Advertisement

Endoluminal Diagnosis of Early Gastric Cancer and Its Precursors: Bridging the Gap Between Endoscopy and Pathology

  • Noriya UedoEmail author
  • Kenshi Yao
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 908)

Abstract

Although dye-based and image-enhanced endoscopic techniques have revolutionized endoscopic diagnosis, conventional white light endoscopy still plays an important role in the diagnosis of early gastric cancer (EGC) during routine endoscopy. Chromoendoscopy reveals morphological characteristics of the mucosal lesions by enhancing mucosal contrast, while narrow-band imaging (NBI) facilitates detailed evaluation of the vascular architecture and surface features. Positive diagnostic findings of EGC on white light imaging and indigo carmine chromoendoscopy are a sharply demarcated lesion and irregularity in surface morphology or color. Magnifying NBI further improves diagnostic accuracy of white light imaging and chromoendoscopy. We review our approach to the endoscopic diagnosis of (pre-)malignant lesions in the stomach and discuss in detail novel endoscopic microvascular architectural patterns which further leverage diagnostic biopsy yield. We expect that further improvement of endoscopic techniques and correlative studies will close the gap between endoscopy and pathology.

Keywords

Gastric cancer Early gastric cancer Chromoendoscopy Narrow band imaging Magnification endoscopy Helicobacter pylori Chronic atrophic gastritis Intestinal metaplasia 

