11
Advanced endoscopic imaging for gastric cancer assessment: New insights with new optics?

https://doi.org/10.1016/j.bpg.2014.10.002Get rights and content

Abstract

The most immediate strategy for improving survival of gastric cancer patients is secondary prevention through diagnosis of early gastric cancer either through screening or follow-up of individuals at high risk. Endoscopy examination is therefore of paramount importance and two general steps are to be known in assessing gastric mucosa – detection and characterization. Over the past decade, the advent of advanced endoscopic imaging technology led to diverse descriptions of these modalities reporting them to be useful in this setting. In this review, we aim at summarizing the current evidence on the use of advance imaging in individuals at high-risk (i.e., advance stages of gastric atrophy/intestinal metaplasia) and in those harbouring neoplastic lesions, and address its potential usefulness providing the readers a framework to use in daily practice. Further research is also suggested.

Introduction

Gastric cancer (GC) is the third most common cause of cancer deaths worldwide [1]. Although advanced GC is associated with poor prognosis and high mortality rates, early detection and treatment can result in 5-year survival rates as high as 96% [2]. Helicobacter pylori (H. pylori) is considered the most important risk factor for GC, by promoting a multi-step process of chronic gastritis, atrophy, intestinal metaplasia (IM), dysplasia and, finally, intestinal-type adenocarcinoma [3].

Secondary prevention through diagnosis of premalignant lesions and early gastric cancer (EGC) and screening or follow-up of individuals at high risk, are probably the most immediate strategies for improving survival ∗[4], [5]. Endoscopy examination is therefore of paramount importance. Identification of EGC, however, is difficult because of the lack of gross endoscopic signs. Moreover, despite the ability of experienced endoscopists to detect abnormalities, accurate differentiation among these gastric lesions for therapeutic decision making (ie, endoscopic resection, surgery, or follow-up) is extremely difficult [6], [7], and it is not surprising that ancillary techniques such as chromoendoscopy have been used for an accurate diagnosis of precancerous lesions and/or invasiveness of cancerous lesions [8], ∗[9], [10], but it lengthens the time of the endoscopic procedure and is not very popular among endoscopists, particularly in Western countries.

Over the past decade, the advent of new advanced endoscopic imaging technology, namely high-resolution with narrow band imaging (NBI) and flexible spectral imaging color enhancement (FICE), with or without magnification has revolutionized the endoscopic examination of the stomach. Diverse descriptions of these modalities have been published, reporting them to be useful for the accurate diagnosis and characterization of gastric precancerous conditions and lesions [11], [12], [13], [14], [15], ∗[16], [17].

Recently, the development of confocal laser endomicroscopy (CLE), endocytoscopy and molecular endoscopy enabled microscopic tissue analysis of the gastric mucosa at real time during endoscopy. This not only aims at imitation of histopathology, but is used to target few biopsies to regions of interest by multiple optical biopsies, and to guide endoscopic interventions [18].

In this review, we will assess GC detection and characterization in individuals at high-risk (i.e., advance stages of gastric atrophy/IM) and in those harbouring neoplastic lesions, and address the usefulness of advanced imaging techniques on that task.

Section snippets

Individuals at high-risk

Whether screening, especially that of the mass population, should be done remains controversial because the incidence of GC varies substantially among countries and within the same ethnic group. Even in a very high risk area, there is only some evidence that mass screening reduces mortality from GC [19]. Therefore, identification of high-risk populations to undergo screening is fundamental for the early detection of GC in countries with medium to low incidence [20].

Patients who have established

NBI (Narrow-band Imaging)

NBI is a novel optical image-enhancement technology that improves visualization of the vascular architecture and the surface microstructure of the superficial mucosa enabling tissue characterization, differentiation and diagnosis without the use of dyes [42]. Presently, two different systems are available: the 200 series using a rotating red-green-blue (RGB) filter and the 100 series, which uses a charge-coupled device (CCD) chip. Each system has its advantages, with the former producing

Algorithm – a stepwise approach to gastroscopy

In all every day gastroscopy observe in detail all gastric mucosa (Fig. 1).

  • -

    standardize observation is suggested by most training programmes and/or position statements (e.g. ESGE);

  • -

    special attention should be given to sufficient insufflation, cleaning of mucosa and retroflexion;

  • -

    interpret each gastroscopy as an opportunity to detect a GC;

  • -

    high-resolution scopes provide better inspection compared with conventional scopes.

First, detect early neoplastic lesions.

