Horiuchi Hiroshi, Kaise Mitsuru, Inomata Hiroko, Yoshida Yukinaga, Kato Masayuki, Toyoizumi Hirobumi, Goda Kenichi, Arakawa Hiroshi, Ikegami Masahiro, Kushima Ryoji, Tajiri Hisao
Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
Scand J Gastroenterol. 2013 May;48(5):626-32. doi: 10.3109/00365521.2013.773460. Epub 2013 Mar 4.
Although focal cancer occasionally coexists with gastric hyperplastic polyps, previous studies have reported that white light endoscopy (WLE) and biopsy sampling cannot effectively predict the coexistence of cancer. The aim of this study was to elucidate efficacious predictors for cancer coexistence.
This retrospective single academic center study analyzed consecutive patients with gastric polyps diagnosed as hyperplastic before endoscopic resection. Using an image catalog of WLE and magnifying endoscopy combined with narrow band imaging (ME-NBI) performed as part of the preresection work-up, three endoscopists independently assessed the coexistence of cancer and the presence of predefined ME-NBI findings in the microvasculature (MV) and fine mucosal structure (FMS).
Twelve of 64 gastric polyps (19%) resected from 51 patients enrolled in the study showed the coexistence of neoplasia. Polyps with coexisting neoplasia were significantly larger than those without (22.6 ± 10.1 vs. 15.5 ± 7.7 mm, respectively). Multivariate analysis of factors significantly associated with the coexistence of neoplasia identified lesion size and three specific endoscopic findings, that is, WLE diagnosis of cancer coexistence, ME-NBI findings of abnormal MV and micrification (size reduction) of the FMS. Combining lesion size (≥20 mm) and ME-NBI findings of FMS micrification had a diagnostic accuracy of 100% sensitivity and 58% specificity for coexisting neoplasia. However, combinations of WLE diagnosis and any other criteria could not achieve a diagnostic sensitivity of 100%.
ME-NBI enhances the prediction of cancer coexistence in gastric hyperplastic polyps, with lesion size (≥20 mm) and FMS micrification the most effective predictive findings.
尽管局灶性癌症偶尔会与胃增生性息肉同时存在，但既往研究报道，白光内镜检查（WLE）及活检采样无法有效预测癌症的并存情况。本研究旨在阐明癌症并存的有效预测指标。
本项回顾性单学术中心研究分析了在内镜切除术前被诊断为增生性胃息肉的连续患者。利用作为切除术前检查一部分所进行的WLE及结合窄带成像的放大内镜检查（ME-NBI）的图像目录，三名内镜医师独立评估癌症的并存情况以及微血管（MV）和精细黏膜结构（FMS）中预设的ME-NBI表现的存在情况。
纳入研究的51例患者切除的64枚胃息肉中，有12枚（19%）显示存在肿瘤并存情况。存在肿瘤并存的息肉明显大于不存在的息肉（分别为22.6±10.1mm和15.5±7.7mm）。对与肿瘤并存显著相关的因素进行多因素分析，确定了病变大小和三种特定的内镜表现，即WLE诊断癌症并存、ME-NBI显示MV异常以及FMS微细化（尺寸缩小）。结合病变大小（≥20mm）和FMS微细化的ME-NBI表现，对肿瘤并存的诊断准确性为100%的敏感性和58%的特异性。然而，WLE诊断与任何其他标准的组合均无法达到100%的诊断敏感性。
ME-NBI提高了胃增生性息肉中癌症并存情况的预测能力，病变大小（≥20mm）和FMS微细化是最有效的预测表现。
