Matsumoto Kohei, Ueyama Hiroya, Yao Takashi, Abe Daiki, Oki Shotaro, Suzuki Nobuyuki, Ikeda Atsushi, Yatagai Noboru, Akazawa Yoichi, Komori Hiroyuki, Takeda Tsutomu, Matsumoto Kenshi, Hojo Mariko, Nagahara Akihito
Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan.
Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan.
Endosc Int Open. 2020 Oct;8(10):E1233-E1242. doi: 10.1055/a-1220-6389. Epub 2020 Sep 21.
Magnifying endoscopy with narrow band imaging (M-NBI) has made a huge contribution to endoscopic diagnosis of early gastric cancer (EGC). However, we sometimes encountered false-negative cases with M-NBI diagnosis (i. e., M-NBI diagnostic limitation lesion: M-NBI-DLL). However, clinicopathological features of M-NBI-DLLs have not been well elucidated. We aimed to clarify the clinicopathological features and histological reasons of M-NBI-DLLs. In this single-center retrospective study, M-NBI-DLLs were extracted from 456 EGCs resected endoscopically at our hospital. We defined histological types of M-NBI-DLLs and analyzed clinicopathologically to clarify histological reasons of M-NBI-DLLs. Of 456 EGCs, 48 lesions (10.5 %) of M-NBI-DLLs were enrolled. M-NBI-DLLs was classified into four histological types as follows: gastric adenocarcinoma of fundic-gland type (GA-FG, n = 25), gastric adenocarcinoma of fundic-gland mucosal type (GA-FGM, n = 1), differentiated adenocarcinoma (n = 14), and undifferentiated adenocarcinoma (n = 8). Thirty-nine lesions of M-NBI-DLLs were -negative gastric cancers (39/47, 82.9 %). Histological reasons for M-NBI-DLLs were as follows: 1) completely covered with non-neoplastic mucosa (25/25 GA-FG, 8/8 undifferentiated adenocarcinoma); 2) well-differentiated adenocarcinoma with low-grade atypia (1/1 GA-FGM, 14/14 differentiated adenocarcinoma); 3) similarity of surface structure (10/14 differentiated adenocarcinoma); and 4) partially covered and/or mixed with a non-neoplastic mucosa (1/1 GA-FGM, 6/14 differentiated adenocarcinoma). Diagnostic limitations of M-NBI depend on four distinct histological characteristics. For accurate diagnosis of M-NBI-DLLs, it may be necessary to fully understand endoscopic features of these lesions using white light imaging and M-NBI based on these histological characteristics and to take a precise biopsy.
窄带成像放大内镜（M-NBI）对早期胃癌（EGC）的内镜诊断做出了巨大贡献。然而，我们有时会遇到M-NBI诊断的假阴性病例（即M-NBI诊断局限性病变：M-NBI-DLL）。然而，M-NBI-DLLs的临床病理特征尚未得到充分阐明。我们旨在阐明M-NBI-DLLs的临床病理特征和组织学原因。在这项单中心回顾性研究中，从我院内镜切除的456例EGC中提取M-NBI-DLLs。我们定义了M-NBI-DLLs的组织学类型，并进行临床病理分析以阐明M-NBI-DLLs的组织学原因。在456例EGC中，纳入了48个M-NBI-DLLs病变（10.5%）。M-NBI-DLLs分为以下四种组织学类型：胃底腺型胃癌（GA-FG，n = 25）、胃底腺黏膜型胃癌（GA-FGM，n = 1）、分化型腺癌（n = 14）和未分化型腺癌（n = 8）。47个M-NBI-DLLs病变中有39个为阴性胃癌（39/47，82.9%）。M-NBI-DLLs的组织学原因如下：1）完全被非肿瘤性黏膜覆盖（25/25 GA-FG，8/8未分化型腺癌）；2）低级别异型性的高分化腺癌（1/1 GA-FGM，14/14分化型腺癌）；3）表面结构相似（10/14分化型腺癌）；4）部分被非肿瘤性黏膜覆盖和/或与非肿瘤性黏膜混合（1/1 GA-FGM，6/14分化型腺癌）。M-NBI的诊断局限性取决于四种不同的组织学特征。为准确诊断M-NBI-DLLs，可能有必要基于这些组织学特征，使用白光成像和M-NBI充分了解这些病变的内镜特征，并进行精确活检。
