Narrow-band Imaging System Research Articles

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.

Recent Knowledge of the Relationship Between Helicobacter pylori and Gastric Cancer and Recent Progress of Gastroendoscopic Diagnosis and Treatment for Gastric Cancer

Gastric cancer is a multi-step process and multi-factorial disease. However, Helicobacter pylori plays the most important role in gastric carcinogenesis because most gastric cancers including both intestinal type and diffuse type arise from mucosa infected by H. pylori. The relationship between H. pylori infection and gastric cancer has been proved in epidemiological studies, animal experiments with Mongolian gerbils, and clinical prospective studies. Significant preventive effect of H. pylori eradication was reported in Japanese randomized study for secondary gastric cancer after endoscopic resection of primary gastric cancer and meta-analysis of randomized studies. The Japanese Society for Helicobacter Research has published a guideline recommending that H. pylori infection should be treated by eradication therapy to suppress the incidence of gastric cancer. The development of endoscopic technology has advanced the diagnosis and treatment of gastric cancer. In the diagnosis of gastric cancer, image enhancement endoscopy including magnifying observation with narrow-band imaging system and microscopic magnifying observation opens the possibility of optical biopsy. Endoscopic resection for early stage of gastric cancer has been established as proper treatment of early gastric cancer. Recently endoscopic submucosal dissection had made en bloc resection possible for mucosal cancers >2 cm in diameter. Because of endoscopic submucosal dissection, endoscopic resection is indicated in a greater number of cases. Although the use of endoscopic treatment for gastric cancer has been increasing steadily, long-term outcome data is necessary.

Narrow-band imaging with magnifying endoscopy for the screening of esophageal cancer in patients with primary head and neck cancers

Although narrow-band imaging (NBI) in endoscopy can improve detection of early-stage esophageal malignancies in patients with head and neck cancers, false-positive results may be obtained in areas with nonspecific inflammatory changes. This study evaluated the feasibility of primary screening with NBI and magnification for the presence of esophageal malignancies in these cancer patients. Sixty-nine patients with documented head and neck cancers were enrolled from April 2008 to January 2009. All patients underwent a meticulous endoscopic examination of the esophagus using a conventional white-light system followed by re-examination using the NBI system and final confirmation with NBI plus magnification. Twenty-one patients (30.4 %) were confirmed to have esophageal neoplasia. Among these 21, 16 (76.2 %) had synchronous lesions, 9 (42.9 %) were asymptomatic, and 10 (47.6 %) had early-stage neoplasia. The incidence of multiple esophageal neoplasia was 57.1 %. NBI was more effective than conventional endoscopy in detecting neoplastic lesions (35 lesions in 21 patients vs. 22 lesions in 18 patients) and was particularly effective in patients with dysplasia (13 lesions in 9 patients vs. 3 lesions in 3 patients). The sensitivity and accuracy of detection were 62.9 % and 64.4 % for conventional endoscopy, 100 % and 86.7 % for NBI alone, and 100 % and 95.6 % for NBI with high magnification, respectively. Compared with current approaches, NBI followed by high magnification significantly increases the accuracy of detection of esophageal neoplasia in patients with head and neck cancers. The result warrants conducting prospective randomized controlled study to confirm its efficacy.

Digital Colposcopy for the Diagnosis of Cervical Adenocarcinoma Using a Narrow Band Imaging System

Although the colposcopic features of cervical glandular disease and cervical adenocarcinoma are not widely well known, unique microvascular patterns are reportedly useful for identifying such diseases. The narrow band imaging (NBI) system used in endoscopy can be used to obtain high-contrast vascular images. Therefore, we examined the utility of NBI colposcopy and compared the results with those of conventional colposcopy. Twenty-one patients with adenocarcinoma in situ or early invasive adenocarcinomas were examined using digital NBI colposcopy, and the photo records were compared with those of conventional colposcopy. The histological examination and immunohistochemistry with anti-CD31 antibody confirmed the microvascular pattern. Digital NBI colposcopy depicted the fine vascular texture on the surface of the cervix more clearly than conventional colposcopy. The vascular pattern was depicted in 86% (18/21) of glandular disease cases. The characteristic fine vascular patterns were critical for identifying cervical glandular diseases. Digital NBI colposcopy was useful for identifying early cervical adenocarcinoma as well as adenocarcinoma in situ. This system yields cervical glandular disease-related colposcopic findings that may be useful for both clinical and educational purposes.

