Magnifying endoscopy of gastric epithelial dysplasia based on the morphologic characteristics

Abstract

Aim: To investigate the difference in magnifying endoscopic findings of gastric epithelial dysplasias (GEDs) according to the morphologic characteristics.

Methods: This study included 46 GED lesions in 45 patients who underwent magnifying endoscopy using narrow band imaging (ME-NBI) before endoscopic resection. During ME-NBI, the microvascular and microsurface (MS) patterns and the presence of light blue crest (LBC) and white opaque substance were investigated. GEDs were categorized as adenomatous, foveolar, and hybrid types, and their mucin phenotype was evaluated.

Results: Of the 46 lesions, 27 (59%) were categorized as adenomatous, 15 (32%) as hybrid, and the remaining 4 (9%) as foveolar. All adenomatous GEDs showed the round pit and/or tubular MS patterns, all foveolar GEDs showed the papillary pattern, and hybrid GEDs showed mixed patterns (P < 0.001). LBC was more frequently observed in adenomatous GEDs than in hybrid or foveolar GEDs (52%, 33%, 0%, respectively), although this difference was not significant (P = 0.127). The papillary MS pattern was associated with MUC5AC and MUC6 expression, and the round pit and/or tubular MS patterns were associated with CD10 expression.

Conclusion: The MS pattern in ME-NBI findings is useful for predicting the morphologic category and mucin phenotype of GEDs, and ME-NBI findings may guide decisions regarding GED treatment.

Keywords: Dysplasia; Magnifying endoscopy; Mucin; Narrow band imaging; Stomach.

Figure 1

Endoscopic and histologic findings of adenomatous gastric epithelial dysplasia. A: An elevated lesion with nodular changes is seen at the antrum; B: Magnifying endoscopy using narrow band imaging shows a mixed (tubular and round pit) microsurface and regular microvascular pattern. Light blue crests are also seen (arrow); C: Histologic examination shows that the dysplasia is composed of tubules lined by columnar cells with hyperchromatic, pencillate nuclei with pseudostratification (Haematoxylin-Eosin stain, × 10). The dysplastic epithelium is strongly positive for CD10 (G) and negative for MUC2 (D), MUC5AC (E) and MUC6 (F) (Immunohistochemistry, × 10).

Figure 2

Endoscopic and histologic findings of foveolar gastric epithelial dysplasia. A: A slightly depressed lesion is seen at the antrum; B: Magnifying endoscopy using narrow band imaging shows a papillary microsurface and slightly irregular microvascular pattern; C: Histologic examination shows that the dysplasia is composed of cuboidal to columnar cells with a pale cytoplasm and basally located ovoid nuclei. Hyperplasia of the foveolar region with irregular glandular branching and epithelial folding are also seen (Haematoxylin-Eosin stain, × 10). The dysplastic epithelium is strongly positive for MUC5AC (E) and negative for MUC2 (D), MUC6 (F) and CD10 (G) (Immunohistochemistry, × 10).