BACKGROUND: Iodine staining of the esophagus has been shown to be useful in detecting esophageal cancer. Narrow-band imaging (NBI), a new endoscopic lighting system, visualizes the microvasculature of the gastrointestinal (GI) mucosa.
OBJECTIVE: To evaluate the detectability of early esophageal cancer through screening endoscopy assisted by NBI as compared with that assisted by iodine staining.
DESIGN: A prospective comparative study.
SETTING: A single endoscopy unit.
PATIENTS: Fifty-six consecutive patients, consisting of 43 males and 12 females with a mean age of 63 years, most of whom were at high risk for esophageal cancer (heavy drinkers and smokers, history of cancer, especially of the head and neck, etc.).
INTERVENTION: Following conventional endoscopic observation, the esophagus was observed with NBI for possible cancerous lesions. The dark-brown areas on NBI were defined as NBI-positive areas. The esophageal mucosa was subsequently stained with 1.5% iodine, and the two findings were compared. Finally, the areas discolored by iodine staining were biopsied for histological evaluation. MAIN OUTCOME MEASUREMENTS: The sensitivity, specificity and positive predictive value (PPV) of the endoscopic detection of esophageal cancer.
RESULTS: Squamous cell carcinoma was detected in 7 out of 127 areas. The esophageal cancers detected were all both NBI-positive and discolored by iodine staining. The sensitivity, specificity and PPV of the NBI-positive areas for cancer were 100%, 52.8% and 10.4%, respectively. On the other hand, the discolored areas with iodine staining for cancer were 100%, 1.7% and 5.6%, respectively. NBI observation was significantly superior to iodine staining in detecting esophageal cancer (p<0.02).
CONCLUSIONS: Esophageal endoscopy assisted by NBI was more useful for detecting early esophageal cancer than that assisted by iodine staining.

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Aim. The metabolic syndrome and inadequate life style promote the development of cancer. We performed a cross-sectional study of the data collected in a health-check program to investigate the relationship among the metabolic syndrome, life style factors, gastric cancer (MK) and colon cancer (CK).
Methods. The subjects were 12,716 medical examinees (mean age: 47.3 years; 7,789 men and 4,927 women). We followed up the examinees. Those who were diagnosed with digestive cancer within 1 year of the initial health check were defined as having digestive cancer at baseline.
Results. Out of 120 examinees, 0.9% (87 men, or 1.1%; 33 women, or 0.7%) had cancer. Out of these, 33 (27 men, 6 women) had MK, and 27 (20 men, 7 women) had CK. Out of all examinees, 1,066 men (13.6%) and 58 women (1.2%) had the metabolic syndrome (MS). The MK-positive rate among the examinees with MS (0.4%, 4 examinees) was not higher than among those without (0.3%, 29 examinees; P=0.715). The CK-positive rate among the examinees with MS (0.5%, 6 examinees) was higher than among those without (0.2%, 21 examinees; P=0.034). The MK- and CK-positive rates among the examinees with impaired fasting glycemia (IFG) (0.6%, or 10 examinees, and 0.5%, or 8 examinees, respectively) were higher than among those without (MK: 0.2%, 23 examinees, and CK: 0.2%, 19 examinees ; P=0.005 and P=0.016, respectively). Logistic regression analysis indicated that IFG was a risk factor for MK (odds ratio, 2.84; 95% CI, 1.28-6.29; P=0.01) and CK (odds ratio, 2.58; 95% CI, 1.06-6.28; P=0.037) among the four components that constitute MS. Life style factors such as smoking, alcohol consumption, coffee consumption and exercise did not relate to MK or CK.
Conclusion. The metabolic syndrome is a significant risk factor for CK. IFG is a significant risk factor both for CK and MK.

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At our health care center, we have performed colorectal cancer screening through fecal occult blood testing for the purpose of health evaluation and promotion. We clarified the features of invasive colorectal cancer related to screening, and evaluated the problem of fecal occult blood testing. The subjects were 115 cases (male: 81, female: 34; average age: 58.1 years) with invasive cancer discovered through fecal occult blood testing. Thirty-eight subjects (33.0%) underwent screening for the first time, 16 subjects (13.9%) had undergone a screening two years or more previously, and 61 subjects (53.0%) had undergone screening every year. Of the subjects who had undergone screening every year, 37 had a negative fecal occult blood test result during the past two years and 24 cases had one or several positive fecal occult blood test results during the past two years. Three subjects with colorectal cancer invading into the SE underwent screening every year, and their assay values in the last two years were much lower than our cut-off value. It is suggested that some individuals use an incorrect method of fecal sampling. Therefore, we should make an effort to increase the follow-up rate of screening abnormalities first of all, and show the correct method of fecal sampling to all individuals who undergo colorectal cancer screening.

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BACKGROUND: Diffusion-weighted imaging (DWI) plays an important role in the detection of acute cerebral infarction. Recent technical developments have made DWI of the body feasible. Several studies have revealed the usefulness of DWI for the diagonois of breast cancer lymph node metastasis. We herein present cases of rectal cancer lymph node metastasis detected by DWI and discuss the efficacy of DWI for the diagnosis of rectal cancer lymph node metastasis.
MATERIALS AND METHODS: Twenty-seven patients with primary rectal cancer were preoperatively assessed by enhanced computed tomography (CT) and DWI. Magnetic resonance imaging (MRI) was performed using the 1.5-T imager (TOSHIBA). Two experienced digestive surgeons and one resident evaluated the involvement of regional lymph node metastasis. All operations were performed by these three doctors. The preoperative lymph node metastases were compared with the pathologic findings. Results: The CT and DWI lymph node metastasis coincided with the metastasis in 10 (58.8%)and 15 (88.2%) of 17 patients.
CONCLUSIONS: Through the use of DWI, pelvic lymph node involvement can be predicted with high accuracy, allowing preoperative identification of patients who need extensive surgery to escape recurrence.

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[in Japanese]

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