Accuracy of biopsy for the preoperative diagnosis of superficial nonampullary duodenal adenocarcinoma

Kinoshita, Satoshi; Nishizawa, Toshihiro; Ochiai, Yasutoshi; Uraoka, Toshio; Akimoto, Teppei; Fujimoto, Ai; Maehata, Tadateru; Goto, Osamu; Kanai, Takanori; Yahagi, Naohisa

doi:10.1016/j.gie.2016.12.007

Cited by 88 publications

(98 citation statements)

References 10 publications

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“…In fact, 3 out of 8 our gastric type tumors were accompanied by adenocarcinoma, while there were only 3 lesions accompanied by adenocarcinoma among the other 47 NADETs. Because the accuracy of duodenal biopsy is not satisfactory for a preoperative diagnosis of cancer in NADETs, and since the procedure for endoscopic removal possibly becomes difficult due to unexpected fibrosis after forceps biopsy [8, 9], ME-CV may be helpful for therapeutic decision-making in NADETs. This is especially the case for lesions with pinecone pattern, because they are presumably gastric type tumors having high malignancy potential, which are candidates for endoscopic removal without biopsy.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathological Features and Magnifying Chromoendoscopic Findings of Non-Ampullary Duodenal Epithelial Tumors

et al. 2018

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Background and Aims: We aimed to investigate an association between clinicopathological features, including immunohistochemical mucin phenotypes, and magnifying chromoendoscopic findings with crystal violet staining (ME-CV) in non-ampullary duodenal epithelial tumors (NADETs). Methods: A total of 55 patients with NADET were divided into 3 groups by mucin phenotype: intestinal, gastrointestinal, or gastric. ME-CV findings were classified into 4 patterns: convoluted, leaf-like, reticular/sulciolar, and pinecone. The clinicopathological features and ME-CV findings were compared among the mucin phenotypes. Results: Tumors of the gastric type were located in the duodenal bulb (p < 0.001), and contained pyloric gland adenoma (p < 0.001) more frequently than the other types. White-light endoscopy indicated that milk-white mucosa was less frequent in tumors of the gastric type than in those of the gastrointestinal type (p = 0.006) and the intestinal type (p < 0.001). ME-CV findings were significantly different between the gastric type and the other type (p = 0.028). Totally, 5 of 8 tumors of the gastric type manifested a pinecone pattern, 4 of which were compatible with pyloric gland adenoma. Conclusions: The endoscopic findings of NADETs differ according to mucin phenotype. A pinecone pattern under ME-CV may be characteristic of NADETs of the gastric type, especially pyloric gland adenoma.

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Section: Discussionmentioning

confidence: 99%

“…In addition, tissue sampling from NADETs through endoscopic forceps biopsy induces fibrosis, which results in difficulty on subsequent endoscopic treatment [8, 9]. Recently, the usefulness of magnifying endoscopy (ME) for the preoperative diagnosis of NADETs has been reported [10-12].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological Features and Magnifying Chromoendoscopic Findings of Non-Ampullary Duodenal Epithelial Tumors

et al. 2018

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“…The sensitivity of biopsy was reported to be 83.6% [17]. The discrepancies are likely to reflect the heterogeneity of these tumors, as the tumors are thought to follow the adenoma-carcinoma sequence in the duodenum, colon, and rectum [18]. Our group previously assessed the sensitivity of preoperative diagnoses based on biopsy in ulcerative colitis [16].…”

Section: Preoperative Diagnoses In Ulcerative Colitismentioning

confidence: 99%

Endoscopic Submucosal Dissection in Patients with Ulcerative Colitis

et al. 2018

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Patients with ulcerative colitis have an increased risk of developing colorectal cancer. This risk has been estimated to reach about 7% at 20 years of disease, 7–14% at 25 years, and as high as 30% after 35 years. The guidelines for the management of inflammatory bowel disease recommend endoscopic resection of circumscribed dysplasia and ongoing colonoscopic surveillance as a reasonable strategy in patients with ulcerative colitis. Submucosal fibrosis due to background inflammation could hamper adequate lifting and endoscopic treatment. Endoscopic mucosal resection (EMR) is difficult for dysplasia within colitic mucosa due to the non-lifting sign. Although endoscopic submucosal dissection (ESD) generally has higher risks of perforation and bleeding compared to EMR, the technique can achieve complete en bloc resection regardless of the lesion size or severity of submucosal fibrosis. Several studies have shown that ESD for circumscribed dysplasia in ulcerative colitis is feasible. While ESD can avert unnecessary surgery, submucosal fibrosis makes the intervention technically demanding in cases of ulcerative colitis. ESD should be performed by expert endoscopists using the most suitable equipment and devices available.

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“…However, making an accurate diagnosis by endoscopic biopsy is not always easy. Recently, we reported an accuracy of only 71.6% for the diagnosis of SNADET . We can usually only obtain a tiny specimen by endoscopic biopsy and, therefore, misdiagnosis may be caused by sampling error.…”

Section: Introductionmentioning

confidence: 99%

How I do it: Endoscopic diagnosis for superficial non‐ampullary duodenal epithelial tumors

Nakayama

Kato

Takatori

et al. 2019

Digestive Endoscopy

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There are no reports on detailed endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors (SNADET) except for relatively small case series. Herein, we conducted a prospective observational study to investigate the relationship between endoscopic findings and histopathological diagnosis of SNADET. A total of 163 SNADET diagnosed using magnified endoscopic examination with image‐enhanced endoscopy (IEE‐ME) were prospectively registered in this study. We investigated location, size, macroscopic type, color, and IEE‐ME findings including surface structure (closed‐ or open‐loop) and presence of white opaque substance (WOS) in SNADET. We analyzed association between these findings and histopathological diagnosis of SNADET based on the Vienna classification (VCL) using logistic regression analysis. In univariate analysis, lesion size, superficial structure, and WOS deposition showed statistical significance, and the oral side of the lesion location showed statistical tendency for association with VCL C4/5. In multivariate analysis, lesion size (odds ratio [OR], 2.92; 95% CI, 1.94–4.39; P < 0.05) and negative WOS (OR, 5.59; 95% CI, 1.72–18.1; P < 0.05) were significantly associated with VCL C4/5 lesions. Superficial structures with a closed‐loop pattern on the surface showed statistical tendency for predicting VCL C4/5 lesions (OR, 2.15; 95% CI, 0.86–5.37; P = 0.10). Based on these findings, we concluded that negative WOS by IEE‐ME and lesion size were independent predictors of VCL C4/5 SNADET. These factors may help us to understand of pathophysiology of SNADET and to select appropriate therapeutic strategies.

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Accuracy of biopsy for the preoperative diagnosis of superficial nonampullary duodenal adenocarcinoma

Cited by 88 publications

References 10 publications

Clinicopathological Features and Magnifying Chromoendoscopic Findings of Non-Ampullary Duodenal Epithelial Tumors

Clinicopathological Features and Magnifying Chromoendoscopic Findings of Non-Ampullary Duodenal Epithelial Tumors

Endoscopic Submucosal Dissection in Patients with Ulcerative Colitis

How I do it: Endoscopic diagnosis for superficial non‐ampullary duodenal epithelial tumors

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