The Role Of Magnifying Narrow-band Imaging Endoscopy In Judging The Histological Type Of Early Gastric Cancer

Background:In recent years,with the development and spread of two minimally invasive techniques,endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD),more and more patients with early gastric cancer(EGC)can be cured by endoscopic resection.The postoperative survival rate is high,the recovery process is quick,and the cost of medical treatment is low.At the same time,It does not affect the quality of life after the operation,due to endoscopic surgery is a minimally invasive treatment with minimal trauma.However,we choose treatment different methods for different pathological types of early gastric cancer.Endoscopic treatment of differentiated-type early gastric cancer has been widely carried out,but undifferentiated-type early gastric cancer has a high risk of lymph nodes metastasis and a high degree of malignancy.There is currently much controversy about whether endoscopic treatment can be performed.Therefore,Therefore,the detection of early gastric cancer and the judgment of the histopathological type are extremely helpful to the choice of treatment.Objective:To evaluate whether magnifying endoscopy with narrow band imaging(ME-NBI)is helpful in judging the pathological type of early gastric cancer.Assess its value for clinical guidance.Methods:Included 39 consecutive patients diagnosed with early gastric cancer by one expert endoscopists at our hospital between January 2016 and January 2018.According to WHO Pathological typing,24 of which are differentiated-type early gastric cancer and 15 undifferentiated-type early gastric cancer.We can clearly observe the microvascular structure(MV)and the microstructure(MS)of the lesion surface by using magnifying endoscopy with narrow band imaging(ME-NBI).The histopathological classification of these lesions was can judged by ME-NBI observing the endoscopic images of the microvascular structural morphology of the lesion surface.EGCs were classified according to MV pattern by NBI-ME.The accuracy of ME-NBI for the histopathological diagnosis of early gastric cancer was evaluated by comparing the endoscopic image to determine the relationship between histopathological findings and their corresponding postoperative histopathological findings.Results:ME-NBI was used to observe the mucosal microvascular structure of lesions.According to Nakayoshi’s classification criteria,the morphology of lesions mucosal microvessels was classified into three types: fine-network pattern(FNP)and spiral-shaped pattern(CSP)and unformed type.According to WHO pathological classification criteria,we divided 39 cases of early gastric cancer into differentiated-type early gastric cancer group(n=24)and undifferentiated-type gastric cancer group(n=15).By carefully observing the relationship between the morphology of the microvessels on the surface of the lesion and histopathological findings,we found that the fine-mesh microvessel structure is mostly differentiated-type early gastric cancer(18/20,90%),and the corkscrew pattern microvascular structure is basically undifferentiated-type early gastric cancer(11/14,78.6%).There were also four early gastric cancer lesions that could not be typed by observing surface microvasculature with ME-NBI.The pathological types of the lesions were judged by observing the mucosal surface microvascular structure with ME-NBI.The microscopy and pathological diagnosis of 29 lesions out of 39 lesions were matched.It was statistically significant the difference(P<0.05).Conclusion:It is useful to determine the histological type of early gastric cancer by observing the microvascular structure of the lesion site using magnifying endoscopy with narrow band imaging(ME-NBI).It has practical guiding significance for clinical work.