Utility of narrow band imaging for identification of the orifice of the bile duct during ERCP

Exact identification of the orifice of the bile duct in the major duodenal papilla is required for selective cannulation during endoscopic retrograde cholangiopancreatography (ERCP). However, there are some cases in which the orifice is unclear. The narrow band imaging (NBI) system is an endoscopic imaging technique based on modification of spectral features that enhances visualization of the vascular network. On NBI, bile appears as a bright red fluid, and it is enhanced in the digestive tract. We report two cases in which the NBI was useful for identification of the orifice of the bile duct during ERCP. We recommend the NBI technique before cannulation in cases where the orifice is unclear on the standard image.

Detection of bladder cancer using narrow-band imaging induced endoscopy (report of 28 cases)

Objective To evaluate the value of photodynamic diagnosis for early detection of bladder cancer using narrow band imaging fluorescence cystoscopy. Methods A total of 28 cases of painless hematuria underwent narrow band imaging(NBI) endoscopy and biopsy. The procedure was as follows: biopsies were taken from lesions that were either fluorescing or nonfluorescing using endoscopy by NBI system) and then TUR was performed on them. Results Of the 28 cases, 79 biopsies were taken. Histopathologic examination showed that 32 of them were of urothelial cell carcinoma. Compared with white light cystoscopy, NBI had a sensitivity of 100% (32/32) ,flat small fluorescence positive lesions were found in peritumoral or other regions, which could not be detected by white light cystoscopy. Conclusion Photodynamic diagnosis using NBI fluorescence cystoscopy is useful for detection of early bladder cancer. Key words: Bladder neoplasms; Cystoscopy; Photodynamic diagnosis; Biopsy

Narrowband Imaging for Early Detection of Malignant Tumors and Radiation Effect After Treatment of Head and Neck Cancer

To determine the value of narrowband imaging (NBI) screening for the early detection of head and neck squamous cell carcinoma (HNSCC) in patients who have received treatment and to assess the impact of radiotherapy on detection rates. Cross-sectional study. Tertiary referral center. From July 1, 2007, through February 28, 2008, a total of 206 patients with HNSCC underwent rhinolarynx videoendoscopic screening performed using conventional white-light and NBI systems during their routine postoperative sessions. The rate of detecting malignant tumors, depending on the anatomical site and stage of cancer and the history of radiotherapy after primary treatment. We identified 68 lesions by endoscopy in conventional white-light and/or NBI mode. Of these, 62 were histopathologically confirmed to be cancerous. The rates of detecting cancerous lesions by white-light and NBI modes were 100% and 97% for oral lesions, 69% and 100% for oropharyngeal lesions (P = .02), and 39% and 100% for hypopharyngeal lesions (P = .001), respectively. No difference was found between the 2 modes with regard to the detection of visible T1 to T4 tumors. However, NBI mode was significantly better than white-light mode for the detection of carcinoma in situ (P < .001). We found that NBI-assisted endoscopy is highly useful for the detection of precancerous lesions in the oropharyngeal and hypopharyngeal mucosa and is not affected by a history of radiotherapy in patients with HNSCC.

Narrow band imaging cholangioscopy in hilar cholangiocarcinoma

Per oral cholangioscopy has been developed as a diagnostic modality for evaluation of bile duct lesions. Per oral cholangioscope with narrow band imaging (NBI) system can provide good quality images of bile duct lesions. There is limited data on per oral cholangioscopy using NBI in biliary tract diseases. We report our experience of NBI cholangioscopy in hilar strictures.

