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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Magnifying narrow-band imaging endoscopy is superior in diagnosis of early gastric cancer
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Wei-Xun Zhou, Fang Yao, Gui-Jun Fei, Tao Guo, Li-Qing Yao, Li-Ping He, Bang-Mao Wang
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Wei-Xun Zhou, Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Li-Qing Yao, Department of Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
Li-Ping He, Department of Gastroenterology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Bang-Mao Wang, Department of Gastroenterology, General Hospital of Tianjin Medical University, Tianjin 300052, China
Author contributions: Yang AM and Lu XH designed the research; Yao F, Fei GJ, Guo T, Yao LQ, He LP and Wang BM performed the research; Zhou WX performed the pathological analysis; and Yu H analyzed the statistics and wrote the paper.
Supported by Profession Specific Funded Projects in Standardization of Targeted Therapy and Cell Therapy and Applied Research of Early Diagnosis and Treatment for Cancer from Chinese Ministry of Health, No. 200902002.
Institutional review board statement: The study was reviewed and approved by the Peking Union Medical College Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors report no financial disclosures or conflict of interest.
Data sharing statement: Statistical code and dataset available from the corresponding author at yangaiming@medmail.com.cn. Consent of data sharing for participants was not obtained but the presented data are anonymized and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ai-Ming Yang, MD, Professor, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China.
yangaiming@medmail.com.cn
Telephone: +86-10-69155778 Fax: +86-10-69155778
Received: February 13, 2015
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.