References

  1. 1.
  2. 2.
    Murakami T. Pathomorphological diagnosis. Definition and gross classification of early gastric cancer. Gann Monogr Cancer Res. 1971;11:53–5.Google Scholar
  3. 3.
    Yamazaki H, Oshima A, Murakami R, Endoh S, Ubukata T. A long-term follow-up study of patients with gastric cancer detected by mass screening. Cancer. 1989;63:613–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Everett AM, Axon ATR. Early gastric cancer in Europe. Gut. 1997;41:142–50.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg. 1992;79:241–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.CrossRefPubMedGoogle Scholar
  7. 7.
    Hirasawa T, Gotoda T, Miyata S, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer. 2009;12:148–52.CrossRefPubMedGoogle Scholar
  8. 8.
  9. 9.
    Schlemper RJ, Itabashi M, Kato Y, Lewin KJ, Riddell RH, Shimoda T, Sipponen P, Stolte M, Watanabe H, Takahashi H, Fujita R. Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists. Lancet. 1997;349:1725–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Lansdown M, Quirke P, Dixon MF, Axon ATR, Johnston D. High grade dysplasia of the gastric mucosa: a marker for gastric carcinoma. Gut. 1990;31:977–83.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lewin KJ, Riddell RH, Weinstein WM. Gastrointestinal pathology and its clinical implications. New York: Igaku-Shoin; 1992.Google Scholar
  12. 12.
    Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut. 2002;51:130–1.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Fujii T, Iishi H, Tatsuta M, Hirasawa R, Uedo N, Hifumi K, Omori M. Effectiveness of premedication with pronase for improving visibility during gastroendoscopy: a randomized controlled trial. Gastrointest Endosc. 1998;47:382–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Chang CC, Chen SH, Lin CP, Hsieh CR, Lou HY, Suk FM, Pan S, Wu MS, Chen JN, Chen YF. Premedication with pronase or N-acetylcysteine improves visibility during gastroendoscopy: an endoscopist-blinded, prospective, randomized study. World J Gastroenterol. 2007;13:444–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kaltenbach T, Sano Y, Friedland S, Soetikno R, American Gastroenterological Association. American Gastroenterological Association (AGA) Institute technology assessment on image-enhanced endoscopy. Gastroenterology. 2008;134:327–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Uedo N, Fujishiro M, Goda K, Hirasawa D, Kawahara Y, Lee JH, Miyahara R, Morita Y, Singh R, Takeuchi M, Wang S, Yao T. Role of narrow band imaging for diagnosis of early-stage esophagogastric cancer: current consensus of experienced endoscopists in Asia-Pacific region. Dig Endosc. 2011;23 Suppl 1:58–71.CrossRefPubMedGoogle Scholar
  17. 17.
    Yao K. The endoscopic diagnosis of early gastric cancer. Ann Gastroenterol. 2013;26:11–22.PubMedPubMedCentralGoogle Scholar
  18. 18.
    ASGE Technology Committee, Wong Kee Song LM, Adler DG, Chand B, Conway JD, Croffie JM, Disario JA, Mishkin DS, Shah RJ, Somogyi L, Tierney WM, Petersen BT. Chromoendoscopy. Gastrointest Endosc. 2007;66:639–49.CrossRefGoogle Scholar
  19. 19.
    Ida K, Hashimoto Y, Takeda S, Murakami K, Kawai K. Endoscopic diagnosis of gastric cancer with dye scattering. Am J Gastroenterol. 1975;63:316–20.PubMedGoogle Scholar
  20. 20.
    Dinis-Ribeiro M, da Costa-Pereira A, Lopes C, et al. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest Endosc. 2003;57:498–504.CrossRefPubMedGoogle Scholar
  21. 21.
    Gono K, Obi T, Yamaguchi M, Ohyama N, Machida H, Sano Y, Yoshida S, Hamamoto Y, Endo T. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt. 2004;9:568–77.CrossRefPubMedGoogle Scholar
  22. 22.
    Osawa H, Yoshizawa M, Yamamoto H, et al. Optimal band imaging system can facilitate detection of changes in depressed type early gastric cancer. Gastrointest Endosc. 2008;67:226–34.CrossRefPubMedGoogle Scholar
  23. 23.
    Kodashima S, Fujishiro M. Novel image-enhanced endoscopy with i-Scan technology. World J Gastroenterol. 2010;16:1043–9.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Yoshii T. Comparative study on chronic gastritis with dissecting microscopic findings of stained stomach and its histological findings: application to endoscopic diagnosis. Progr Dig Endosc. 1976;9:49–53. in Japanese.Google Scholar
  25. 25.
    Sakaki N, Iida Y, Okazaki Y, Kawamura S, Takemoto T. Magnifying endoscopic observation of the gastric mucosa, particularly in patients with atrophic gastritis. Endoscopy. 1978;10:269–74.CrossRefPubMedGoogle Scholar
  26. 26.
    Yagi K, Nakamura A, Sekine A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection. J Gastroenterol Hepatol. 2002;17:39–45.CrossRefPubMedGoogle Scholar
  27. 27.
    Yao K, Oishi T, Matsui T, Yao T, Iwashita A. Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer. Gastrointest Endosc. 2002;56:279–84.CrossRefPubMedGoogle Scholar
  28. 28.