Detecting early oral cancer: narrowband imaging system observation of the oral mucosa microvasculature

The aim of this study was to analyze and describe the intrapapillary capillary loops (IPCL), which are a feature of early oral neoplastic lesions, using a narrowband imaging (NBI) system. Forty-one patients (26 men, 15 women; mean age, 52.34 years; range, 23-83 years) presenting with non-neoplastic or neoplastic lesions, and normal cases, were examined using the prototype Evis Lucera Spectrum (Olympus Co.). The images were analyzed and an IPCL classification was devised. All normal cases (n=10) had regularly distributed capillary loops of the same shape (type I). Non-neoplastic lesions (n=8) had mild changes of the capillary loops (types II and III) and neoplastic lesions (n=23) were irregularly distributed and had several loop shapes (types III and IV). The microvascular organization of non-neoplastic lesions was notably different from that of neoplastic lesions. A brownish area was found in five cases of early carcinoma. The narrowband imaging system is a potential approach for clinically analyzing microvascular organization and IPCL. It could be useful for diagnosing oral squamous cell carcinoma at an earlier stage and for determining the margin of resection.

Magnifying endoscopic observation of mantle cell lymphoma in the stomach using the narrow-band imaging system

Multiple lymphomatous polyposis (MLP) is characterized by multiple polypoid tumors affecting several segments of the gastrointestinal tract due to involvement in Hodgkin’s or non-Hodgkin’s lymphoma [1] [2] [3]. The histologic picture of MLP is in most cases consistent with mantle cell lymphoma, but some patients with mucosa-associated lymphoid tissue lymphoma and follicular lymphoma presenting with MLP have recently been reported [4]. This is the first report of magnifying endoscopic observation of MLP using narrow-band imaging (NBI).

A case of early gastric cancer successfully diagnosed by magnifying endoscopy with narrow band imaging system

A case of early gastric cancer successfully diagnosed by magnifying endoscopy with narrow band imaging system

Diagnosis of Laryngopharyngeal Carcinoma Using Bronchoscopy

We used video-bronchoscopy for the purpose of laryngopharyngeal observation. The Narrow Band Imaging (NBI) system on the video-bronchoscope was useful for the differential diagnosis of benign and malignant micro-lesions and for estimating the range of intraepithelial cancer lesions. It was easy to manipulate the bronchoscope for otorhinolaryngologists since it could be inserted transnasally. After the observation, a biopsy was performed immediately through the channel. Proper diagnoses were obtained in most of cases.

Peritoneal Vascular Density Assessment Using Narrow-Band Imaging and Vascular Analysis Software, and Cytokine Analysis in Women With and Without Endometriosis

The development and onset of endometriosis is associated with angiogenesis and angiogenic factors including cytokines. We analyzed intrapelvic conditions in women with endometriosis via vascular density assessment of grossly normal peritoneum and determination of cytokine levels in peritoneal fluid. Seventy-three patients underwent laparoscopic surgery because of gynecologic disease including endometriosis in our department using a narrow-band imaging system. Each patient was analyzed for peritoneal vascular density using commercially available vascular analysis software (SolemioENDO ProStudy; Olympus Corp, Tokyo, Japan). Each patient was also subjected to analysis of interleukin 6 (IL-6), IL-8, tumor necrosis factor-α, and vascular endothelial growth factor concentrations in peritoneal fluid. We defined 4 groups as follows: group 1, endometriosis: gonadotropin-releasing hormone (GnRH) agonist administration group (n = 27); group 2, endometriosis: GnRH agonist nonadministration group (n = 15); group 3, no endometriosis: GnRH agonist administration group (n = 18); and group 4, no endometriosis: GnRH agonist nonadministration group (n = 13). No significant differences in peritoneal vascular density between the 4 groups were found under conventional light; however, under narrow-band light, vascular density in the endometriosis groups (groups 1 and 2) was significantly higher. Cytokine analysis of the 4 groups determined that IL-6 and IL-8 concentrations were significantly higher compared with the no endometriosis groups (groups 3 and 4). Tumor necrosis factor-α and vascular endothelial growth factor concentrations were not significantly different between groups. In endometriosis, peritoneal vascular density was significantly higher as assessed using the narrow-band imaging system and SolemioENDO ProStudy, whereas GnRH agonist did not obviously decrease vascular density but IL-6 concentration was lower in the GnRH agonist administration group.

