We hypothesized that the changes in white zone (fusion and erasure signs) and blood vessel (extend and draw sign) were the indications of EGC and we retrospectively investigated this hypothesis. For the investigation of the white zone in the demarcation area, both fusion (P < 0.0001) and erasure signs (P < 0.0001) were observed more often in EGC than in IM, with an accuracy of 80.7%. For the investigation of blood vessel in the demarcation area, both the extend (P < 0.001) and the draw sign (P < 0.0001) were observed more often in EGC than in IM, with an accuracy of 59.9%. Estimations of the white zone and blood vessels in the demarcation area are useful for the diagnosis of EGC.

The application value in diagnosis of chronic atrophic gastritis using the magnifying endoscopy and narrow-band imaging

Objective To explore the application value in diagnosis of chronic atrophic gastritis using the magnifying endoscopy and narrow-band imaging. Methods A total of 98 cases of chronic atrophic gastritis patients was selected, and carried out the ordinary white light endoscopy, magnifying endoscopy and narrow-band imaging(ME-NBI) and pathological examination in file, followed by comparison of the results. Results The sensitivity and specificity of chronic atrophic gastritis by magnifying endoscopy and narrow-band imaging mode were 74.07% and 82.35%, respectively; which were significantly higher than that obtained by conventional endoscopy, which were 48.15% and 64.71% (P<0.05). In magnifying endoscopy and narrow-band imaging endoscopy group, 60 patients were positive, which intestinal metaplasia accounted for 35%, while in conventional endoscopy group, 39 patients were positive which was only 17.95% (P<0.05). Conclusions Magnifying endoscopy and narrow-band imaging can improve the diagnostic accuracy of chronic atrophic gastritis. Key words: Endoscopy/MT; Gastritis, atrophic/DI

Tu1190 Minimum Criteria of Narrow Band Imaging Magnification Endoscopy for the Detection of Superficial Esophageal Squamous Cell Carcinoma: A Randomized Controlled Trial

Tu1190 Minimum Criteria of Narrow Band Imaging Magnification Endoscopy for the Detection of Superficial Esophageal Squamous Cell Carcinoma: A Randomized Controlled Trial

Mo1978 Standard Endoscopy vs Magnifying Narrow-Band Imaging Endoscopy for Prediction of Helicobacter pylori-Infected Stomach

Mo1978 Standard Endoscopy vs Magnifying Narrow-Band Imaging Endoscopy for Prediction of Helicobacter pylori-Infected Stomach

473 Predicting the Invasion Depth of Differentiated Early Gastric Cancer: Comparison of Narrow-Band Imaging Magnification and Endoscopic Ultrasonography

473 Predicting the Invasion Depth of Differentiated Early Gastric Cancer: Comparison of Narrow-Band Imaging Magnification and Endoscopic Ultrasonography

Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G).

Gastric cancer is the third leading cause of cancer death worldwide. Early detection and accurate diagnosis of mucosal cancer is desirable in order to achieve decreased mortality; cause-specific survival of patients with early gastric cancer is reported to exceed 95%. Endoscopy is the functional modality to detect early cancer; however, the procedure is not definitive when using conventional white-light imaging. In contrast, magnifying narrow-band imaging (M-NBI), a novel endoscopic technology, is a powerful tool for characterizing gastric mucosal lesions because it can visualize the microvascular architecture and microsurface structure. To date, many reports on the diagnosis of early gastric cancer by M-NBI, including multicenter prospective randomized studies conducted in Japan, have been published in peer-reviewed international journals. Based on these published data, we devised a proposal for a diagnostic strategy for gastric mucosal cancer using M-NBI to simplify the process of diagnosis and improve accuracy. Herein, we recommend a diagnostic algorithm for early gastric cancer using magnifying endoscopy.

Sa1733 Magnifying Narrow-Band Imaging of Gastric Mucosal Morphology Correlates With H. pylori Related Epigenetic Field Defect

Sa1733 Magnifying Narrow-Band Imaging of Gastric Mucosal Morphology Correlates With H. pylori Related Epigenetic Field Defect

Dual-focus versus conventional magnification endoscopy for the diagnosis of superficial squamous neoplasms in the pharynx and esophagus: a randomized trial.

