Surface pattern classification by enhanced-magnification endoscopy for identifying early gastric cancers

  • Kyosuke Tanaka
    Correspondence
    Reprint requests: Kyosuke Tanaka, MD, Department of Endoscopic Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507 Japan.
    Affiliations
    Current affiliations: Departments of Endoscopic Medicine (K.T., H.T., I.I.), Gastroenterology and Hepatology (S.K., Y.H., R.K., S.M., Y.T.), and Pathology (T.S.), Mie University School of Medicine, Tsu, Japan
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  • Hideki Toyoda
    Affiliations
    Current affiliations: Departments of Endoscopic Medicine (K.T., H.T., I.I.), Gastroenterology and Hepatology (S.K., Y.H., R.K., S.M., Y.T.), and Pathology (T.S.), Mie University School of Medicine, Tsu, Japan
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  • Shigenori Kadowaki
    Affiliations
    Current affiliations: Departments of Endoscopic Medicine (K.T., H.T., I.I.), Gastroenterology and Hepatology (S.K., Y.H., R.K., S.M., Y.T.), and Pathology (T.S.), Mie University School of Medicine, Tsu, Japan
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  • Yasuhiko Hamada
    Affiliations
    Current affiliations: Departments of Endoscopic Medicine (K.T., H.T., I.I.), Gastroenterology and Hepatology (S.K., Y.H., R.K., S.M., Y.T.), and Pathology (T.S.), Mie University School of Medicine, Tsu, Japan
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  • Ryo Kosaka
    Affiliations
    Current affiliations: Departments of Endoscopic Medicine (K.T., H.T., I.I.), Gastroenterology and Hepatology (S.K., Y.H., R.K., S.M., Y.T.), and Pathology (T.S.), Mie University School of Medicine, Tsu, Japan
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  • Shinpei Matsuzaki
    Affiliations
    Current affiliations: Departments of Endoscopic Medicine (K.T., H.T., I.I.), Gastroenterology and Hepatology (S.K., Y.H., R.K., S.M., Y.T.), and Pathology (T.S.), Mie University School of Medicine, Tsu, Japan
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  • Taizo Shiraishi
    Affiliations
    Current affiliations: Departments of Endoscopic Medicine (K.T., H.T., I.I.), Gastroenterology and Hepatology (S.K., Y.H., R.K., S.M., Y.T.), and Pathology (T.S.), Mie University School of Medicine, Tsu, Japan
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  • Ichiro Imoto
    Affiliations
    Current affiliations: Departments of Endoscopic Medicine (K.T., H.T., I.I.), Gastroenterology and Hepatology (S.K., Y.H., R.K., S.M., Y.T.), and Pathology (T.S.), Mie University School of Medicine, Tsu, Japan
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  • Yoshiyuki Takei
    Affiliations
    Current affiliations: Departments of Endoscopic Medicine (K.T., H.T., I.I.), Gastroenterology and Hepatology (S.K., Y.H., R.K., S.M., Y.T.), and Pathology (T.S.), Mie University School of Medicine, Tsu, Japan
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      Background

      The correlation between fine surface patterns of gastric mucosal lesions and early gastric cancer is not sufficiently clear.

      Objective

      To evaluate the efficacy of surface pattern classification by enhanced-magnification endoscopy (EME) for identifying early gastric cancers.

      Design

      Observational study.

      Setting

      All procedures were performed at Mie University Hospital.

      Patients

      A total of 380 consecutive patients who underwent EGD by using magnification endoscopy. Among these subjects were found 250 newly detected lesions suspected of being gastric cancer.

      Methods

      Conventional magnification endoscopy (CME), magnification chromoendoscopy (MCE), and EME were performed, and surface patterns of lesions were classified into 5 types: type I, small round pits of uniform size and shape; type II, slit-like pits; type III, gyrus and villous patterns; type IV, irregular arrangement and size; and type V, destructive pattern. Biopsy specimens were obtained from all lesions.

      Main Outcome Measurements

      Correlation between surface pattern classification by EME and histopathologic findings of early gastric cancer.

      Results

      Surface patterns were evident by CME/MCE in only 66.4% (166/250) of lesions but in 100% (250/250) of lesions by EME. Classification by EME was as follows: type I, 52 lesions; type II, 12; type III, 146; type IV, 32; and type V, 8. By histopathologic examination, 16 early gastric cancers were detected between type IV or V lesions. Thus, classification of types IV-V strongly correlated with the presence of gastric cancer (sensitivity 100%, specificity 89.7%).

      Limitations

      Single-center study.

      Conclusions

      Surface pattern classification by EME may be useful for identifying early gastric cancers.

      Abbreviations:

      CME (conventional magnification endoscopy), EME (enhanced-magnification endoscopy), MCE (magnification chromoendoscopy), ME (magnification endoscopy), NBI (narrow-band imaging), PA (proportion of agreement)
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