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Comparative Study
. 2017 Oct 7;23(37):6894-6901.
doi: 10.3748/wjg.v23.i37.6894.

In vivo histological diagnosis for gastric cancer using endocytoscopy

Issei Tsurudome  1 , Ryoji Miyahara  2 , Kohei Funasaka  1 , Kazuhiro Furukawa  3 , Masanobu Matsushita  1 , Takeshi Yamamura  3 , Takuya Ishikawa  1 , Eizaburo Ohno  1 , Masanao Nakamura  1 , Hiroki Kawashima  1 , Osamu Watanabe  1 , Masato Nakaguro  4 , Akira Satou  4 , Yoshiki Hirooka  3 , Hidemi Goto  1
Affiliations
Comparative Study

In vivo histological diagnosis for gastric cancer using endocytoscopy

Issei Tsurudome et al. World J Gastroenterol. .

Abstract

Aim: To examine usefulness of virtual biopsy using endocytoscopy by comparing the in vivo endocytoscopic and histopathological images of gastric cancers.

Methods: Endocytoscopy was performed in 30 patients with early gastric cancer. Of these, 26 patients showed well differentiated adenocarcinomas, while 4 patients showed poorly differentiated adenocarcinomas (including one signet ring cell carcinoma). Cancerous and non-cancerous areas were observed after double staining with 0.05% crystal violet and 0.1% methylene blue. The endocytoscopic images obtained were evaluated by an expert endoscopist and an expert pathologist without knowledge of patient clinical data, and endocytoscopic and histopathological diagnoses were compared.

Results: The endocytoscopic images of the cancerous area were assessed as evaluable in 25 (83.3%) and 27 (90%) patients by endoscopist A and pathologist B, respectively, and those of the non-cancerous area as evaluable in 28 (93.3%) and 23 (76.7%) patients by the endoscopist and pathologist, respectively. The sensitivity, specificity, and diagnostic accuracy of gastric cancer diagnosis using evaluable endocytoscopic images were 88.0% and 92.9%, and 90.6% by endoscopist A, and 88.9% and 91.3%, and 90.0% by pathologist B, respectively. Evaluation of the diagnostic concordance rate between the endoscopist and the pathologist by inter-observer agreement calculation revealed no significant difference between the two observers. The inter-observer agreement (κ-value) for endocytoscopic diagnosis was 0.745.

Conclusion: Endocytoscopy is useful for the differentiation of cancerous from non-cancerous gastric mucosa, making it a promising tool for virtual biopsy.

Keywords: Crystal violet; Double staining; Endocytoscopy; Gastric cancer; In vivo histopathology; Magnifying endoscopy; Methylene blue; Virtual biopsy.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Normal mucosa (fundic gland mucosa). A: Endocytoscopic appearance of fundic gland mucosa. The foveolar epithelium was arranged in a circle, and the glandular lumens were round. The nuclei were weakly stained; B: Histological appearance of the corresponding normal mucosa (H&E-stained horizontal section, × 200).
Figure 2
Figure 2
Normal mucosa (pyloric gland mucosa). A: Endocytoscopic appearance of pyloric gland mucosa. The foveolar epithelium was regularly arranged in ridges, and the glandular lumens were slit-like. The nuclei were weakly stained; B: Histological appearance of the corresponding pyloric gland mucosa (H&E-stained horizontal section, × 200).
Figure 3
Figure 3
Intestinal metaplastic mucosa. A: Endocytoscopic appearance of intestinal metaplastic mucosa. The foveolar epithelium exhibited a villous architecture and the gland lumens were widened. Goblet cells (arrow) were observed among the epithelial cells. The nuclei were stained more intensely than in the normal mucosa; B: Histological appearance of the corresponding intestinal metaplastic mucosa (H&E-stained horizontal section, × 200).
Figure 4
Figure 4
Well differentiated adenocarcinoma. A: Endocytoscopic appearance of a well differentiated adenocarcinoma. The glands were branched irregularly and the width of the lumen varied. The epithelium was arranged in a disorderly fashion. The nuclei were deeply stained and pseudostratified; B: Histological appearance of the corresponding well-differentiated adenocarcinoma (H&E-stained horizontal section, × 200).
Figure 5
Figure 5
Poorly differentiated adenocarcinoma. A: Endocytoscopic appearance of a poorly differentiated adenocarcinoma. The tubular architecture was lost, and the nuclei were hyper-chromatic and anisokaryotic; B: Histological appearance of the corresponding poorly differentiated adenocarcinoma (H&E-stained horizontal section, × 200).
Figure 6
Figure 6
Signet ring cell carcinoma. A: Endocytoscopic appearance of a signet ring cell carcinoma. Slit-like glandular lumens surrounded by regularly arranged foveolar cells were observed, a finding consistent with normal mucosa in endocytoscopy; B: Histological appearance of the corresponding signet ring cell carcinoma (H&E-stained horizontal section, × 200). Signet-ring cells were observed in the lamina propria (circle), but not exposed on the mucosal surface.
See this image and copyright information in PMC

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