Diagnostic Value of Image-Enhanced Video Cholangiopancreatoscopy

We summarized past and present results concerning the observation capability of cholangiopancratoscopy using chromoendoscopy, autofluorescence imaging (AFI), and narrow-band imaging (NBI). New generation peroral and percutaneous transhepatic video cholangiopancreatoscopes provide superior quality images. Pilot studies suggest that chromoendocholangioscopy using methylene blue or cholangioscopy using AFI can distinguish benign from malignant bile duct lesions. On the other hand, the NBI system enhances the imaging of certain features such as mucosal structures and microvessels in pancreatobiliary lesions. In patients with main-duct-type intraductal papillary mucinous neoplasm, peroral pancreatoscopy can be used to determine extent of tumor involvement. Although many technical hurdles still need to be overcome, image-enhanced cholangiopancratoscopy appears to be a promising modality to improve diagnostic accuracy of pancreatobiliary diseases, particularly in distinguishing benign from malignant lesions.

Gastrointestinal: Gastric mucosa‐associated lymphoma presented with unique vascular features on magnified endoscopy combined with narrow‐band imaging

Gastric lymphoma arising from mucosal associated lymphoid tissue (MALT) has distinct clinical and histological characteristics compared with nodal B-cell lymphoma. Magnified endoscopy (ME) combined with narrow band imaging (NBI) is widely used and the usefulness is well recognized for the diagnosis of gastritis and gastric cancer. However, there has been no report on ME combined with NBI for gastric MALT lymphoma, despite the necessity of differentiating it from gastric cancer. We report a case ofgastricMALTlymphomainwhichMEcombinedwithNBIcould detectuniquevascularfeaturesdifferentfromthoseseenincircumscribed atrophic gastritis or poorly differentiated adenocarcinoma. A 66-year-old woman underwent endoscopic screening of the upper gastrointestinal tract revealed ill-defined, brownish, superficial depressed lesion in the anterior wall of the upper gastric body (Fig. 1). ME combined with NBI system, consisting of an image processor (CV-260SL, Olympus Medical Systems, Tokyo, Japan), a light source (CLV-260SL), and a zoom endoscope (GIF-Q240Z) showed the disappearance of the surface structure and the appearance of abnormal blood vessels.Abnormal vessels were defined as new vessels that were not seen in the adjacent mucosa. They were large vessels like a tree trunk with long, bare branches that can be called as ‘tree like appearance’ (Fig. 2). Biopsy was taken from this abnormal portion and revealed hyperplasia of atypical centrocyte-like cells with small to medium-sized, ovoid nuclei and clear cytoplasm in the lamina propria mucosae and their infiltration among glandular epithelial cells, suggesting lymphoepithelial lesion. The atypical lymphocytes were immunohistochemically CD20+ ,C D10-, and CD5-. These findings were consistent with gastric MALT lymphoma. In this case report, we have shown that the tree-like appearance of the abnormal blood vessels, clearly observed by ME with NBI, could be one of the unique features suggestive of gastric MALT lymphoma. This finding could be helpful because superficial depressed type lesion potentially include circumscribed atrophic gastritis and poorly differentiated adenocarcinoma. Of note, these vascular findings are relatively easy to detect by using NBI, because NBI can present clearly defined vascular image. Therefore, our data also suggest the importance of NBI for the endoscopic evaluation of gastric MALTlymphoma.The combination of ME with NBI may also reduce the number of biopsy of gastric MALT lymphoma because it can provide precise information about the distribution of MALT lymphoma in the stomach.