Conventional magnification narrow-band imaging (CM-NBI) endoscopy has demonstrated high diagnostic accuracy for superficial squamous neoplasms in the pharynx and esophagus. This study aimed to evaluate the diagnostic utility of the newly developed dual-focus NBI (DF-NBI) compared with that of CM-NBI. We recruited patients with squamous cell carcinoma (SCC) in the head and neck, or esophagus, or with a history of SCC. The primary endpoint of this prospective controlled non-inferiority trial was the sensitivity of DF-NBI and CM-NBI for detecting superficial carcinoma in the pharynx and esophagus. Secondary endpoints included other diagnostic values and the resolving power of each endoscope. Superficial carcinoma was defined as high grade dysplasia and SCC invading up to the submucosal layer. The study included 93 patients. A total of 28 superficial carcinomas were detected in the pharynx and esophagus. The sensitivities of DF-NBI and CM-NBI for superficial carcinoma were 82 % and 71 %, respectively. The lower limit of the 90 % confidence interval for the difference between the sensitivities exceeded the non-inferiority threshold. The specificity and overall accuracy of DF-NBI vs. CM-NBI were 93 % vs. 90 % and 91 % vs. 86 %, respectively (both non-significant differences). The maximum resolving power of a conventional magnification endoscope was significantly higher than a dual-focus endoscope (7.2 µm vs. 11.6 µm: P < 0.001). The findings indicate the non-inferiority of DF-NBI versus CM-NBI in detecting superficial carcinoma in the pharynx and esophagus. DF-NBI appears to have a resolving power that, although significantly lower, is sufficient to achieve high diagnostic accuracy, comparable to that of CM-NBI.University Hospital Medical Information Network (UMIN, No. 000007585).

Effectiveness of Magnifying Narrow-Band Imaging Endoscopy for Differential Diagnosis between the High-Risk Mixed-Type and Low-Risk Simple-Type of Low-Grade, Well-Differentiated Gastric Tubular Adenocarcinoma.

Backgrounds. Magnifying endoscopy with narrow-band imaging (NBI-ME) is useful for diagnosing differentiated early gastric cancer (D-EGC). D-EGC is classified as high- or low-grade based on its glandular architectural and cytological atypia. Low-grade, well-differentiated tubular adenocarcinoma (LG-tub1) mixed with high-grade tub1 (HG-tub1) and/or other histological types (M-LG-tub1) may indicate a primitive high-risk malignant lesion compared to histologically simple-type LG-tub1 (S-LG-tub1). Because LG-tub1 is occasionally difficult to diagnose due to its unclear demarcation under conventional white light endoscopy, early precise diagnoses are important. Methods. We compared NBI-ME and postendoscopic submucosal dissection histological findings for 30 S-LG-tub1 and 15 M-LG-tub1 lesions. We classified the NBI-ME findings of S-LG-tub1 (and not D-EGC) into four patterns. The differential diagnosis between M-LG-tub1 and S-LG-tub1 depended on the presence of more than one of these patterns without or with other patterns (referred to as “limited-to-four-pattern [LFP] sign-positive” and “sign-negative”, resp.). Result. The sensitivity, specificity, accuracy, positive and negative predictive values, and intraobserver and interobserver agreement, using the “LFP sign” for the differential diagnosis between M-LG-tub1 and S-LG-tub1, were 87.9%, 91.7%, 88.9%, 96.7%, 73.3%, and k = 0.842 and k = 0.737, respectively. Conclusion. NBI-ME may be useful in differentiating between high-risk M-LG-tub1 and low-risk S-LG-tub1.

Light-NBI to identify high-risk phenotypes for gastric adenocarcinoma: do we still need biopsies?

Objective Early diagnosis of gastric cancer may be achieved through surveillance of patients with extensive gastric intestinal metaplasia (eGIM). However, diagnosis of eGIM generally implies histology. We aimed at determining the accuracy of high-resolution endoscopy with light-narrow band imaging (NBI) to assess the presence of eGIM on a per-patient basis. Material and methods Prospective cohort of 60 patients divided into two groups: derivation cohort (n = 25) to evaluate the reliability and validity, and a real-time validation group (n = 35). In the derivation group, six endoscopists with two levels of expertise were asked to estimate the grade of GIM based in endoscopic images (white light endoscopy, light-NBI and amplification/near focus). In the real-time validation set, experienced endoscopists were asked to similarly record their real-time optical diagnosis. Histology was then considered as the gold standard. Results In the derivation group diagnosis accuracy was 60% with WLE (non-expert 59% vs. 61% experts), increasing to 73% after NBI magnification (non-expert 63% vs. 83% expert, p < 0.05). Moreover, proportion of agreement with histology was 83%, with a correct diagnosis of eGIM in 87% for experienced observers. In the real-time group experts obtained 89% global diagnostic accuracy correctly identifying 91% of the eGIM. The sensitivity, specificity, LR + and LR- of real-time endoscopic diagnosis of eGIM was 0.92 (CI95%:0.67–0.99), 0.96 (0.79–0.99), 21.1 (3.08–144) and 0.09 (0.013–0.57). Conclusion For the first time the reliability of high-resolution endoscopy with light-NBI for extension of GIM is described. Our results suggest that more than 90% of individuals at risk could be identified without the need for biopsies, simplifying the current recommendations.

