CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(02): E145-E155
DOI: 10.1055/s-0043-121267
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Multiple convex demarcation line for prediction of benign depressed gastric lesions in magnifying narrow-band imaging

Takashi Kanesaka
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Noriya Uedo
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Kenshi Yao
Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
,
Yasumasa Ezoe
Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Hisashi Doyama
Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
,
Ichiro Oda
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Kazuhiro Kaneko
Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Chiba, Japan
,
Yoshiro Kawahara
Division of Endoscopy, Okayama University, Okayama, Japan
,
Chizu Yokoi
Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan
,
Yasushi Sugiura
Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan
,
Hideki Ishikawa
Department of Molecular Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
,
Yoji Takeuchi
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Masamichi Arao
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Taro Iwatsubo
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Hiroyoshi Iwagami
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Kenji Matsuno
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Manabu Muto
Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Yutaka Saito
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Yasuhiko Tomita
Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
› Author Affiliations
Further Information

Publication History

submitted 11 March 2017

accepted after revision 08 September 2017

Publication Date:
01 February 2018 (online)

Abstract

Background and study aims With magnifying narrow-band imaging (M-NBI) of the gastric mucosa, a characteristic demarcation line (DL) is occasionally found in non-cancerous depressed lesions. This DL forms multiple convex shapes along the edge of the epithelia of surrounding mucosa. We have termed this novel finding a multiple convex DL (MCDL). In this study, we clarified the prevalence of an MCDL in depressed gastric lesions detected in patients at high risk for gastric cancer and determined the diagnostic yield necessary to distinguish between cancer and non-cancer.

Patients and methods This was a post hoc analysis of a multicenter prospective trial. In total, 362 small (≤ 10 mm) depressed lesions were detected in 1353 patients. Presence or absence of a DL in target lesions was evaluated on M-NBI images. The proportion of MCDLs among lesions with a DL was evaluated.

Results Images of 347 lesions (39 cancerous and 308 non-cancerous) were evaluable. A DL was present in 252/347 lesions (73 %). When the cutoff value for the proportion of MCDLs needed to distinguish non-cancer from cancer was set at two-thirds, an MCDL was observed in 86/252 lesions (34 %). In 86 lesions with an MCDL, 83 (97 %) were non-cancerous. The sensitivity, specificity, positive predictive value, and negative predictive value of an MCDL for non-cancerous lesions were 38 %, 91 %, 97 %, and 19 %, respectively.

Conclusions Presence of an MCDL had high specificity and positive predictive value for non-cancerous lesions. Evaluating the shape of the DL is useful for differentiation between cancer and non-cancerous lesions.