Recent Advances in the Endoscopic Diagnosis of Early Gastric Cancer Hisao Tajiri 1 , Junko Fujisaki 1 , Takashi Nakayoshi 1 , Nanako Saito 1 , Masahiro Ikegami 2 1Department of Endoscopy, The Jikei University School of Medicine, Tokyo 2Department of Pathology, The Jikei University School of Medicine, Tokyo Keyword: 適応型構造強調処理 , 適応型 IHb , 色彩強調処理 , 狭帯域フィルター内視鏡システム , 拡大電子内視鏡 pp.21-29
Published Date 2003/1/25
DOI https://doi.org/10.11477/mf.1403101001
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 With the adaptive index of hemoglobin(IHb)color enhancement processing technology, the intensity of enhancement can be selected for each pixel, corresponding to the brightness level of the pixel. We studied whether or not adaptive IHb color enhancement would be of great help during ordinary endoscopy for determining the extent of invasion in cases of early gastric cancer. This technique was useful in the diagnosis of the extent of cancer invasion of depressed-type early gastric cancers. It is therefore expected that adaptive IHb color enhancement will be useful for detecting discolored areas especially in the corpus and for the qualitative diagnosis of cancer.

 The narrow band imaging(NBI)system is composed of a sequential electronic endoscope system and a source of light equipped with new narrow band filters corresponding to red, green and blue. This system with a magnifying endoscope was able to yield very clear images of the capillaries on the mucosal surface. When conventional magnifying endoscopic images and NBI images of type IIc early gastric cancer were compared, it was found that the capillary network in the depressed surface was more clearly visualized with the NBI system. Depressed differentiated-type adenocarcinomas are more likely to show fine network patterns, whereas undifferentiated-type adenocarcinomas are more likely to show irregular corkscrew patterns. These patterns, probably representing microvascular structure of the mucosal surface, would be specific for each histological type of carcinoma. CD31 and CD34 are known to be specific for the vascular endothelium. Three-dimensional images of micro-vessels with a laser scanning microscope from obtained-specimens are in the process of being compared with endoscopic images, with the goal of establishing a new diagnostic strategy based on microvascular pattern analysis. We have been using the NBI system for differential diagnosis between minute cancer and erosion, the degree of differentiation, and the extent of invasion of early gastric cancer.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院