Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9156
Peer-review started: February 13, 2015
First decision: March 26, 2015
Revised: April 10, 2015
Accepted: May 27, 2015
Article in press: May 27, 2015
Published online: August 14, 2015
Processing time: 185 Days and 10.3 Hours
AIM: To evaluate the diagnostic effectiveness of white light endoscopy, magnifying endoscopy (ME), and magnifying narrow-band imaging endoscopy (ME-NBI) in detecting early gastric cancer (EGC).
METHODS: From March 2010 to June 2012, a total of 3616 patients received screening for gastric cancer by magnifying endoscopy. There were 3675 focal gastric lesions detected using conventional high definition white light endoscopy (HD-WLE) in four different referential hospitals that were recruited for further investigation using ME and ME-NBI. The images obtained from HD-WLE, ME, and ME-NBI were reviewed by four experienced endoscopists to evaluate their diagnostic effectiveness for EGC. The diagnosis of cancerous and non-cancerous lesions was conducted by evaluating the microvascular and microsurface patterns using the VS classification system. The final endoscopic diagnosis of each lesion was determined by consultation when a disagreement occurred. We used histopathological results as the gold standard for the diagnosis of EGC.
RESULTS: Among the 3675 lesions found, 1508 were validated by pathological findings as chronic gastritis, 1279 as chronic gastritis with intestinal metaplasia, 631 as low-grade neoplasia, and 257 as EGC. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of HD-WLE for the diagnosis of EGC were 71.2%, 99.1%, 85.5%, 97.9% and 97.1%, respectively. The results of ME for diagnosing EGC were 81.3%, 98.8%, 83.3%, 98.6% and 97.6%, respectively. The results of ME-NBI for the diagnosis of EGC were 87.2%, 98.6%, 82.1%, 99.0% and 97.8%, respectively. The diagnostic sensitivity and accuracy of paired ME and ME-NBI were significantly better than those of HD-WLE (P < 0.05).
CONCLUSION: HD-WLE has a relatively high accuracy for diagnosing EGC and is an effective screening tool. Further investigations of ME and ME-NBI are required to achieve superior accuracy.
Core tip: The early detection of gastric cancer is critical to improving prognosis. A variety of techniques, including magnifying endoscopy (ME) and magnifying narrow-band imaging endoscopy (ME-NBI), are used to identify early gastric cancer (EGC). Conventional white light endoscopy shows a relatively high specificity and accuracy in diagnosing EGC, which suggests that it should be a first-line endoscopic screening modality. However, further investigations using ME and ME-NBI are needed to achieve higher sensitivity and accuracy. Additionally, the ability to visualize microstructures in suspected gastric lesions could be significantly improved.