Elsevier

Gastrointestinal Endoscopy

Volume 68, Issue 3, September 2008, Pages 574-580
Gastrointestinal Endoscopy

Case study
White opaque substance within superficial elevated gastric neoplasia as visualized by magnification endoscopy with narrow-band imaging: a new optical sign for differentiating between adenoma and carcinoma

https://doi.org/10.1016/j.gie.2008.04.011Get rights and content

Background

The microvascular pattern (MVP) as visualized by magnification endoscopy (ME) is a reliable marker for differentiating between benign and malignant gastric flat lesions. However, in cases of gastric neoplasia of 0-IIa type, it is sometimes impossible to visualize the MVP because a white opaque substance (WOS) obscures the subepithelial MVP.

Objective

To investigate whether the morphology of the WOS could be a useful optical sign for discriminating between adenoma and carcinoma.

Setting

Single tertiary referral center.

Materials

Forty-six gastric neoplasias of only 0-IIa type (18 adenomas and 28 early carcinomas) were evaluated.

Intervention

The prevalence and the morphology of the WOS as visualized by ME with narrow-band imaging (NBI) according to histologic type (adenoma vs carcinoma).

Main Outcome Measurements

The WOS is more frequently present in adenomas than in carcinomas. With regard to the morphology of the WOS, 100% of the examples of WOS within adenomas demonstrated a regular distribution; in contrast, 83% of the examples of WOS within carcinomas showed an irregular distribution.

Results

In cases in which a neoplasia of 0-IIa type showed either WOS with a regular distribution or a regular MVP, the sensitivity and specificity for discriminating adenoma from carcinoma were 94% and 96%, respectively.

Limitations

The number of cases was limited. The WOS has not yet been characterized by chemical analysis.

Conclusion

In cases in which the WOS is observed, rather than assessing the MVP, morphologic analysis of the WOS could be an alternative new optical sign for discriminating adenoma from carcinoma when using ME with NBI.

Section snippets

Patients and methods

Forty-six consecutive gastric neoplasias of 0-IIa type from 42 patients, which could be investigated by ME with NBI between April 2006 and October 2007 in Fukuoka University Chikushi Hospital, were included in this study. Preparation of the patient for ME was the same as for standard endoscopy. Briefly, 30 minutes prior to the endoscopic procedure, all the patients were asked to drink a mixture consisting of 100 mL of water with 10,000 units of pronase (Kaken Pharmaceutical Co. Ltd., Tokyo,

Results

By high-resolution nonmagnifying endoscopy with WLI alone, WOS could not be visualized in any of the lesions. WOS could be detected by ME with both WLI and NBI. Nevertheless, when using ME with NBI, the visualization of the WOS is much clearer, and the analysis of its morphology is much easier than when using ME with WLI. Therefore, the morphology was determined by using ME with NBI. WOS is more frequently present in adenomas than in carcinomas (78% vs 43%, respectively; P < .05, Table 1).

Discussion

We were the first to report the MV architecture as visualized by ME, which is characteristic for early gastric cancer,7 and we have demonstrated that ME based on the MVP is clinically useful for differentiating between gastric cancerous and noncancerous lesions by retrospective10 and prospective studies.11 According to our results, when we investigated gastric lesions of the superficial flat (0-IIb) type or superficial depressed (0-IIc) type by ME, an irregular MV pattern as visualized by ME

Acknowledgements

The English is this manuscript was revised by Miss K. Miller (Royal English Language Centre, Fukuoka, Japan).

References (24)

  • K. Yao et al.

    Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy

    Dig Endosc

    (2001)
  • The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002

    Gastrointest Endosc

    (2003)
  • Presented at the 15th United European Gastroenterology Week, October 29, 2007, Paris, France (Gut 2007;56:A16).

    View full text