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. 2016 Jul 15;10(4):532-41.
doi: 10.5009/gnl15364.

Magnifying Endoscopy with Narrow Band Imaging of Early Gastric Cancer: Correlation with Histopathology and Mucin Phenotype

Kyung-Sun Ok  1 , Gwang Ha Kim  2 , Do Youn Park  3 , Hyun Jeong Lee  2 , Hye Kyung Jeon  2 , Dong Hoon Baek  2 , Bong Eun Lee  2 , Geun Am Song  2
Affiliations

Magnifying Endoscopy with Narrow Band Imaging of Early Gastric Cancer: Correlation with Histopathology and Mucin Phenotype

Kyung-Sun Ok et al. Gut Liver. .

Abstract

Background/aims: Magnifying endoscopy with narrow band imaging (ME-NBI) is a useful modality for the detailed visualization of microsurface (MS) and microvascular (MV) structures in the gastrointestinal tract. This study aimed to determine whether the MS and MV patterns in ME-NBI differ according to the histologic type, invasion depth, and mucin phenotype of early gastric cancers (EGCs).

Methods: The MS and MV patterns of 160 lesions in 160 patients with EGC who underwent ME-NBI before endoscopic or surgical resection were prospectively collected and analyzed. EGCs were categorized as either differentiated or undifferentiated and as either mucosal or submucosal, and their mucin phenotypes were determined via immunohistochemistry of the tumor specimens.

Results: Differentiated tumors mainly displayed an oval and/or tubular MS pattern and a fine network or loop MV pattern, whereas undifferentiated tumors mainly displayed an absent MS pattern and a corkscrew MV pattern. The destructive MS pattern was associated with submucosal invasion, and this association was more prominent in the differentiated tumors than in the undifferentiated tumors. MUC5AC expression was increased in lesions with either a papillary or absent MS pattern and a corkscrew MV pattern, whereas MUC6 expression was increased in lesions with a papillary MS pattern and a loop MV pattern. CD10 expression was more frequent in lesions with a fine network MV pattern.

Conclusions: ME-NBI can be useful for predicting the histopathology and mucin phenotype of EGCs.

Keywords: Magnifying endoscopy; Mucins; Narrow band imaging; Stomach neoplasms.

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Figures

Fig. 1
Fig. 1
Classification of microsurface and microvascular patterns using magnifying endoscopy with narrow band imaging in early gastric cancers.
Fig. 2
Fig. 2
A case of differentiated cancer. (A) A depressed lesion is observed in the lower body. (B) Magnifying endoscopy with narrow band imaging indicates an oval and/or tubular microsurface and fine network microvascular patterns. (C) Histologic examination shows a well-differentiated adenocarcinoma in the lamina propria (H&E stain, ×40). The cancer cells are strongly positive for CD10 (G) and negative for MUC2 (D), MUC5AC (E) and MUC6 (F).
Fig. 3
Fig. 3
A case of undifferentiated cancer. (A) A depressed lesion is observed in the lower body. (B) Magnifying endoscopy with narrow band imaging indicates an absence of microsurface and corkscrew microvascular patterns. (C) Histologic examination shows a signet ring cell carcinoma in the lamina propria (H&E stain, ×40). The cancer cells are strongly positive for MUC5AC (E) and negative for MUC2 (D), MUC6 (F) and CD10 (G).
Fig. 4
Fig. 4
Magnifying endoscopy with narrow band imaging of early gastric cancers according to the invasion depth of the tumor. (A) The main microsurface pattern in mucosal cancers was oval and/or tubular, and the main microsurface pattern in submucosal cancers was destructive (p<0.001). (B) There was no difference in the microvascular patterns between mucosal and submucosal cancers (p=0.677).
Fig. 5
Fig. 5
A case of submucosal cancer. (A) An elevated lesion with a central depression is observed in the mid-body. (B) Magnifying endoscopy with narrow band imaging shows destructive microsurface and fine network microvascular patterns. (C) Histologic examination shows a well-differentiated adenocarcinoma with deep submucosal invasion (H&E stain, ×40). The cancer cells are strongly positive for MUC5AC (E) and MUC6 (F) and negative for MUC2 (D) and CD10 (G).
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