  • -

    A stepwise observation should be

Conflict of interest

Mário Dinis-Ribeiro has a research and training grant from Olympus Europe.

References (77)

  • T. Tahara et al.

    Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis

    Gastrointest Endosc

    (2009)
  • M. Rugge et al.

    Gastric epithelial dysplasia in the natural history of gastric cancer: a multicenter prospective follow-up study. Interdisciplinary Group on Gastric Epithelial Dysplasia

    Gastroenterology

    (1994)
  • K. Yao et al.

    Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer

    Gastrointest Endosc

    (2002)
  • K. Yao et al.

    Novel zoom endoscopy technique for visualizing the microvascular architecture in gastric mucosa: a new diagnostic endoscopic system for early gastric cancer

    Clin Gastroenterol Hepatol

    (2005)
  • K. Yao et al.

    Novel zoom endoscopy technique for diagnosis of small flat gastric cancer, a prospective, blind study

    Clin Gastroenterol Hepatol

    (2007)
  • T. Nagahama et al.

    Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video)

    Gastrointest Endosc

    (2011)
  • B. Hayee et al.

    Magnification narrow-band imaging for the diagnosis of early gastric cancer: a review of the Japanese literature for the Western endoscopist

    Gastrointest Endosc

    (2013)
  • D. Dias-Silva et al.

    The learning curve for narrow-band imaging in the diagnosis of precancerous gastric lesions by using Web-based video

    Gastrointest Endosc

    (2014)
  • T.D. Wang

    Confocal microscopy from the bench to the bedside

    Gastrointest Endosc

    (2005)
  • R. Kiesslich et al.

    Diagnosing Helicobacter pylori in vivo by confocal laser endoscopy

    Gastroenterology

    (2005)
  • J.N. Zhang et al.

    Classification of gastric pit patterns by confocal endomicroscopy

    Gastrointest Endosc

    (2008)
  • M. Goetz

    Molecular imaging in GI endoscopy

    Gastrointest Endosc

    (2012)
  • M.S. Hoetker et al.

    Molecular in vivo imaging of gastric cancer in a human-murine xenograft model: targeting epidermal growth factor receptor (EGFR)

    Gastrointest Endosc

    (2012)
  • J. Ferlay et al.

    GLOBOCAN 2012 v1.0, Cancer incidence and mortality Worldwide: IARC Cancer Base No. 11 [Internet]

    (2013)
  • R. Soetikno et al.

    Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract

    J Clin Oncol

    (2005)
  • P. Correa

    Human gastric carcinogenesis: a multistep and multifactorial process – first American Cancer Society Award Lecture on Cancer epidemiology and prevention

    Cancer Res

    (1992)
  • B.R. Lin et al.

    Endoscopic diagnosis of intestinal metaplasia of stomach – accuracy judged by histology

    Hepatogastroenterology

    (1999)
  • S. Redeen et al.

    Relationship of gastroscopic features to histological findings in gastritis and Helicobacter pylori infection in a general population sample

    Endoscopy

    (2003)
  • M. Areia et al.

    Estimation of the extent of gastric intestinal metaplasia by methylene blue chromoendoscopy

    Eur J Gastroenterol Hepatol

    (2008)
  • L.G. Capelle et al.

    Narrow band imaging for the detection of gastric intestinal metaplasia and dysplasia during surveillance endoscopy

    Dig Dis Sci

    (2010)
  • M. Kaise et al.

    Magnifying endoscopy combined with narrow-band imaging for differential diagnosis of superficial depressed gastric lesions

    Endoscopy

    (2009)
  • P. Pimentel-Nunes et al.

    A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions

    Endoscopy

    (2012)
  • C. Hamashima et al.

    The Japanese guidelines for gastric cancer screening

    Jpn J Clin Oncol

    (2008)
  • M. Areia et al.

    Screening for gastric cancer and surveillance of premalignant lesions: a systematic review of cost-effectiveness studies

    Helicobacter

    (2013)
  • P. Correa

    Chronic gastritis as a cancer precursor

    Scand J Gastroenterol

    (1984)
  • J.L. Whiting et al.

    The long term results of endoscopic surveillance of premalignant gastric lesions

    Gut

    (2002)
  • L. Atkins et al.

    Correlation of gross gastroscopic findings with gastroscopic biopsy in gastritis

    N Engl J Med

    (1956)
  • A. Bah et al.

    Endoscopic features of Helicobacter pylori-related gastritis

    Endoscopy

    (1995)
  • Cited by (7)

    View all citing articles on Scopus
    View full text