The Diagnosis of Histological Type by M-NBI:The Differentiated Type of Gastric Cancer Takao Kanemitsu 1 , Kenshi Yao 2 , Takashi Nagahama 3 , Kentaro Imamura 3 , Kenjiro Kuhara 3 , Toshiki Kojima 2 , Haruhiko Takahashi 3 , Shoko Fujiwara 2 , Yoichiro Ono 3 , Toshiyuki Matsui 3 , Kenta Chuman 3,4 , Hiroshi Tanabe 4 , Akinori Iwashita 4 , Kensei Ohtsu 5 1Division of Gastroenterology, Sada hospital, Fukuoka, Japan 2Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan 3Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan 4Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan 5Department of Gastroenterology, Tobata Kyoritsu Hospital, Kitakyushu, Japan Keyword: NBI併用拡大内視鏡 , 乳頭腺癌 , 胃癌 , 組織型 , VEC pattern pp.615-620
Published Date 2016/5/24
DOI https://doi.org/10.11477/mf.1403200622
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 Pathological studies indicate that papillary adenocarcinomas are more aggressive than tubular adenocarcinomas, but a definitive diagnosis is not possible using conventional endoscopy alone. The VEC(vessels within epithelial circle)pattern visualized using ME-NBI(magnifying endoscopy with narrow band imaging)may be a characteristic feature of papillary adenocarcinoma. We investigated whether the VEC pattern is useful in the preoperative diagnosis of papillary adenocarcinoma and determined whether VEC-positive lesions are more malignant than VEC-negative lesions. Out of 395 consecutive early gastric cancers resected using the ESD method, we analyzed 35 VEC-positive lesions and 70 VEC-negative size- and macroscopic-type matched lesions. Histological papillary structure was observed in 94.3%(33/35)of the VEC-positive and 8.6%(6/70)of the VEC-negative lesions, and this difference was significant(p<0.001). The incidence of coexisting undifferentiated carcinoma was 22.9%(8/35)in the VEC-positive and 2.9%(2/70)in the VEC-negative cancers(p=0.002). Incidence of submucosal invasion by the carcinoma was 25.7%(9/35)and 10.0%(7/70), respectively(p=0.045). In conclusion, the VEC pattern visualized by ME-NBI is a promising preoperative diagnostic marker of papillary adenocarcinoma. Coexisting undifferentiated carcinoma and submucosal invasion were each observed in approximately one-fourth of VEC-positive cancers.

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