Kikuchi Hirotoshi, Kamiya Kinji, Hiramatsu Yoshihiro, Miyazaki Shinichiro, Yamamoto Masayoshi, Ohta Manabu, Baba Satoshi, Konno Hiroyuki
Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan,
Ann Surg Oncol. 2014 Nov;21(12):3954-62. doi: 10.1245/s10434-014-3781-8. Epub 2014 May 24.
Staging laparoscopy (SL) is often used to diagnose peritoneal metastasis in patients with advanced gastric cancer, but accurate detection of metastasis can be difficult. We evaluated the usefulness of laparoscopic narrow-band imaging (NBI) versus conventional laparoscopic white-light imaging (WLI) for the diagnosis of peritoneal metastasis.
We excised 37 white nodules from the parietal peritoneum of 26 patients with gastric cancer and suspected peritoneal metastasis. The WLI and NBI findings were compared with the pathological findings. All the peritoneal lesions examined were observed as white nodules on WLI. Intranodular vessels were evaluated by WLI and NBI for (1) vessel dilatation, (2) vessel tortuousness, (3) vessel heterogeneity, and (4) brown spots.
Each individual abnormal finding had a diagnostic accuracy of less than 79 % with or without NBI. Detection of any one abnormal finding had a sensitivity, specificity, and accuracy of 47.8, 85.7, and 62.2 %, respectively, on WLI and 91.3, 71.4, and 83.8 %, respectively, on NBI, for detection of peritoneal metastasis. Detection of any one abnormal finding on NBI plus clear demarcation of the nodule on WLI had a sensitivity of 91.3 %, specificity of 92.9 %, and accuracy of 91.9 % for detection of peritoneal metastasis. Pathological examination showed that a brown spot detected on NBI correlated with dilated vessels around cancer cells. Vascular endothelial growth factor was expressed in 76.2 % of peritoneal metastases.
NBI was more sensitive for the detection of dilated vessels than WLI. NBI could be a useful tool for the diagnosis of peritoneal metastasis during SL.
分期腹腔镜检查（SL）常用于诊断进展期胃癌患者的腹膜转移，但准确检测转移可能具有挑战性。我们评估了腹腔镜窄带成像（NBI）与传统腹腔镜白光成像（WLI）在诊断腹膜转移方面的有效性。
我们从26例患有胃癌且怀疑有腹膜转移的患者的壁腹膜上切除了37个白色结节。将WLI和NBI的检查结果与病理结果进行比较。所有检查的腹膜病变在WLI上均表现为白色结节。通过WLI和NBI评估结节内血管的（1）血管扩张、（2）血管迂曲、（3）血管异质性和（4）褐色斑点。
无论有无NBI，每项单独的异常表现诊断准确率均低于79%。对于腹膜转移的检测，在WLI上检测到任何一项异常表现的敏感性、特异性和准确率分别为47.8%、85.7%和62.2%，在NBI上分别为91.3%、71.4%和83.8%。在NBI上检测到任何一项异常表现并结合WLI上结节的清晰边界，对于腹膜转移检测的敏感性为91.3%，特异性为92.9%，准确率为91.9%。病理检查显示，NBI上检测到的褐色斑点与癌细胞周围扩张的血管相关。76.2%的腹膜转移灶中表达血管内皮生长因子。
NBI在检测扩张血管方面比WLI更敏感。NBI可能是SL期间诊断腹膜转移的有用工具。
