Kumagai Youichi, Yamamoto Eisuke, Higashi Morihiro, Ishiguro Toru, Hatano Satoshi, Toyomasu Yoshitaka, Amano Kunihiko, Suzuki Okihide, Ishibashi Kei-Ichiro, Mochiki Erito, Tamaru Jun-Ichi, Ishida Hideyuki
Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
Department of Pathology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Sci Rep. 2020 Nov 5;10(1):19221. doi: 10.1038/s41598-020-76309-6.
Duodenal cancer is a leading cause of death after colectomy in patients with familial adenomatous polyposis (FAP). Detailed endoscopic evaluation of duodenal lesions with potential for carcinoma development is therefore mandatory. Here we investigated the features of duodenal lesions in FAP patients using an endocytoscopy system (ECS). We retrospectively reviewed duodenal lesions in 15 cases of FAP using an ECS (GIF-H290EC) with methylene blue (MB) as the vital dye. With reference to the Spigelman classification, we investigated the number of lesions using white light (WL), narrow-band imaging (NBI), and MB staining. Using the maximum magnification power of the ECS we investigated the histology (duct openings or finger-like projections) and grade of dysplasia (presence or absence of enlarged oval-shaped nuclei) of the lesions. The number of duodenal lesions increased in ascending order of WL, NBI, and MB (P < 0.05). Among 51 MB-unstained lesions, 46 (90.2%) were proven to be duodenal neoplasms histologically. Duct openings were seen in 90.2% of tubular adenomas and tubulovillous adenomas. Finger-like projections were seen in 33.3% of tubular adenomas and in 88.2% of tubulovillous adenomas. Enlarged oval-shaped nuclei were observed in 100% of duodenal cancers, 33.3% of high-grade adenomas, and 9.4% of low-grade adenomas. MB staining allows more accurate detection of duodenal neoplasms in comparison to conventional WL and NBI observation. In cases of FAP, use of the maximum magnification power of the ECS may allow selection of lesions with high malignant potential.
十二指肠癌是家族性腺瘤性息肉病（FAP）患者结肠切除术后的主要死亡原因。因此，对具有癌变可能的十二指肠病变进行详细的内镜评估是必不可少的。在此，我们使用内镜检查系统（ECS）研究了FAP患者十二指肠病变的特征。我们回顾性分析了15例FAP患者使用带有亚甲蓝（MB）作为活体染料的ECS（GIF-H290EC）检查的十二指肠病变情况。参照Spigelman分类法，我们使用白光（WL）、窄带成像（NBI）和MB染色来研究病变数量。利用ECS的最大放大倍数，我们研究了病变的组织学特征（导管开口或指状突起）和发育异常程度（是否存在椭圆形核增大）。十二指肠病变数量按WL、NBI和MB的顺序递增（P < 0.05）。在51处未被MB染色的病变中，46处（90.2%）经组织学证实为十二指肠肿瘤。90.2%的管状腺瘤和tubulovillous腺瘤可见导管开口。33.3%的管状腺瘤和88.2%的tubulovillous腺瘤可见指状突起。在100%的十二指肠癌、33.3%的高级别腺瘤和9.4%的低级别腺瘤中观察到椭圆形核增大。与传统的WL和NBI观察相比，MB染色能更准确地检测十二指肠肿瘤。在FAP病例中，使用ECS的最大放大倍数可能有助于选择具有高恶性潜能的病变。
