Detection and characterization of early gastric cancer for curative endoscopic submucosal dissection

Abstract

Because endoscopic submucosal dissection (ESD) of gastric cancer can only be curative if the cancer is detected at an early stage and a precise preoperative diagnosis is made, we reviewed the detection and characterization of early gastric cancer (EGC) using both conventional endoscopy with white-light imaging (C-WLI) and image-enhanced endoscopy (chromoendoscopy [CE] and magnifying narrow-band imaging [M-NBI]). Systematic screening of the stomach by C-WLI after ideal preparation of the patient is important for detecting a mucosal lesion, which can then be characterized using CE. However, a limitation of C-WLI with CE is the diagnosis of flat or small gastric cancers. To overcome this, M-NBI together with a comprehensive diagnostic system, termed the 'vessel plus surface classification' system, was developed and has proven very useful. Preoperative assessment for ESD involves determining: (i) histological type; (ii) size; (iii) depth of invasion; (iv) presence or absence of associated ulceration; and (v) horizontal extent of the cancer. A limitation of endoscopic diagnosis using M-NBI is the histologically undifferentiated type of carcinoma, in which case the biopsy specimen is used to make a histopathological diagnosis.

Diagnostic performance and limitations of magnifying narrow-band imaging in screening endoscopy of early gastric cancer: a prospective multicenter feasibility study

“…The patient's preparation was the same as for conventional endoscopy [9]. When a circumscribed mucosal lesion showing changes in surface or color [9,10] was detected, the lesion was subsequently examined at maximal magnification using NBI.…”

“…The patient's preparation was the same as for conventional endoscopy [9]. When a circumscribed mucosal lesion showing changes in surface or color [9,10] was detected, the lesion was subsequently examined at maximal magnification using NBI. According to the predetermined criteria, the M-NBI examination was performed by the same endoscopist, without any consultation with other endoscopists, and the assisting physician immediately recorded the results on the uniform case record form.…”

“…Otherwise, an endoscopic diagnosis of non-cancer will be made. The details of the VS classification system have been reported elsewhere [9,11].…”

The vessels within epithelial circle (VEC) pattern as visualized by magnifying endoscopy with narrow-band imaging (ME-NBI) is a useful marker for the diagnosis of papillary adenocarcinoma: a case-controlled study

“…If a VEC pattern is detected using ME-NBI, we recommend further investigations. To determine the horizontal extent of undifferentiated carcinoma, we recommend taking multiple biopsies because chromoendoscopy and ME-NBI are of limited diagnostic value in cases of undifferentiated carcinoma, as previously reported [12,18]. Accordingly, even when the preoperative histological diagnosis from a biopsy specimen is of differentiated carcinoma, we should take multiple biopsies from the apparently nonneoplastic mucosa to confirm histologically that there are no cancerous cells as soon as we detect a VEC pattern using ME-NBI.…”

“…Accordingly, even when the preoperative histological diagnosis from a biopsy specimen is of differentiated carcinoma, we should take multiple biopsies from the apparently nonneoplastic mucosa to confirm histologically that there are no cancerous cells as soon as we detect a VEC pattern using ME-NBI. In addition, we should make an accurate diagnosis of the depth of submucosal invasion using endoscopic ultrasound [18], because the VEC pattern is a warning sign for possible invasive cancer.…”