Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
In vivo histological diagnosis for gastric cancer using endocytoscopy
Issei Tsurudome, Ryoji Miyahara, Kohei Funasaka, Kazuhiro Furukawa, Masanobu Matsushita, Takeshi Yamamura, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima, Osamu Watanabe, Masato Nakaguro, Akira Satou, Yoshiki Hirooka, Hidemi Goto
Issei Tsurudome, Ryoji Miyahara, Kohei Funasaka, Masanobu Matsushita, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima, Osamu Watanabe, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
Kazuhiro Furukawa, Takeshi Yamamura, Yoshiki Hirooka, Department of Endoscopy, Nagoya University Hospital, Nagoya 466-8560, Japan
Masato Nakaguro, Akira Satou, Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya 466-8560, Japan
Akira Satou, Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
Author contributions: Tsurudome I and Miyahara R designed and performed the research; Tsurudome I, Miyahara R, Funasaka K, Furukawa K, Matsushita M, Yamamura T, Ishikawa T, Ohno E, Nakamura M, Kawashima H and Watanabe O collected the data; Tsurudome I, Nakaguro M and Satou A analyzed the data; Tsurudome I and Miyahara R wrote the paper; Hirooka Y provided the critical review of the manuscript; Goto H provided administrative support and supervised the study.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Nagoya University Hospital.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ryoji Miyahara, MD, PhD, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan. myhr@med.nagoya-u.ac.jp
Telephone: +81-52-744-2172 Fax: +81-52-744-2180
Received: June 28, 2017
Peer-review started: June 28, 2017
First decision: July 27, 2017
Revised: August 12, 2017
Accepted: September 6, 2017
Article in press: September 5, 2017
Published online: October 7, 2017
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.
Core tip: Endocytoscopy, which allows for ultra-high-magnifying observation of the gastrointestinal mucosa, has recently been developed, enabling the visualization of the gastrointestinal mucosa at resolutions approaching those of histology. Although the usefulness of virtual biopsy using endocytoscopy in the diagnosis of esophageal cancer, colorectal cancer, lung cancer and ulcerative colitis has been reported, few studies are available on the diagnosis of gastric cancer. This study showed the usefulness of virtual biopsy using endocytoscopy by comparing the in vivo endocytoscopic and histopathological images of gastric cancers.
