Yao Kenshi, Iwashita Akinori, Tanabe Hiroshi, Nagahama Takashi, Matsui Toshiyuki, Ueki Toshiharu, Sou Suketo, Kikuchi Yosuke, Yorioka Makoto
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Zokumyoin, Chikushino-city, Fukuoka, Japan.
Clin Gastroenterol Hepatol. 2007 Jul;5(7):869-78. doi: 10.1016/j.cgh.2007.02.034. Epub 2007 Jun 4.
BACKGROUND & AIMS: During gastroscopy we frequently encounter flat reddened lesions in the stomach. Making a correct diagnosis of flat small early gastric cancer is dependent not on endoscopic diagnosis, but on histopathologic diagnosis of biopsy specimens alone. We investigated the diagnostic accuracy of magnified endoscopic findings for differentiating between reddened mucosa caused by gastritis and flat reddened gastric cancer, prospectively and blindly.
A total of 603 consecutive patients were examined by upper-gastrointestinal zoom endoscopy and the prevalence of each of the following magnified endoscopic findings, which already had been reported as characteristic for differentiated carcinoma, was recorded: (1) presence of a demarcation line between the reddened lesion and the surrounding mucosa, (2) disappearance of the regular subepithelial capillary network pattern, and (3) presence of an irregular microvascular pattern within the flat reddened lesion. Patients with known gastric carcinomas were excluded from this study.
A total of 158 flat reddened lesions from 158 patients were detected. Pathologically, 144 flat reddened lesions showed only gastritis, whereas 14 lesions were newly diagnosed as carcinoma. Regarding diagnostic accuracy for carcinoma, the negative predictive values of the presence of a demarcation line and disappearance of the regular subepithelial capillary network pattern were 100% and 100%, respectively, and the diagnostic accuracy of the irregular microvascular pattern was 98.7%.
The novel zoom endoscopic findings based on microvascular architecture are very useful for making a differential diagnosis between flat early gastric carcinoma and gastritis.
在胃镜检查过程中，我们经常会在胃内遇到扁平的发红病变。正确诊断扁平型早期胃癌并非依赖于内镜诊断，而仅取决于活检标本的组织病理学诊断。我们前瞻性地、盲法地研究了放大内镜检查结果对鉴别胃炎引起的发红黏膜与扁平型发红胃癌的诊断准确性。
对603例连续患者进行了上消化道变焦内镜检查，并记录了以下已报道的分化型癌特征性放大内镜检查结果的发生率：（1）发红病变与周围黏膜之间存在分界线；（2）规则的上皮下毛细血管网模式消失；（3）扁平发红病变内存在不规则微血管模式。已知患有胃癌的患者被排除在本研究之外。
共检测到158例患者的158处扁平发红病变。病理检查显示，144处扁平发红病变仅为胃炎，而14处病变新诊断为癌。关于癌的诊断准确性，分界线的存在和规则的上皮下毛细血管网模式消失的阴性预测值分别为100%和100%，不规则微血管模式的诊断准确性为98.7%。
基于微血管结构的新型变焦内镜检查结果对于鉴别扁平型早期胃癌和胃炎非常有用。
