A Case of Superficial Primary Malignant Melanoma of the Esophagus Detected and Treated at Stage 0.

The patient was a 79-year-old male. At three years and eight months after his initial presentation, upper gastrointestinal endoscopy revealed a black-flattened elevated lesion in the middle third of the esophagus, which was diagnosed as malignant melanoma on biopsy. No lymph node or distant metastasis was found. A diagnosis of cT1bN0M0 Stage I was thus made. We performed a robot-assisted, minimally invasive esophagectomy and D2 dissection. The postoperative diagnosis was pT1a (MM), N0, M0, vascular invasion+, stage 0. The patient was recurrence-free for 14 months after surgery. We presume that an aggressive biopsy diagnosis is important for the early detection of malignant melanoma.

Performance of Computer-Aided Detection and Diagnosis of Colorectal Polyps Compares to That of Experienced Endoscopists.

BACKGROUND: Differential diagnosis of neoplasms and non-neoplasms is crucial in ensuring appropriate and proper medical management for patients undergoing colonoscopy. Diagnostic ability can vary, depending on the colonoscopist's experience. To overcome this issue, artificial intelligence (AI) may be effective. AIMS: To assess the performance of a computer-aided detection (CADe) and a computer-aided diagnosis (CADx) system for the detection and characterization of colorectal polyps by comparing their data with those of experienced endoscopists. METHODS: This retrospective, still image-based validation study was conducted at three Japanese medical centers. A total of 579 white-light images (WLIs) and 605 linked color images (LCIs) were used for testing the CADe and 308 WLIs and 296 blue laser/light images (BLIs) for testing the CADx. The performances of the CADe and CADx systems were assessed and compared with the correct answers provided by three experienced endoscopists. RESULTS: CADe in WLI demonstrated a sensitivity of 94.5% (95% confidence interval (CI), 92.0-96.9%) and a specificity of 87.2% (84.5-89.9%). CADe in LCI demonstrated a sensitivity of 96.0% (93.9-98.1%) and a specificity of 85.1% (82.3-87.9%). CADx in WLI demonstrated a sensitivity of 95.5% (92.9-98.1%) and a specificity of 84.4% (73.4-91.5%), resulting in an accuracy of 93.2% (90.4-96.0%). CADx in BLI showed a sensitivity of 96.3% (93.9-98.7%) and a specificity of 88.7% (77.1-95.1%), resulting in an accuracy of 94.9% (92.4-97.4%). CONCLUSIONS: CADe and CADx demonstrated sufficient diagnostic performance to support the use of an AI system.

Digestive disease management in Japan: a report on the 6th diagnostic pathology summer fest in 2012.

The 6th Diagnostic Pathology Summer Fest, held in Tokyo on August 25-26, 2012, opened its gates for everyone in the medical profession. Basic pathology training can contribute to the improvement of algorithms for diagnosis and treatment. The 6th Summer Fest with the theme 'Pathology and Clinical Treatment of Gastrointestinal Diseases' was held at the Ito International Research Center, The University of Tokyo. On August 25, 'Treatment of Early Gastrointestinal Cancer and New Guidelines' was discussed in the first session, followed by 'Biopsy Diagnosis of Digestive Tract: Key Points of Pathological Diagnosis for Inflammation and Their Clinical Significance' in the second session. On August 26, cases were discussed in the third session, and issues on pathological diagnosis and classification of neuroendorcrine tumor in the fourth session. The summaries of speeches and discussions are introduced along with the statements of each speaker. This meeting was not a formal evidence-based consensus conference, and 20 experts gave talks on their areas of specialty. Discussion was focused on how the management strategy should be standardized on the algorithm of patient care.

[Gastrography].

This article describes a method of gastrographic examination and its use in diagnosis of gastric cancer. Gastrography includes four examination methods: barium filled, mucosal relief, compression, and double contrast studies. Diagnosis by gastrography is based on the histogenesis of gastric cancer. Depressive undifferentiated type cancer, which arises from the fundic gland mucosa, shows a clear depressed border between the carcinoma and normal mucosa. The surface of the cancer also shows granular changes in regenerative mucosa. Depressive differentiated type cancer, which develops from intestinal metaplastic mucosa, has a smooth mucosal surface and shows depression of the cancer accompanied with slightly elevated margins. Most elevated type gastric cancers are intramucosal cancers of differentiated type carcinoma. However, cancers showing elevation of more than 3cm would be predicted to show invasive potential by conventional statistical gastric cancer studies.

[Present and future state of cancer screening for esophageal cancer and gastric cancer].

Recently, endoscopic examinations have played a major role in the diagnosis and treatment in the field of gastroenterology. It is considered that endoscopy would be an important examination for cancer screening of the esophagus and the stomach. However, endoscopic services for cancer screening are in short supply. Furthermore, we have to take the complications and poor economic benefits of endoscopy in to consideration when we apply it as a practical cancer screening system. Thus, an effective primary screening system must be provided for the endoscopic screening of cancer of the esophagus and the stomach. People with a defect in aldehyde dehydrogenase-2(ALDH2)should be distinguished by their facial flushing in drinking and for their high risks of esophageal cancer. In cases with gastric cancer screening by endoscopy, an x-ray study is expected to be a primary screening because of its efficacy. It already has been recommended for population-based screening in Japanese guidelines for gastric cancer screening. In cases with opportunistic screening of gastric cancer, patients should be allowed to choose from several studies such as the x-ray study, direct endoscopy, and the so-called high risk screening of gastric cancer for estimating risks and planning of screening for gastric cancer.

Mass screening for gastric cancer: how to select patients for endoscopic examination.

BACKGROUND: Gastroendoscopy (GS) has recently been applied in mass screening for gastric cancer, instead of X-ray examination, to improve the quality of the screening. However, as there are currently limitations in the application of endoscopy in all types of screening for gastric cancer, patients must be selected for mass screening by endoscopy. We investigated how to select individuals for endoscopic examination of gastric cancer screening and the effectiveness of X-ray primary screening before endoscopy. METHODS: All 7942 patients who underwent upper endoscopy for gastric cancer screening at our hospital between April 2005 and March 2008 were divided into two groups: an X-ray screening group (2782 subjects, endoscopy following primary X-ray screening), and a GS direct group (5160 subjects, endoscopy only). RESULTS: Thirty-seven carcinomas were detected among the 2782 subjects in the X-ray screening group undergoing endoscopy, representing a cancer detection rate of 1.33%. In the GS direct group, 23 carcinomas were detected in the 5160 subjects undergoing endoscopy, representing a cancer detection rate of 0.45%. However, our results suggested that the gastric cancer detection rate by endoscopy was three times higher when it was performed following X-ray screening. CONCLUSION: There are various conflicting demands for future screening. Our results suggest that it is appropriate to perform an initial X-ray examination followed by endoscopy in prospective screening for gastric cancer.