2018-4-13+推荐阅读-早期胃癌的NBI诊断

Diagnosis of Gastric Cancer by Magnifying Endoscopy with NarrowBand Imaging: Impact and Clinical Feasibility of Narrow-Band Imaging for Accomplishing Endoscopic Pathology
Strategy for Diagnosing Gastric Cancer by Magnifying Endoscopy with NBI
The strategy for magnifying endoscopic diagnosis of gastrointestinal cancers is organ specific (Fig. 5). Because the esophagus lined with squamous epithelia does not show any FMS, magnifying endoscopic diagnosis for squamous esophageal cancer solely depends on the findings of microvessels called the intrapapillary capillary loop (IPCL), which is very specific for squamous epithelium. In contrast, magnifying endoscopic diagnosis for colon cancer can be achieved on the findings of FMS, the so-called pit patterns. For magnifying endoscopic diagnosis of gastric cancer, we have to fully utilize the findings of FMS as well as microvessels to overcome the diagnostic difficulties. Therefore, NBI is essential for magnifying endoscopic diagnosis of gastric cancer.
Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8641, Japan
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178 M. Kaise
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Fig. 1. Normal mucosal images obtained by magnifying endoscopy with narrow-band imaging (NBI). a On the mucosal surface of the gastric fundic gland are microvessels surrounding the gland pits, which show a honeycomb pattern. b On the mucosal surface of the gastric pyloric gland, microvessels are included in papillary or tubular pits. c On the mucosal surface of glands of the intermediate zone, microvessels surround the tubular type pit and stripe pit
Mitsuru Kaise
Summary. Although early and precise endoscopic diagnosis of gastric cancer is crucial for reducing its high mortality rates, the diagnosis is difficult because of the broad and heterogeneous appearances of neoplastic mucosa and inflamed gastric mucosa. Narrow-band imaging yields very clear endoscopic images of fine mucosal structures (FMS) and microvessels and has advanced magnifying endoscopic diagnosis into a new stage, endoscopic pathology. Significant microvascular findings related to superficial depressed gastric cancer (0IIc) are dilation, abrupt caliber alteration, and heterogeneity in shape and tortuousness, and those of FMS are complete or partial disappearance. The histopathology of gastric cancer is predictable according to microvascular patterns; fine network pattern and corkscrew pattern correspond to well- and poorly differentiated adenocarcinomas, respectively. Although we have to fully utilize these endoscopic findings for accomplishing endoscopic pathology, the relative importance of the two microstructures differs according to the macroscopic appearance of gastric cancers. In superficial elevated gastric cancer (0IIa), FMS findings such as heterogeneity in shape have greater meaning than microvascular findings because of the frequent absense of irregular microvessels. In superficial flat gastric cancer (0IIb), irregular microvessels enclosed in a villous or papillary microstructure named intrastructural irregular vessel (ISIV) is specific, and the relative importance of FMS is lower.
NBI in Diagnosis of Gastric Cancer 1ions of gastric microstructures by atrophy, chronic inflammation, and metaplasia. a Helicobacter pylori-infected pyloric mucosa lined with a small round, tubular, or gyrus-like pattern of fine mucosal structure, which is different from normal pyloric mucosa (b). b Atrophic gastric mucosa: fine mucosal structures disappear and stretched microvessels appear
The development of magnifying video-endoscopy combined with narrow-band imaging (NBI) has changed this situation and opened a new era. NBI yields very clear
Although magnifying endoscopic diagnosis for gastric disorders including gastric cancer has been attempted in past decades [1], the diagnostic approach did not
180 M. Kaise
Fine mucosal structure
Microvessel
Fig. 4. A representative image of early gastric cancer obtained by magnifying endoscopy with NBI. NBI yields very clear images of fine mucosal structure (FMS) as well as microvessels of the gastric mucosa, which has advanced magnifying endoscopic diagnosis into a new stage, endoscopic pathology
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Fig. 3. Histopathological classification of gastric cancer. Gastric cancer shows a broad spectrum of histopathology, which is one of the reasons gastric microstructural findings are complicated. a Well-differentiated tubular adenocarcinoma; b moderately differentiated adenocarcinoma; c poorly differentiated adenocarcinoma