Vascular Density of Peritoneal Endometriosis Using Narrow-Band Imaging System and Vascular Analysis Software

A pilot study was designed to analyze the vascular density of peritoneal endometriosis in 3 groups of lesions (red, black, and white) in 23 patients with peritoneal endometriosis who underwent laparoscopic surgery using the narrow-band imaging system and vascular analysis software. In the peritoneum, 21 red lesions were present in 10 patients, 12 black lesions were present in 9 patients, 12 white lesions were present in 8 patients, and 2 types of lesion were concomitantly present in 4 patients. Median vascular density of red, black, and white lesions under conventional light was 60.3%, 62.3%, and 60.6%, respectively, and under narrow-band light was 64.4%, 61.5%, and 62.0%, respectively, showing no significant differences among the lesions under either conventional or narrow-band light (p = .71 and p = .84, respectively). The median difference in vascular density under narrow-band and conventional light was not significantly different in black lesions (0.8%) or white lesions (1.0%); however, a difference of 4.5% was noted for red lesions (p <.001). We conclude that red lesions are indicative of early-stage endometriosis with angiogenesis. Use of the narrow-band system and vascular analysis software can enable accurate, objective, and reproducible evaluation of vascular density.

Combination of magnifying endoscopy and narrow band imaging in diagnosis of early gastric cancer

Objective To evaluate the use of magnifying endoscopy combined with narrow band imaging （NBI） system in diagnosis of early gastric cancer. Methods From March 2008 to December in 2008, a total of 56 patients with suspected gastric mucosal lesions were enrolled in the study. The lesions were observed with magnifying endoscopy combined with NBI and indigo-earmine-chromoendoscopy, and the results were compared with pathologic diagnosis from targeted biopsies. Results Out of 56 patients, 16 were diagnosed as early gastric cancer pathologically. The accordance rate with the pathological diagnosis, sensibility, specificity, false positive rate and false negative rate of the magnifying endoscopy combined with NBI system were 94. 6% （53/56）, 93.8% （ 15/16）, 95.0% （38/40）, 5.0% （2/40） and 6. 3% （ 1/16）, respectively; while those of chromoendoscopy were 91.1% （51/56） , 87. 5% （14/16）, 92. 5% （37/40） , 7.5% （3/40） and 12. 5% （2/16）, respectively （P 〉 0. 05）. There was no difference between NBI and chromoendoscopy in regarding of observing pit pattern, however, NBI was superior in displaying intrapapillary capillary loop. Conclusion Combination of magnifying endoscopy and NBI provides clear images of gastric mucosa and intrapapillary capillary, which is useful in diagnosis of early gastric cancer and can improve accuracy of biopsy. When combined with chromoendoscopy, it can further improve the yield of diagnosis. Key words: Narrow band imaging; Magnifying endoscopy; Early gastric cancer

Narrow-Band Imaging Provides Reliable Screening for Esophageal Malignancy in Patients With Head and Neck Cancers

The narrow-band imaging (NBI) system is a novel technology that enhances the visualization of microvasculature and mucosal patterns. The aim of this study was to assess the reliability of the NBI system for esophageal cancer screening in patients with head and neck cancers. A total of 142 patients with head and neck squamous cell carcinoma (SCC) were examined by NBI endoscopy, followed by Lugol chromoendoscopy between April 2006 and June 2008 at the Okayama University Hospital, Okayama, Japan. Detection of SCC and high-grade intraepithelial neoplasia (HGIN) was conducted. The median age of the patients was 64 years (range: 29-86 years), and approximately three-fourths of all the patients were male. In total, 21 superficial lesions in 16 patients were detected by NBI endoscopy. Of these, 4 lesions were diagnosed histologically as SCC and 11 lesions as HGIN. An additional 22 Lugol-voiding lesions >or=5 mm were detected in 19 patients by Lugol chromoendoscopy. Although 1 of these lesions was diagnosed as HGIN, 21 lesions were diagnosed as low-grade intraepithelial neoplasia or lesions without atypical findings. The sensitivity of NBI endoscopy for detecting esophageal SCC and HGIN was 90.9% (95% confidence interval (CI), 58.7-99.8), specificity was 95.4% (95% CI, 90.3-98.3), and accuracy was 95.1% (95% CI, 90.1-98.0). NBI seems to be useful and reliable for screening for esophageal SCC in patients with head and neck cancers.

