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Laparoscopic Narrow-Band Imaging for the Diagnosis of Peritoneal Metastasis in Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Staging laparoscopy (SL) is often used to diagnose peritoneal metastasis in patients with advanced gastric cancer, but accurate detection of metastasis can be difficult. We evaluated the usefulness of laparoscopic narrow-band imaging (NBI) versus conventional laparoscopic white-light imaging (WLI) for the diagnosis of peritoneal metastasis.

Methods

We excised 37 white nodules from the parietal peritoneum of 26 patients with gastric cancer and suspected peritoneal metastasis. The WLI and NBI findings were compared with the pathological findings. All the peritoneal lesions examined were observed as white nodules on WLI. Intranodular vessels were evaluated by WLI and NBI for (1) vessel dilatation, (2) vessel tortuousness, (3) vessel heterogeneity, and (4) brown spots.

Results

Each individual abnormal finding had a diagnostic accuracy of less than 79 % with or without NBI. Detection of any one abnormal finding had a sensitivity, specificity, and accuracy of 47.8, 85.7, and 62.2 %, respectively, on WLI and 91.3, 71.4, and 83.8 %, respectively, on NBI, for detection of peritoneal metastasis. Detection of any one abnormal finding on NBI plus clear demarcation of the nodule on WLI had a sensitivity of 91.3 %, specificity of 92.9 %, and accuracy of 91.9 % for detection of peritoneal metastasis. Pathological examination showed that a brown spot detected on NBI correlated with dilated vessels around cancer cells. Vascular endothelial growth factor was expressed in 76.2 % of peritoneal metastases.

Conclusions

NBI was more sensitive for the detection of dilated vessels than WLI. NBI could be a useful tool for the diagnosis of peritoneal metastasis during SL.

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DISCLOSURES

Hirotoshi Kikuchi, Kinji Kamiya, Yoshihiro Hiramatsu, Shinichiro Miyazaki, Masayoshi Yamamoto, Manabu Ohta, Satoshi Baba, and Hiroyuki Konno have no conflicts of interest or funding to disclose.

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Authors and Affiliations

  1. Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Hirotoshi Kikuchi MD, PhD, Kinji Kamiya MD, PhD, Yoshihiro Hiramatsu MD, PhD, Shinichiro Miyazaki MD, Masayoshi Yamamoto MD, PhD & Hiroyuki Konno MD, PhD

  2. Oncology Center, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Manabu Ohta MD, PhD

  3. Department of Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Satoshi Baba MD, PhD

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  1. Hirotoshi Kikuchi MD, PhD
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  2. Kinji Kamiya MD, PhD
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  8. Hiroyuki Konno MD, PhD
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Correspondence to Hirotoshi Kikuchi MD, PhD.

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Kikuchi, H., Kamiya, K., Hiramatsu, Y. et al. Laparoscopic Narrow-Band Imaging for the Diagnosis of Peritoneal Metastasis in Gastric Cancer. Ann Surg Oncol 21, 3954–3962 (2014). https://doi.org/10.1245/s10434-014-3781-8

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  • DOI: https://doi.org/10.1245/s10434-014-3781-8

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