Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.
Dig Endosc. 2011 Apr;23(2):146-52. doi: 10.1111/j.1443-1661.2010.01070.x. Epub 2010 Dec 13.
Presently, the differential diagnosis of gastric adenoma and well-differentiated adenocarcinoma by endoscopy is very difficult. We carried out magnifying endoscopy with narrow band imaging (NBI) in lesions that required discrimination between gastric adenoma and well-differentiated adenocarcinoma, and prospectively evaluated whether the tumor typing that we propose is useful for their differential diagnosis.
The materials were 93 lesions that required differential diagnosis between gastric adenoma and well-differentiated adenocarcinoma among the gastric epithelial tumors for which endoscopic treatment was planned at three facilities during the 14 months between November 2008 and December 2009. According to the typing method proposed by our facility based on images of the mucosal ultrastructure and microvessels obtained by magnified endoscopy combined with NBI, type I-II and type III-V lesions were diagnosed as gastric adenoma and well-differentiated adenocarcinoma, respectively, before endoscopic treatment, and the accuracy of the diagnoses were prospectively examined by comparing them with the postoperative pathological findings.
Of the 93 lesions, 87 could be typed into the five types of our typing method, but six lesions could not be classified. The 87 lesions consisted of 16 type I, 12 type II, 29 type III, 27 type IV, and three type V lesions. The percentages of accurate preoperative diagnoses of types I-II as adenoma and types III-V as well-differentiated adenocarcinoma were 79% and 93%, respectively.
The tumor typing based on NBI was useful for the endoscopic differentiation of gastric adenoma and well-differentiated adenocarcinoma.
目前，通过内镜对胃腺瘤和高分化腺癌进行鉴别诊断非常困难。我们对需要鉴别胃腺瘤和高分化腺癌的病变进行了窄带成像（NBI）放大内镜检查，并前瞻性评估了我们提出的肿瘤分型对其鉴别诊断是否有用。
本研究的材料为 93 例病变，这些病变均为 2008 年 11 月至 2009 年 12 月期间在三个医疗机构中计划通过内镜治疗的胃上皮肿瘤中的胃腺瘤和高分化腺癌需要进行鉴别诊断的病变。根据我们基于放大内镜结合 NBI 获得的黏膜超微结构和微血管图像提出的分型方法，在进行内镜治疗前将 I-II 型和 III-V 型病变分别诊断为胃腺瘤和高分化腺癌，并通过与术后病理结果比较前瞻性地检查这些诊断的准确性。
93 例病变中，87 例可根据我们的分型方法分为 5 种类型，但有 6 例病变无法分类。87 例病变包括 16 例 I 型、12 例 II 型、29 例 III 型、27 例 IV 型和 3 例 V 型病变。I-II 型术前诊断为腺瘤的准确率为 79%，III-V 型术前诊断为高分化腺癌的准确率为 93%。
基于 NBI 的肿瘤分型有助于内镜鉴别胃腺瘤和高分化腺癌。
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