Comparative study of conventional colonoscopy, magnifying chromoendoscopy, and magnifying narrow-band imaging systems in the differential diagnosis of small colonic polyps between trainee and experienced endoscopist

Removal of colorectal neoplastic polyps can reduce the incidence of colorectal cancers. It is important to distinguish neoplastic from nonneoplastic polyps. We compared the ability of a trainee and an experienced endoscopist in distinguishing between neoplastic polyps and nonneoplastic polyps by conventional white-light, magnifying narrow-band imaging (NBI), and magnifying chromoendoscopy. One hundred and sixty-three small colorectal polyps from 104 patients were studied. All polyps were diagnosed by trainees and experienced endoscopists using conventional white-light, magnifying NBI, and magnifying chromoendoscopy. The kappa values of interobserver agreement between trainees and experienced endoscopists were evaluated before this study. Sensitivity, specificity, and diagnostic accuracy were assessed by reference to histopathology. The first 50 polyps were diagnosed by the trainee as the first stage and the rest 113 polyps were diagnosed as the second stage. Magnifying NBI and magnifying chromoendoscopy were significant better than conventional white-light by the experienced endoscopist (diagnostic accuracy: NBI 85.3%, chromoendoscopy 87.7%, conventional view 74.8%). No significant differences were found for the trainee. The kappa values (0.77 approximately 0.85) were good for each endoscopic modality for the experienced endoscopist. However, only NBI and chromoendoscopy had acceptable kappa values (0.40 approximately 0.48) for the trainee. The trainee improved diagnostic accuracy in the second stage, but not yielded the level of the experienced endoscopist. Magnifying NBI and magnifying chromoendoscopy had a better interobserver agreement than conventional white-light among trainees and experienced endoscopists. The trainee needs learning time to improve diagnostic ability, even using a new modality such as magnifying NBI.

Diagnosis of colorectal lesions with the magnifying narrow-band imaging system

Narrow-band imaging (NBI) emphasizes the surface microvasculature of the GI tract and may help in detecting small neoplasms. The aim of this study was to clarify the value of the NBI system in tissue characterization and differential diagnosis. A prospective study. Digestive Disease Center of Showa University Northern Yokohama Hospital. The subjects were 495 patients who, from January 2006 to June 2007, underwent a complete colonoscopic examination. A total of 617 lesions were evaluated in the 495 patients (33 hyperplastic polyps, 532 adenomas, 52 submucosally invasive [T1] cancers). Most hyperplastic polyps showed a faint pattern. The vascular patterns of adenomas were mainly the network pattern or the dense pattern. The major vascular patterns of cancers were the irregular pattern and the sparse pattern. The irregular pattern was characteristic for protruded or flat-elevated cancers, whereas the sparse pattern was unique for depressed cancers. When we assumed that the faint pattern was diagnostic for hyperplastic polyps, we could differentiate between neoplastic and non-neoplastic lesions with a sensitivity of 90.9% and a specificity of 97.1%. Likewise, irregular and sparse patterns were assumed to be indices of massively invasive submucosal cancer, the sensitivity was 100%, the specificity was 95.8%, and the accuracy rate was 96.1%. This study was performed at a single center. The NBI system was valuable for distinguishing between neoplastic and non-neoplastic lesions, as well as between cancers and adenomas. Vascular pattern analysis can also be a promising tool for determining treatment selection, either endoscopy or surgery.