Ji XW, Lin J, Wang YT, Ruan JJ, Xu JH, Song K, Mao JS. Endoscopic detection and diagnostic strategies for minute gastric cancer: A real-world observational study. World J Gastrointest Oncol 2024; 16(8): 3529-3538 [PMID: 39171159 DOI: 10.4251/wjgo.v16.i8.3529]
Corresponding Author of This Article
Jian-Shan Mao, MD, PhD, Chief, Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. jshmao@zju.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
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/
World J Gastrointest Oncol. Aug 15, 2024; 16(8): 3529-3538 Published online Aug 15, 2024. doi: 10.4251/wjgo.v16.i8.3529
Endoscopic detection and diagnostic strategies for minute gastric cancer: A real-world observational study
Xiao-Wei Ji, Jie Lin, Yan-Ting Wang, Jing-Jing Ruan, Jing-Hong Xu, Kai Song, Jian-Shan Mao
Xiao-Wei Ji, Jie Lin, Yan-Ting Wang, Jing-Jing Ruan, Jian-Shan Mao, Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Jing-Hong Xu, Kai Song, Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Co-first authors: Xiao-Wei Ji and Jie Lin.
Author contributions: Ji XW and Lin J participated in data validation, analysis, and drafted the initial manuscript; Wang YT and Ruan JJ supervised the study and revised the manuscript; Xu JH and Song K performed pathological diagnosis; Mao JS was the guarantor who designed the study.
Supported bythe National Science Foundation Committee of China, No 81372348; and Clinical Research Fund Project of Zhejiang Medical Association, No 2020ZYC-A10.
Institutional review board statement: The study was approved by the Research Ethics Committee of The Second Affiliated Hospital of Zhejiang University School of Medicine (Protocol No. 2022/0502).
Informed consent statement: Informed consent was waived after evaluation by the Research Ethics Committee.
Conflict-of-interest statement: The manuscript has been approved by all of the authors and there are no conflicts of interest.
Data sharing statement: The data presented in this study are available from the corresponding author upon reasonable request at jshmao@zju.edu.cn.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Shan Mao, MD, PhD, Chief, Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. jshmao@zju.edu.cn
Received: April 24, 2024 Revised: May 26, 2024 Accepted: June 18, 2024 Published online: August 15, 2024 Processing time: 105 Days and 14 Hours
Abstract
BACKGROUND
Minute gastric cancers (MGCs) have a favorable prognosis, but they are too small to be detected by endoscopy, with a maximum diameter ≤ 5 mm.
AIM
To explore endoscopic detection and diagnostic strategies for MGCs.
METHODS
This was a real-world observational study. The endoscopic and clinicopathological parameters of 191 MGCs between January 2015 and December 2022 were retrospectively analyzed. Endoscopic discoverable opportunity and typical neoplastic features were emphatically reviewed.
RESULTS
All MGCs in our study were of a single pathological type, 97.38% (186/191) of which were differentiated-type tumors. White light endoscopy (WLE) detected 84.29% (161/191) of MGCs, and the most common morphology of MGCs found by WLE was protruding. Narrow-band imaging (NBI) secondary observation detected 14.14% (27/191) of MGCs, and the most common morphology of MGCs found by NBI was flat. Another three MGCs were detected by indigo carmine third observation. If a well-demarcated border lesion exhibited a typical neoplastic color, such as yellowish-red or whitish under WLE and brownish under NBI, MGCs should be diagnosed. The proportion with high diagnostic confidence by magnifying endoscopy with NBI (ME-NBI) was significantly higher than the proportion with low diagnostic confidence and the only visible groups (94.19% > 56.92% > 32.50%, P < 0.001).
CONCLUSION
WLE combined with NBI and indigo carmine are helpful for detection of MGCs. A clear demarcation line combined with a typical neoplastic color using nonmagnifying observation is sufficient for diagnosis of MGCs. ME-NBI improves the endoscopic diagnostic confidence of MGCs.
Core Tip: Minute gastric cancers (MGCs) represent the incipient stage of GC; therefore, they may be missed during endoscopy because the maximum diameter is ≤ 5 mm. Narrow-band imaging secondary observation combined with indigo carmine third observation could detect MGCs missed by white light endoscopy. A lesion with a clear demarcation line and a typical neoplastic color using nonmagnifying observation can be diagnosed as MGCs.
