Role of magnifying endoscopy with narrow-band imaging in the diagnosis of noninvasive gastric neoplasia

Keisuke Tanaka; Shinya Maekawa; Takashi Yoshida; Tatsuya Yamaguchi; Shinichi Takano; Shuya Matsuda; Hiroshi Hayakawa; Yasuaki Ishida; Masaru Muraoka; Satoshi Kawakami; Yoshimitsu Fukasawa; Toru Kuno; Fumihiko Iwamoto; Yuya Tsukui; Shoji Kobayashi; Yukiko Asakawa; Hiroko Shindo; Mitsuharu Fukasawa; Yasuhiro Nakayama; Taisuke Inoue; Tomoyoshi Uetake; Masahiko Ohtaka; Tadashi Sato; Kunio Mochizuki; Nobuyuki Enomoto

doi:10.1002/jgh3.12513

Role of magnifying endoscopy with narrow-band imaging in the diagnosis of noninvasive gastric neoplasia

JGH Open. 2021 Feb 26;5(4):446-453. doi: 10.1002/jgh3.12513. eCollection 2021 Apr.

Authors

Keisuke Tanaka¹, Shinya Maekawa¹, Takashi Yoshida¹, Tatsuya Yamaguchi¹, Shinichi Takano¹, Shuya Matsuda¹, Hiroshi Hayakawa¹, Yasuaki Ishida¹, Masaru Muraoka¹, Satoshi Kawakami¹, Yoshimitsu Fukasawa¹, Toru Kuno¹, Fumihiko Iwamoto¹, Yuya Tsukui¹, Shoji Kobayashi¹, Yukiko Asakawa¹, Hiroko Shindo¹, Mitsuharu Fukasawa¹, Yasuhiro Nakayama¹, Taisuke Inoue¹, Tomoyoshi Uetake¹, Masahiko Ohtaka¹, Tadashi Sato¹, Kunio Mochizuki², Nobuyuki Enomoto¹

Affiliations

¹ First Department of Internal Medicine, Faculty of Medicine University of Yamanashi Yamanashi Japan.
² Department of Pathology, Faculty of Medicine University of Yamanashi Yamanashi Japan.

Abstract

Background and aim: There are no globally approved, distinguishing criteria enabling the classification of gastric adenomas and intramucosal carcinomas for differential diagnosis of noninvasive neoplasia (NIN).

Methods: Next-generation sequencing of 50 cancer-related genes was undertaken on 68 pathologically diagnosed microdissected gastric neoplasms (25 adenomas, 27 intramucosal carcinomas, and 16 submucosal carcinomas) obtained during endoscopic submucosal dissection. Findings from magnifying endoscopy with narrow-band imaging (M-NBI) of 52 NINs (the 25 adenomas and 27 intramucosal carcinomas) were compared with these data.

Results: Among all 68 neoplasms, the most frequently mutated genes were APC (76% in adenoma, 11.1% in intramucosal carcinoma, and 0% in submucosal carcinoma; P < 0.001) and TP53 in intramucosal and submucosal carcinomas (8% in adenoma, 48.1% in intramucosal carcinoma, and 75% in submucosal carcinoma; P < 0.001). Dividing the NIN neoplasms into five groups according to their mutational status (A1: APC mutation, A2: APC + α mutation, B: APC + TP53 mutation, C: TP53 mutation, D: no mutation in either APC or TP53) resulted in almost identical diagnoses by pathology and M-NBI for groups A1 (12/13, 92%), C (12/13, 92%), and D (16/17, 94%) but not for groups A2 (3/7, 43%) or B (0/2, 0%). This finding implies that NINs with the APC + α mutation have carcinoma-like endoscopic features despite most being judged as adenomas by pathology.

Conclusion: A diagnosis of NINs by pathology or M-NBI in the subset of gastric tumors classified by cancer-related mutations is not completely identical, suggesting the possible additional role of M-NBI in diagnosing NINs. Further studies are needed to confirm this.

Keywords: cancer‐related gene mutations; gastric adenoma; gastric intramucosal carcinoma; gastric noninvasive neoplasia; magnifying narrow‐band imaging.