Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan.
Gastric Cancer. 2012 Apr;15(2):170-8. doi: 10.1007/s10120-011-0093-6. Epub 2012 Mar 13.
In biopsy specimens with low grade adenomas, it is often difficult to identify the presence of high grade adenomas or early carcinomas and low grade adenomas preoperatively, and clear guidelines have not yet been defined for the applicability of endoscopic treatment to low grade adenomas identified in biopsy specimens.
We aimed to clarify the usefulness of magnifying endoscopy with narrow band imaging (NBI) compared to conventional white light endoscopy for diagnosing actual high grade adenomas or early carcinomas with low grade adenomas, using the VS (microvascular pattern [V] and microsurface pattern [S]) classification for low grade adenomas in biopsy specimens. The study cohort consisted of 135 patients who were diagnosed with low grade adenomas in preoperative biopsy specimens and received endoscopic submucosal dissection.
In the elevated type of lesion, magnifying endoscopy with NBI diagnosed high grade adenomas or early carcinomas at a higher sensitivity and specificity than conventional white light endoscopy (82.4 vs. 70.6%, P = 0.391, 97.3 vs. 54.7%, P < 0.0001). In the depressed macroscopic type of lesion, magnifying endoscopy with NBI also diagnosed high grade adenomas or early carcinomas at a higher sensitivity (95.5 vs. 68.2%, P = 0.0459) than conventional white light endoscopy. Although the specificity was high, at 100%, the difference when compared to conventional white light endoscopy was not significant (100 vs. 100%, P > 0.99).
For low grade adenomas in biopsy specimens, it is vital to take sufficient consideration of endoscopic findings and not take action based only on the biopsy results. If a decision is made using the VS classification with magnifying endoscopy with NBI, actual high grade adenomas or early carcinomas can be differentiated from low grade adenomas so that endoscopic treatment can be performed more strictly.
在低级别腺瘤的活检标本中，术前往往难以识别高级别腺瘤或早期癌和低级别腺瘤的存在，并且对于活检标本中发现的低级别腺瘤，内镜治疗的适用性尚未明确界定明确的指南。
我们旨在通过使用 VS（微血管模式[V]和微表面模式[S]）分类来阐明在活检标本中诊断实际高级别腺瘤或早期癌与低级别腺瘤相比，窄带成像（NBI）放大内镜对低级别腺瘤的诊断价值。研究队列包括 135 名在术前活检标本中被诊断为低级别腺瘤并接受内镜黏膜下剥离术的患者。
在隆起型病变中，与常规白光内镜相比，NBI 放大内镜对高级别腺瘤或早期癌的诊断具有更高的敏感性和特异性（82.4%对 70.6%，P=0.391，97.3%对 54.7%，P<0.0001）。在凹陷型宏观类型病变中，NBI 放大内镜对高级别腺瘤或早期癌的诊断也具有更高的敏感性（95.5%对 68.2%，P=0.0459）比常规白光内镜。虽然特异性很高，为 100%，但与常规白光内镜相比，差异不显著（100%对 100%，P>0.99）。
对于活检标本中的低级别腺瘤，必须充分考虑内镜检查结果，不要仅根据活检结果采取行动。如果使用 NBI 放大内镜的 VS 分类做出决定，可以将实际的高级别腺瘤或早期癌与低级别腺瘤区分开来，以便更严格地进行内镜治疗。
