Diagnostic algorithm of magnifying endoscopy with narrow band imaging for superficial non‐ampullary duodenal epithelial tumors

Kikuchi, Daisuke; Hoteya, Shu; Iizuka, Toshiro; Kimura, Ryusuke; Kaise, Mitsuru

doi:10.1111/den.12282

Cited by 68 publications

(84 citation statements)

References 14 publications

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“…A previous study categorized the surface pattern of SNADT as preserved, micrified or absent and subsequently divided these into two types, mono and mixed, using a novel diagnostic algorithm for ME-NBI (10). In addition, vessels were defined to possess one of the following patterns: Absent, network, intrastructural vascular (ISV) with dilated, tortuous in the mucosal structure or unclassified (10). All mixed-type lesions identified were classified as category 4 (mucosal high-grade neoplasia) or category 5 (submucosal invasion by carcinoma) tumors, on the basis of the revised Vienna classification (10).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, vessels were defined to possess one of the following patterns: Absent, network, intrastructural vascular (ISV) with dilated, tortuous in the mucosal structure or unclassified (10). All mixed-type lesions identified were classified as category 4 (mucosal high-grade neoplasia) or category 5 (submucosal invasion by carcinoma) tumors, on the basis of the revised Vienna classification (10). Additionally, ~50% (10/23) of the monotype lesions were identified to be category 3 (mucosal low-grade neoplasia) tumors (10).…”

Section: Discussionmentioning

confidence: 99%

“…All mixed-type lesions identified were classified as category 4 (mucosal high-grade neoplasia) or category 5 (submucosal invasion by carcinoma) tumors, on the basis of the revised Vienna classification (10). Additionally, ~50% (10/23) of the monotype lesions were identified to be category 3 (mucosal low-grade neoplasia) tumors (10). However, among the monotype lesions, the proportion of category 4/5 tumors was 100% in lesions with an unclassified vascular pattern, 64.3% in lesions with an ISV pattern, 33.3% in lesions with an absent pattern, and 25.5% (1/4) in lesions with a network pattern (10).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, ~50% (10/23) of the monotype lesions were identified to be category 3 (mucosal low-grade neoplasia) tumors (10). However, among the monotype lesions, the proportion of category 4/5 tumors was 100% in lesions with an unclassified vascular pattern, 64.3% in lesions with an ISV pattern, 33.3% in lesions with an absent pattern, and 25.5% (1/4) in lesions with a network pattern (10). Thus, the results of this study are useful for the identification of benign and malignant lesions in SNADTs (10).…”

Section: Discussionmentioning

confidence: 99%

“…In order to overcome the limitation of traditional white-light endoscopy, ME-NBI was used to identify distinctions between potentially malignant lesions. The surface pattern of the mass was preserved in one region and was absent in another region, which may indicate a mixed type of tumor (10). In addition, irregular vascular patterns with clear demarcation were observed (Fig.…”

Section: Case Reportmentioning

confidence: 94%

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An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report