Image segmentation of pyramid style identifier based on Support Vector Machine for colorectal endoscopic images.

With the increase of colorectal cancer patients in recent years, the needs of quantitative evaluation of colorectal cancer are increased, and the computer-aided diagnosis (CAD) system which supports doctor's diagnosis is essential. In this paper, a hardware design of type identification module in CAD system for colorectal endoscopic images with narrow band imaging (NBI) magnification is proposed for real-time processing of full high definition image (1920 × 1080 pixel). A pyramid style image segmentation with SVMs for multi-size scan windows, which can be implemented on an FPGA with small circuit area and achieve high accuracy, is proposed for actual complex colorectal endoscopic images.

Significance of a white opaque substance under magnifying narrow-band imaging colonoscopy for the diagnosis of colorectal epithelial neoplasms

The aim of this study was to examine the significance of a white opaque substance (WOS) found on magnifying narrow-band imaging (M-NBI) for the diagnosis of colorectal neoplastic lesions. We retrospectively reviewed colonoscopy records from 2006 to 2012 at our institution and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms observed by M-NBI colonoscopy. The colonoscopic and histologic characteristics of the lesions were compared between WOS-positive and WOS-negative lesions. We further classified the WOS as regular or irregular and compared the histologic characteristics between the two types of lesions. There were 105 WOS-positive lesions and 451 WOS-negative lesions. The former were subdivided into lesions with regular and irregular WOS. The incidence of high-grade dysplasia or carcinoma was significantly higher in WOS-positive lesions (61.9%) than in WOS-negative lesions (28.6%) (P < .05). Among the WOS-positive lesions, massive submucosal invasion was more frequent in lesions with irregular WOS (82.4%) than in those with regular WOS (1.4%) (P < .05). Among cancers with massive submucosal invasion, lymph node metastasis was more frequent in cancers with irregular WOS (17.4%) than in those with regular WOS or without the WOS (0%) (P < .05). A WOS in colorectal neoplasms may be an optical marker for high-grade dysplasia and cancer. An irregular WOS may be indicative of massive submucosal invasion and lymph node metastasis.

Tu1722 Does Antibody Producibility Affect the Serum Anti-Helicobacter pylori Immunoglobulin G Antibody Titer?