    Nakagawa S, Kato M, Shimizu Y, Nakagawa M, Yamamoto J, Luis PA, Kodaira J, Kawarasaki M, Takeda H, Sugiyama T, Asaka M. Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy. Gastrointest Endosc. 2003;58:71–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Anagnostopoulos GK, Yao K, Kaye P, Fogden E, Fortun P, Shonde A, Foley S, Sunil S, Atherton JJ, Hawkey C, Ragunath K. High-resolution magnification endoscopy can reliably identify normal gastric mucosa, Helicobacter pylori-associated gastritis, and gastric atrophy. Endoscopy. 2007;39:202–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Ohnita K, Isomoto H, Shikuwa S, Yamaguchi N, Nakayama T, Nishiyama H, Okamoto K, Fukuda E, Takeshima F, Hayashi T, Kohno S, Nakao K. Magnifying chromoendoscopic findings of early gastric cancer and gastric adenoma. Dig Dis Sci. 2011;56:2715–22.CrossRefPubMedGoogle Scholar
  31. 31.
    Kato T, Yagi N, Kamada T, Shimbo T, Watanabe H, Ida K, Study Group for Establishing Endoscopic Diagnosis of Chronic Gastritis. Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: a multicenter prospective study. Dig Endosc. 2013;25:508–18.CrossRefPubMedGoogle Scholar
  32. 32.
    Bansal A, Ulusarac O, Mathur S, Sharma P. Correlation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial. Gastrointest Endosc. 2008;67(2):210–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;1:87–97.CrossRefGoogle Scholar
  34. 34.
    Redeen S, Petersson F, Jonsson KA, Borch K. Relationship of gastroscopic features to histological findings in gastritis and Helicobacter pylori infection in a general population sample. Endoscopy. 2003;35:946–50.CrossRefPubMedGoogle Scholar
  35. 35.
    Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med. 2001;345:784–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Uedo N. Do we need multiple biopsies for assessing gastric cancer risk? Dig Dis Sci. 2011;56:926–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Tahara T, Shibata T, Nakamura M, et al. Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis. Gastrointest Endosc. 2009;70:246–53.CrossRefPubMedGoogle Scholar
  38. 38.
    Kawamura M, Abe S, Oikawa K, Terai S, Saito M, Shibuya D, Kato K, Shimada T, Uedo N, Masuda T. Topographic differences in gastric micromucosal patterns observed by magnifying endoscopy with narrow band imaging. J Gastroenterol Hepatol. 2011;26:477–83.CrossRefPubMedGoogle Scholar
  39. 39.
    Kanzaki H, Uedo N, Ishihara R, Nagai K, Matsui F, Ohta T, Hanafusa M, Hanaoka N, Takeuchi Y, Higashino K, Iishi H, Tomita Y, Tatsuta M, Yamamoto K. Comprehensive investigation of areae gastricae pattern in gastric corpus using magnifying narrow band imaging endoscopy in patients with chronic atrophic fundic gastritis. Helicobacter. 2012;17:224–31.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Busuttil RA, Boussioutas A. Intestinal metaplasia: a premalignant lesion involved in gastric carcinogenesis. J Gastroenterol Hepatol. 2009;24:193–201.CrossRefPubMedGoogle Scholar
  41. 41.
    Nagata N, Shimbo T, Akiyama J, et al. Predictability of gastric intestinal metaplasia by mottled patchy erythema seen on endoscopy. Gastroenterol Res. 2011;4:203–9.Google Scholar
  42. 42.
    Uedo N, Ishihara R, Iishi H, et al. A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy. 2006;38:819–24.CrossRefPubMedGoogle Scholar
  43. 43.
    Yao K, Iwashita A, Tanabe H, et al. Author’s reply to Letter to the Editor, “White opaque substance” and “light blue crest” within gastric flat tumors or intestinal metaplasia: same or different signs? Gastrointest Endosc. 2009;70(402):402–3.CrossRefGoogle Scholar
  44. 44.
    An JK, Song GA, Kim GH, et al. Marginal turbid band and light blue crest, signs observed in magnifying narrow-band imaging endoscopy, are indicative of gastric intestinal metaplasia. BMC Gastroenterol. 2012;12:169.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Yao K, Iwashita A, Yao T, Furukawa H, Furukawa K, Takemura S, Matsui T. Quantitative method to characterize electronic endoscopic color images of early gastric carcinomas, using index of hemoglobin. Gastraenterol Endosc. 1997;39:2253–63. Japanese with English abstract.Google Scholar
  46. 46.
    Yao K, Anagnostopoulos GK, Ragunath K. Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy. 2009;4:462–7.CrossRefGoogle Scholar
  47. 47.
    Ezoe Y, Muto M, Uedo N, et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology. 2011;141:2017–25.CrossRefPubMedGoogle Scholar
  48. 48.
    Yamada S, Doyama H, Yao K, et al. An efficient diagnostic strategy for small, depressed early gastric cancer with magnifying narrow-band imaging: a post-hoc analysis of a prospective randomized controlled trial. Gastrointest Endosc. 2014;79:55–63.CrossRefPubMedGoogle Scholar
  49. 49.
    Zhang Q, Wang F, Chen ZY, Wang Z, Zhi FC, Liu S, Bai Y. Comparison of the diagnostic efficacy of white light endoscopy and magnifying endoscopy with narrow band imaging for early gastric cancer: a meta-analysis. Gastric Cancer. 2015 Apr 29. [Epub ahead of print].Google Scholar
