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Novelnarrow-bandimagingmagnifyingendoscopicclassificationforearlygastriccancerDigestiveandLiverDisease42(2010)AkiraYokoyama,HaruhiroInoue,HitomiMinami,YoshikiWada,YoshitakaSato,HitoshiSatodate,ShigeharuHamatani,Shin-eiKud(Differentiated-type)還是未分化型(undifferentiated-typeNarrow-bandimagingmagnifyingimageswereclassifiedintofourcategoriesbasedonabnormalmicrovascularpatternsandirregularitiesinthesuperficialglandularstructure:fine-networkpattern,corkscre ttern,intra-lobularlooppattern-1andintra-lobularlooppattern-2.網(wǎng)狀(fine-networkpattern) 螺絲狀 葉片內(nèi)線圈狀1(intra-lobularlooppattern- 葉片內(nèi)線圈狀2(intra-lobularlooppattern- FNPhasasmallglandularopeningtothemucosalsurfacewithanabnormalmesh-likeMVstructurethatencircleseachglandularopening.ILL-1hasavillousglandularstructurecontainingloop-likemicrovessels.InILL-2,thevilloushasbeguntobreakapart.InCSP,almostallglandularstructureshavedisappearedandtherearenumerousabnormalcorkscrew-likeves-sels.Amongstthedifferentiated-typeadenocarcinomalesions,fine-networkpattern,intra-lobularlooppattern-1,intra-lobularlooppattern-2andcorkscre tternwereobservedin15.7%,59.6%,24.2%and0.5%,respectively.Differentiated-typeadenocarcinomasmainlyexhibitedfine-networkpatternorintra-lobularlooppattern.Inundifferentiated-typeadenocarcinomalesions,intra-lobularlooppattern-2andcorkscre tternwereobservedin41.2%and58.8%,respectively.Therefore,undifferentiated-typeadenocarcinomaswereallclassifiedasintra-lobularlooppattern-2and FNPILL1ILL2CSPamildredelevatedlesiononthelessercurvatureoftheupperbodyinthestomach.NBImagnifyingendoscopyonmagnification(B,C)showsanabnormalmesh-likemicrovascularstructure(FNP)ontheelevatedaspect.Thepathologicalpicture(D,HEstaining)demonstrateswelldifferentiated-typeadeno-carcinomalocatedinthelaminapropriaofthestomach.(0-IIa)型早癌.Acaseofdepressedearlygastriccancer(0-IIc)showsILL-1ontheposteriorwallofthemiddlebodyinthestomach(A).NBImagnifyingendoscopy(B)andmag-nifyingendoscopywithcrystalvioletstaining(C)shownumerousmicrovesselsthatcanbeseeninsidethesurfaceglandularstructures(ILL-1).Thepathologicalpicture(D,HEstaining)demonstrateswelldifferentiated-typeadenocarcinomalocatedinthelaminapropriaoftheAcaseofdepressedearlygastriccancer(0-IIc)showsILL-2ontheposteriorwallofthemiddlebodyinthestomach(A).NBImagnifyingendoscopy(B)andmag-nifyingendoscopywithindigocarmine(C)onmagnificationshowvillousglandularstructurewithsignsofbreakingapartfromeachother(ILL-2),andthemicroves-selsinthebackgroundofavillousglandularstructureshowssignsofbreakingapartisCS-likemicrovessels.Thepathologicalpicture(D,HEstaining)demonstratesundifferentiated-typeadenocarcinomalocatedinthelaminapropriaoftheIfanundifferentiated-typeadenocarcinomaisdiagnosed,thelesionshouldbetreatedTheOlympus-EVISLUCERASPECTRUMsystemandahigh-resolutionmagnifyinguppergastrointestinalendoscope(GIF-H260Z,Olympus,Tokyo,Japan)wereusedinallcases.Thestructure–enhancementfunctionofthe processorwassetto6or8.Ahood(MB-162,Olympus,Tokyo,Japan.ELASTICTOUCH,Top,Tokyo,Japan)mountedonthetipofthescopeenabledtheoptimaldistanceof3mmtobemaintainedbetweenthemucosalsurfaceandthetipofthescopeunderhigh-powermagnification[1].Ini-tiallythelesionwasobservedcarefullywithoutmagnification.Theentirelesionwasthenexaminedsequentiallywithbothmoderateandhigherpowermagnification.Thiswastoensurethathigherpowermagnificationendoscopywasundertakenintheareapre-ciselywherethegastriccancerwaslocated.Thisisanessentialpartoftheassessmentasunderhigh-powermagnification,therangeoffocusisnarrowwithsmallvisualfieldthatmakesassessmentoftherelationshipbetweentheMVpatternandsurfaceglandularstruc-turedifficultifhighmagnificationisusedwithoututilisingmoderatemagnification.TheboundarybetweentheareaofboththeMVpatternandthesurfaceglandularstructureusingNBImag-nifyingendoscopywasdetermined,focussingthe“demarcationline” mendedbyYaoetal.[3].Next,partofthelesionobservedunderhigher-powermagnificationbyfocussingonthe“whitezone”asmendedbyYagietal.Inthisway,thesur-faceglandularstructurepatternofmanylesionscouldbeobservedclearlywithoutcrystalvioletstainin

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