Tu1722 Does Antibody Producibility Affect the Serum Anti-Helicobacter pylori Immunoglobulin G Antibody Titer? Hyun Ah Chung*, Sun-Young Lee, Jeong Hwan Kim, Hyung Seok Park, Chan Sup Shim, in-Kyung Sung Department of Internal Medicine, Kunkuk University School of Medicine, Seoul, Korea (the Republic of) Background/Aims: Serum antibody titer differs according to the antibody producibility of the host. Hepatitis B vaccination is performed to all Koreans in the infancy or childhood supported by the national insurance, but some do not produce hepatitis B virus surface antibody (HBsAb) after the vaccination. The aim of this study was to elucidate whether the serum anti-H. pylori IgG antibody titer is related to serum HBsAb titer in Korean adults. Methods: Consecutive Korean adults with positive Giemsa staining who underwent serum pepsinogen (PG) assay, anti-H. pylori IgG antibody test, hepatitis B virus surface antigen (HBsAg)/antibody test, and endoscopic biopsy for H. pylori evaluation on the same day were included. Subjects were excluded if they were under 20 years old, showed a positive HBsAg finding, had a recent history of medication, or were in immunocompromised state. Results: Of 158 Korean adults who fulfilled the study inclusion criteria, 107 subjects (67.7%) showed marked H. pylori infiltration based on the Updated Sydney System, whereas 33 (20.9%) and 18 (11.4%) showed moderate and mild infiltration. The serum anti-H. pylori IgG antibody titer was significantly correlated with the amount of H. pylori infiltration on gastric biopsy (p!0.001), PG II concentration (pZ0.012), and PG ratio (p!0.001), but not to the serum HBsAb titer (pZ0.649) and PG I concentration (pZ0.115). The serum HBsAb titer in the subjects with marked H. pylori infiltration on the gastric biopsy was not different from those of the subjects with moderate and mild H. pylori infiltration (pZ0.505). Conclusions: The serum anti-H. pylori IgG antibody titer is significantly linked to the bacterial load of the stomach regardless of the antibody producibility of the host. The serum anti-H. pylori IgG antibody test can be used for estimating the burden of bacteria in immunocompetent host with H. pylori infection. Tu1723 Difference of Micoromucosal Patterns of the Gastric Corpus Mucosa BetweenHelicobacter pylori-Associated and Autoimmune Gastritis Patient Noriya Uedo*, Ervin Toth, Ryu Ishihara, Tomofumi Akasaka, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Artur Nemeth, Gabriele W. Johansson, Henrik Thorlacius, Hiroyasu Iishi Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Endoscopy, Skane University Hospital, Malmo, Sweden; Surgery, Skane University Hospital, Malmo, Sweden Background: Helicobacter pylori (H. pylori)-associated gastritis and autoimmune gastritis are two major entities of chronic atrophic gastritis. However, characteristic of micromucosal pattern observed by magnifying endoscopy of these diseases has not been fully investigated. Aim of this study is to compare magnifying endoscopic appearance between H. pylori-associated and autoimmune gastritis. Methods: Six H. pylori naive, 14 H. pylori-associated gastritis and 7 autoimmune gastritis patients were enrolled in this study. A videoendoscope, EVIS GIFFQ260Z, that can be used in high-resolution white light, autofluorescence (AFI) and magnifying narrow band imaging (M-NBI) modes was used to evaluate mucosal features. Extent of mucosal atrophy in the corpus was determined as extent of greenish areas in AFI. A 2 2 cm area at the lesser curvature of the corpus about 4 cm proximal to the angulus was set as the region of interest for evaluation of micromucosal patterns. The micromucosal patterns were classified into Foveola and Groove type according to magnifying chromoendoscopic and M-NBI findings. The Foveola type mucosa was characterized as mucosa with round, oval, or short linear foveolae (gastric pits) on magnifying chromoendoscopy. On M-NBI, it had network of dark brown subepithelial capillary that surround light brown epithelium. The Groove type mucosa was characterized by mucosal crests or papillae that were divided by continuous grooves on magnifying chromoendoscopy, and had light brown epithelium that encase dark brown subepithelial capillary. Proportion of the micromucosal patterns were categorized as, Foveola O80%; Foveola 50-80%; Groove 50-80%; and Groove O80%. Biopsy sample was taken from the region of interest to evaluate histological grade of gastritis. Results: All H. pylori naive patients had purple corpus mucosa and the micromucosal pattern was Foveola type. 10 of 14 (71%) patients with H. pylori-associated gastritis showed medium to large greenish atrophic mucosa at the lesser curvature of the corpus, and 13 of 14 (93%) had various proportion of groove type mucosa. All autoimmune gastritis patients had large area of greenish mucosa in the entire corpus but most (O80%) of micromucosal pattern was Foveola type. The biopsy specimen in H. pylori-associated gastritis patients had higher grade of intestinal metaplasia than that in autoimmune gastritis patients. Conclusion: Micromucosal pattern of the gastric corpus mucosa in H. pylori associated-gastritis patients was unlike to that of autoimmune gastritis patients suggesting different pathogenesis of these diseases AB572 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015 Summary of endoscopic appearances

Sa1591 The Diagnostic Ability of Micro Vascular Pattern Observed by Endocytoscopy

Sa1591 The Diagnostic Ability of Micro Vascular Pattern Observed by Endocytoscopy

Sa1652 Clinical Usefulness of Narrow Band Imaging Magnification for Ulcerative Colitis Associated Cancer/Dysplasia

Sa1652 Clinical Usefulness of Narrow Band Imaging Magnification for Ulcerative Colitis Associated Cancer/Dysplasia

Ten-millimeter advanced transverse colon cancer accompanied by a sessile serrated adenoma and/or polyp

A woman in her fifties underwent total colonoscopy that showed a 10-mm protruding lesion with a depressed area in the mid-transverse colon (A). The protruding area of the lesion was whitish in color, whereas the depressed area was reddish. Magnifying narrow-band imaging showed thick and branched vessels and expanded crypt openings in the whitish protruding area and irregular disrupted microvessels without surface structure in the reddish depressed area (B, C). The lesion in the transverse colon was predicted to be an invasive cancer accompanied with sessile serrated adenoma and/or polyp (SSA/P) because the magnifying narrow-band imaging pattern of the reddish depressed area was classified as type 3 on the narrow-band imaging classification system (NBI International Colorectal Endoscopic [NICE] Classification), and the pattern of the whitish protruding area was compatible with SSA/P. The patient underwent local transverse colon resection with lymph node dissection. Pathology examination of the resected specimen showed a moderately differentiated adenocarcinoma invading the subserosa, accompanied by SSA/P (D, H&E, orig. mag. x 7.5). Studies have indicated that SSA/Ps can undergo rapid malignant transformation and cause interval cancers. Findings in our patient showed a small and superficial morphology but deep invasion to the subserosa, suggesting such rapid malignant transformation.