Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy

Table 1 The revised Vienna classification and clinical management

Category	Diagnosis	Clinical management
1	Negative for neoplasia	Optional follow-up
2	Indefinite for neoplasia	Follow-up
3	Mucosal low-grade neoplasia	Endoscopic resection or follow-up
	Low-grade adenoma
	Low-grade dysplasia
4	Mucosal high-grade neoplasia	Endoscopic or surgical local resection
	4.1 High-grade adenoma/dysplasia
	4.2 Noninvasive carcinoma (carcinoma in situ)
	4.3 Suspicious for invasive carcinoma
	4.4 Intramucosal carcinoma
5	Submucosal invasion by carcinoma	Surgical resection

Table 2 Relationship between endoscopic findings and final histological grade

	Category3(n = 121)		Category4(n = 275)		P value
Diameter (mean, mm)	11.5 ± 0.7		17.5 ± 0.7		< 0.0001
Location (portion)
First	23	19%	46	17%	NS
Second	92	76%	205	74%
Third or fourth	6	5%	24	9%
Color
Red	36	30%	124	45%	< 0.01
Isochromatic or white	85	70%	151	55%
Macroscopic type
0-I	29	24%	58	21%	NS
0-IIa	71	59%	170	62%
0-IIc	21	17%	47	17%

Color or macroscopic type is adopted from the predominant color when tumor showed multiple colors or macroscopic types. Data from Goda et al[5]. NS: Not significant.

Table 3 Comparison of magnifying endoscopy with narrow-band imaging findings according to vessel plus surface classification system and final histological grade in all 64 superficial non-ampullary duodenal epithelial tumors

	Diagnosis from ER specimens				P value
	Category 3(n = 27)		Category 4(n =37)
Demarcation line	27	100%	37	100%	1
Microvascular pattern; V
Regular/Absent	10/8	37%/30%	5/17	14%/46%	0.56
Irregular	9	33%	15	41%
Microsurface pattern; S
Regular	13	48%	4	11%	0.0008
Irregular	14	52%	33	89%

ER: Endoscopic resection.