Narrow-band imaging of intestinal lymphomas

Mikihiro Fujiya, MD from the Division of Gastroenterology at Asahikawa Medical University in Asahikawa, Japan discusses this Original Article “Decreased numbers of vascular networks and irregular vessels on narrow-band imaging are useful findings for distinguishing intestinal lymphoma from lymphoid hyperplasia.”

In this study, we focused on the endoscopic features of intestinal malignant lymphoma using narrow-band imaging (NBI).

The gastrointestinal (GI) tract is known to be a major organ affected by both primary and secondary lymphoma. GI lymphomas are generally detected using conventional endoscopy, and are subsequently assessed based on the histological diagnosis of the biopsied specimens. However, making a differential diagnosis of intestinal lymphoma using conventional endoscopy and the histological findings is not always appropriate due to the difficulty in differentiating intestinal lymphoma from a hyperplastic response of the immune system. NBI is useful for assessing the capillary architecture and microvessels, which are frequently altered in histological specimens of malignant lymphoma. While the NBI findings of intestinal lymphoma have been described in several case reports, there have so far been no comparative studies assessing the efficacy of NBI for diagnosing intestinal lymphoma. We therefore conducted the present study in order to establish an endoscopic marker for malignant lymphoma by NBI.

Figure 2Figure 2. Decreased number of vascular networks in intestinal lymphoma. A, Faint red spots of systemic diffuse large B-cell lymphoma were detected in the colon on conventional endoscopy. B, Narrow-band imaging (NBI) revealed a small, whitish polyp. C, NBI revealed loss of vessel networks on the surface of the lesion. D, The histologic findings showed that lymphoma cells had infiltrated the lamina propria.

The present study shows that decreased vessel networks and irregular vessels are characteristic findings of intestinal lymphoma on NBI, and are therefore useful for differentiating intestinal lymphoma from benign lymphoid hyperplasia. We are currently conducting a multicenter comparative study to determine the efficacy of using these NBI findings for diagnosing intestinal lymphoma, and are also evaluating the inter- and intra-observer agreement of using these findings.

We hope that our findings will help to determine the optimal staging and thereby improve the efficacy of chemotherapy for malignant lymphoma.

Read the abstract for this article online here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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