腺窦型胃腺瘤（FGA）发生在Helicobacter pylori（Hp）未感染个体中，并在形态上模拟未感染Hp的胃占位性增生息肉（HpN-GHP）。由于其低级别组织学异型性，FGA即使通过活检也常难以与HpN-GHP区分。我们进行了一项回顾性的研究，以建立一种内窥镜诊断指标。我们分析了41名患者的51个FGA和24名患者的36个HpN-GHP。所有病变均通过白光内窥镜（WLE）和放大内窥镜的狭带成像（NBIME）拍摄。三名专家和三名非专家分别评估了WLE和WLE+NBIME图像的六个病变诊断项目。我们分析了诊断项目和组织学特征之间的相关性，并比较了不同方式的诊断准确性。我们创建了一个综合诊断指数，并计算了其准确性和一致性。与HpN-GHP相比，FGA更常显示如下特征：明亮红色（94.1％对44.4％），外周增生（58.8％对8.3％），乳头/回旋样微结构（96.1％对33.3％），可见毛细血管（70.6％对38.9％）和界限线（98.0％对41.7％）（P < 0.05）.白区增厚仅在HpN-GHP中出现（52.8％）。专家的诊断准确度（WLE vs. WLE+NBIME的平均值）分别为90.8 ± 1.1％和93.5 ± 2.4％（P = 0.15），非专家为88.5 ± 3.0％和86.6 ± 3.5％（P = 0.51）。当满足四个标准（明亮红色、乳头/回旋样微结构、界限线和无白区增厚）时，FGA的敏感性和特异性分别为90.2％和94.4％，观察者间诊断一致性的kappa值≥0.6。综合诊断指数有助于FGA和HpN-GHP的可重复性、准确性的术前鉴别诊断。© 2023年，作者（s）在The International Gastric Cancer Association和The Japanese Gastric Cancer Association拥有独家许可。

Foveolar-type gastric adenoma (FGA) occurs in Helicobacter pylori (Hp)-naïve individuals and morphologically mimics Hp-naïve gastric hyperplastic polyp (HpN-GHP). FGA is often difficult to distinguish from HpN-GHP even by biopsy, due to its low-grade histologic atypia. We conducted a retrospective study to create an endoscopic diagnostic index.We analyzed 51 FGAs in 41 patients and 36 HpN-GHPs in 24 patients. All lesions were photographed by white-light endoscopy (WLE) and narrow-band imaging with magnification endoscopy (NBIME). Three experts and three non-experts reviewed the WLE and WLE+NBIME images to assess six items for lesion diagnosis. We analyzed correlations between the diagnostic items and histologic features and compared the diagnostic accuracy between modalities. We created a composite diagnostic index and calculated its accuracy and consistency.FGAs more frequently showed the following features vs. HpN-GHPs: bright-red color (94.1% vs. 44.4%), peripheral hyperplasia (58.8% vs. 8.3%), papillary/gyrus-like microstructure (96.1% vs. 33.3%), visible capillaries (70.6% vs. 38.9%), and demarcation line (98.0% vs. 41.7%) (P < 0.05). White-zone thickening was seen only in HpN-GHPs (52.8%). Diagnostic accuracy (mean, WLE vs. WLE+NBIME) was 90.8 ± 1.1% vs. 93.5 ± 2.4% (P = 0.15) for experts and 88.5 ± 3.0% vs. 86.6 ± 3.5% (P = 0.51) for non-experts. When satisfying the four criteria (bright-red color, papillary/gyrus-like microstructure, demarcation line, and absent white-zone thickening), sensitivity and specificity for FGA were 90.2% and 94.4%, respectively, with a kappa value of ≥ 0.6 for interobserver diagnostic agreement.Composite diagnostic index contributes to the reproducible, accurate, preoperative differential diagnosis of FGA and HpN-GHP.© 2023. The Author(s) under exclusive licence to The International Gastric Cancer Association and The Japanese Gastric Cancer Association.