基于黏蛋白表型的醋酸喷洒放大窄带成像在非壶腹性十二指肠黏膜上皮肿瘤中的应用

Magnifying Narrow-Band Imaging with Acetic Acid Spray for Superficial Non-Ampullary Duodenal Epithelial Tumors Based on the Mucin Phenotype.

机构信息

Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan.

Department of Pathology, Kyoto Katsura Hospital, Kyoto, Japan.

出版信息

Digestion. 2022;103(6):421-427. doi: 10.1159/000526236. Epub 2022 Oct 20.

DOI:10.1159/000526236

PMID:36265448

Abstract

INTRODUCTION

This study aimed to identify the characteristics of superficial non-ampullary duodenal epithelial tumors (SNADETs) based on the mucin phenotype using magnifying narrow-band imaging with acetic acid spray (MA-NBI) and evaluate the efficacy of MA-NBI in differentiating gastric-type (G-type) from intestinal-type (I-type) lesions.

METHODS

We retrospectively identified 59 resected SNADETs in 59 patients who underwent MA-NBI. We evaluated surface patterns using MA-NBI to differentiate G-type from I-type lesions. Surface structures were classified into three patterns: tubular, villous, or oval structures. Lesions displaying a single pattern among the three patterns were classified as monotype, whereas those displaying multiple surface patterns were classified as mixed type. In addition, lesions with disorganized and unclear structures with irregular margins were classified as irregular surface structures.

RESULTS

In total, 32 (54%), 26 (44%), and 1 (2%) lesions were classified as Vienna category 3, 4, and 5 tumors, respectively, whereas 49 (83%) and 10 (17%) were classified as I- and G-type lesions, respectively. Oval structures were more frequently observed in G-type lesions (70%), whereas tubular structures were more frequently observed in I-type lesions (78%) (p < 0.001). Category 4 and 5 lesions had significantly higher mixed and irregular surface structure rates than category 3 lesions (41 vs. 6%, p = 0.003 and 81 vs. 3%, p < 0.001, respectively).

CONCLUSION

MA-NBI can distinguish the mucin phenotypes of SNADETs and may facilitate histological grade diagnosis.

摘要

简介

本研究旨在通过醋酸喷洒放大窄带成像（MA-NBI），根据黏蛋白表型识别浅表非壶腹十二指肠上皮肿瘤（SNADETs）的特征，并评估 MA-NBI 在鉴别胃型（G 型）与肠型（I 型）病变中的作用。

方法

我们回顾性分析了 59 例接受 MA-NBI 检查的 SNADET 患者的 59 例手术切除标本。我们使用 MA-NBI 评估表面模式，以区分 G 型与 I 型病变。表面结构分为管状、绒毛状或椭圆形结构。三种模式中仅有一种模式的病变被归类为单型，而具有多种表面模式的病变被归类为混合型。此外，结构紊乱、边界不规则的不规则表面结构的病变也被归类为不规则表面结构。

结果

共有 32 例（54%）、26 例（44%）和 1 例（2%）病变分别归类为维也纳分类 3、4 和 5 类肿瘤，而 49 例（83%）和 10 例（17%）分别归类为 I 型和 G 型病变。G 型病变中更常出现椭圆形结构（70%），而 I 型病变中更常出现管状结构（78%）（p<0.001）。第 4 类和第 5 类病变的混合型和不规则表面结构的比例显著高于第 3 类病变（41%比 6%，p=0.003；81%比 3%，p<0.001）。