Lin

Yang

et al. 2017

Oncology Letters

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Abstract. Early superficial non-ampullary duodenal tumors are particularly rare, the clinical manifestations, including typical endoscopic or imaging features, and treatment methods are not well-characterized. The present case report describes a case of an asymptomatic 74-year-old male who presented to the Taizhou People's Hospital (Taizhou, China) for a regular health screening, where a primary superficial non-ampullary duodenal tumor was identified. Upper endoscopy revealed ~1.2 cm lesion in the second portion of the duodenum. Chromoscopy and magnification endoscopy indicated an early cancer characteristic. Subsequent endoscopic submucosal dissection was performed to remove the lesion. Histopathology validated that the lesion was a high-grade intro-epithelial neoplasm without lymph node or blood vessel invasion. IntroductionSuperficial non-ampullary duodenal tumor (SNADT), adenoma or carcinoma, is a rare type of gastrointestinal tract epithelial tumor and can be defined as a lesion limited to the mucosa, and/or submucosa which is not arising from the papilla of Vater (1,2). Typically, the likelihood of developing duodenal adenoma in patients with familial adenomatous polyposis (FAP) is high and this type of adenoma may progress to carcinoma (3). In contrast, sporadic NADT may develop de novo or through the adenoma-carcinoma pathway, as observed in patients with FAP (4). The prognosis of patients with advanced stage carcinoma is poor (5). However, if the duodenal tumor is diagnosed at an early stage and the patient undergoes complete resection, using an endoscopic method, the patient may experience a markedly improved outcome. Therefore, early detection and treatment of lesions are required (6).As the incidence of sporadic SNADT is rare, endoscopic markers suggestive of early stage SNADT have not been established. In addition, although endoscopic approaches, including endoscopic mucosa resection (EMR) and endoscopic submucosal dissection (ESD), are minimally invasive, and localized treatments in comparison to conventional surgery, there are a number of high risk complications (including bleeding and perforation) which may occur during the endoscopic resection (ER) (7-9). Therefore, the relatively rare incidence, and the presence of a thin duodenal wall and rich vascularity make it difficult to detect and treat SNADT lesions.The present case report describes an elderly patient presented to the Taizhou People's Hospital (Taizhou, China) for esophagogastroduodenoscopy and was identified to exhibit a superficial lesion (~1.2 cm) in the second portion of the duodenum. Chromoscopy and magnification endoscopy with narrow band imaging (ME-NBI) indicated an early stage lesion. Subsequently, ESD was performed to remove the lesion. Histopathology validated the high-grade intro-epithelial tumor diagnosis with negative margins, and without lymph or blood vessel involvement. Case reportIn the present case report, a 70-year-old Chinese male presented to the Taizhou People's Hospital (Taizhou, China) for a regular health scree...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 94%

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An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report

Lin

Yang

et al. 2017

Oncology Letters

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Genomic profiling of intestinal/mixed‐type superficial non‐ampullary duodenal epithelial tumors

et al. 2021

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Background and Aim The mechanism underlying carcinogenesis and the genomic features of superficial non‐ampullary duodenal epithelial tumors (SNADETs) have not been elucidated in detail. In this study, we examined the genomic features of incipient SNADETs, such as small lesions resected via endoscopic treatment, using next‐generation sequencing (NGS). Methods Twenty consecutive patients who underwent endoscopic treatment for SNADETs of less than 20 mm between January and December 2017 were enrolled. Targeted genomic sequencing was performed through NGS using a panel of 160 cancer‐related genes. Furthermore, the alteration/mutation frequencies in SNADETs were examined. Results The maximum size of the SNADETs examined in this study was 12 mm in diameter. Five SNADETs were classified as low‐grade dysplasia (LGD) tumors, while 14 SNADETs were classified as high‐grade dysplasia tumors. Only one carcinoma in situ was detected. NGS data for 16 samples were obtained. APC alterations were detected in 81% of samples (13/16). KRAS, BRAF, and TP53 alterations were detected in 25% (4/16), 18.8% (3/16), and 6.3% (1/16) of cases, respectively. Conclusion We detected APC alterations in most small SNADETs resected via endoscopic treatment, from LGD to carcinoma samples. Even in SNADETs classified as small LGD exhibited KRAS and BRAF alterations.

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Endoscopic Diagnosis of Early Duodenal Epithelial Neoplasia and Therapeutic Strategy

Tsuji¹,

Doyama²,

Yao³

2021

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Diagnostic algorithm of magnifying endoscopy with narrow band imaging for superficial non‐ampullary duodenal epithelial tumors

Cited by 68 publications

References 14 publications

An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report

An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report

Genomic profiling of intestinal/mixed‐type superficial non‐ampullary duodenal epithelial tumors

Endoscopic Diagnosis of Early Duodenal Epithelial Neoplasia and Therapeutic Strategy

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