  50. 50.
    Yao K, Iwashita A, Tanabe H, et al. 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. Gastrointest Endosc. 2008;68:574–80.CrossRefPubMedGoogle Scholar
  51. 51.
    Yao K, Iwashita A, Nambu M, et al. Nature of white opaque substance in gastric epithelial neoplasia as visualized by magnifying endoscopy with narrow-band imaging. Dig Endosc. 2012;24:419–25.CrossRefPubMedGoogle Scholar
  52. 52.
    Doyama H, Yoshida N, Tsuyama S, Ota R, Takeda Y, Nakanishi H, Tsuji K, Tominaga K, Tsuji S, Takemura K, Yamada S, Katayanagi K, Kurumaya H, Iwashita A, Yao K. The “white globe appearance” (WGA): a novel marker for a correct diagnosis of early gastric cancer by magnifying endoscopy with narrow-band imaging (M-NBI). Endosc Int Open. 2015;3:E120–4.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Watanabe Y, Shimizu M, Itoh T, Nagashima K. Intraglandular necrotic debris in gastric biopsy and surgical specimens. Ann Diagn Pathol. 2001;5:141–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.CrossRefGoogle Scholar
  55. 55.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.CrossRefGoogle Scholar
  56. 56.
    Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(6 Suppl):S3–43.Google Scholar
  57. 57.
    Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. Acta Pathol Microbiol Scand. 1965;64:31–49.PubMedGoogle Scholar
  58. 58.
    Yao K, Yao T, Matsui T, Iwashita A, Oishi T. Hemoglobin content in intramucosal gastric carcinoma as a marker of histologic differentiation: a clinical application of quantitative electronic endoscopy. Gastrointest Endosc. 2000;52:241–5.CrossRefPubMedGoogle Scholar
  59. 59.
    Nakayoshi T, Tajiri H, Matsuda K, Kaise M, Ikegami M, Sasaki H. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy. 2004;36:1080–4.CrossRefPubMedGoogle Scholar
  60. 60.
    Yokoyama A, Inoue H, Minami H, et al. Novel narrow-band imaging magnifying endoscopic classification for early gastric cancer. Dig Liver Dis. 2010;42:704–8.CrossRefPubMedGoogle Scholar
  61. 61.
    Kobayashi M, Takeuchi M, Ajioka Y, Hashimoto S, Sato A, Narisawa R, Aoyagi Y. Mucin phenotype and narrow-band imaging with magnifying endoscopy for differentiated-type mucosal gastric cancer. J Gastroenterol. 2011;46(9):1064–70.CrossRefPubMedGoogle Scholar
  62. 62.
    Kanemitsu T, Yao K, Nagahama T, Fujiwara S, Takaki Y, Ono Y, Matsushima Y, Matsui T, Tanabe H, Ota A, Iwashita A. 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. Gastric Cancer. 2014;17:469–77.CrossRefPubMedGoogle Scholar
  63. 63.
    Kanesaka T, Sekikawa A, Tsumura T, Maruo T, Osaki Y, Wakasa T, Shintaku M, Yao K. Absent microsurface pattern is characteristic of early gastric cancer of undifferentiated type: magnifying endoscopy with narrow-band imaging. Gastrointest Endosc. 2014;80:1194–8.CrossRefPubMedGoogle Scholar
  64. 64.
    Okada K, Fujisaki J, Kasuga A, Omae M, Hirasawa T, Ishiyama A, Inamori M, Chino A, Yamamoto Y, Tsuchida T, Nakajima A, Hoshino E, Igarashi M. Diagnosis of undifferentiated type early gastric cancers by magnification endoscopy with narrow-band imaging. J Gastroenterol Hepatol. 2011;26:1262–9.CrossRefPubMedGoogle Scholar
  65. 65.
    Yoshinaga S, Gotoda T, Oda I, Saito Y, Matsuda T, Nakajima T, et al. Clinical imaging of early gastric cancers—conventional endoscopy: including chromoendoscopy using indigo carmine. Stomach Intestine. 2009;44:650–62.Google Scholar
  66. 66.
    Nagahama T, Yao K, Maki S, et al. Usefull of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy. Gastrointest Endosc. 2011;75:1259–67.CrossRefGoogle Scholar
  67. 67.
    Abe S, Oda I, Shimazu T, et al. Depth-predicting score for differentiated early gastric cancer. Gastric Cancer. 2011;14:35–40.CrossRefPubMedGoogle Scholar
  68. 68.
    Choi J, Kim SG, Im JP, et al. Endoscopic prediction of tumor invasion depth in early gastric cancer. Gastrointest Endosc. 2011;73:917–27.CrossRefPubMedGoogle Scholar
  69. 69.
    Choi J, Kim SG, Im JP, Kim JS, Jung HC, Song IS. Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of depth of tumor invasion in early gastric cancer. Endoscopy. 2010;42:705–13.CrossRefPubMedGoogle Scholar
  70. 70.
    Mocellin S, Marchet A, Nitti D. EUS for the staging of gastric cancer: a meta-analysis. Gastrointest Endosc. 2011;73:1122–34.CrossRefPubMedGoogle Scholar
  71. 71.
    Yao K, Tominaga K, Doyama H. Current clinical feasibility of magnifying endoscopy for predicting early gastric cancer invasion depth. Stomach Intestine. 2015;50:616–8. in Japanese.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Gastrointestinal OncologyOsaka Medical Center for Cancer and Cardiovascular DiseaseOsakaJapan
  2. 2.Department of EndoscopyFukuoka University Chikushi HospitalChikushino, FukuokaJapan

Personalised recommendations