Predominantly histological diagnosis of mixed-type early gastric cancer using narrow-band imaging with magnifying endoscopy: A case report

Abstract

The criteria for curative resection after endoscopic resection of gastric cancer were recently revised in the Japanese Gastric Cancer Association's Japanese Gastric Cancer Treatment Guidelines 2014 (version 4). Mixed-type (predominantly differentiated-type) early gastric cancer smaller than 3cm in diameter, ulcer positive, and pT1a invasion depth is now indicated for endoscopic resection with curative intent. Consequently, making an accurate preoperative diagnosis of the pathological type has now become even more important. Since making a diagnosis on the basis of biopsy specimens is not always accurate for mixed-type early gastric cancer, diagnosing the pathological type using narrow-band imaging with magnifying endoscopy (NBI-ME) is useful.

A 68-year-old man underwent esophagogastroduodenoscopy for medical checkup. A depressed lesion with fold convergence was detected at the posterior side of the middle gastric body. Biopsy was obtained, and mixed early gastric cancer was suspected. Mixed-type (predominantly differentiated-type) early gastric cancer was accurately diagnosed by NBI-ME prior to the operation; therefore, it was successfully treated by curative resection with endoscopic submucosal dissection.