Near-focus magnification and second-generation narrow-band imaging for early gastric cancer in a randomized trial

Abstract

Background Magnifying endoscopy with narrow-band imaging (NBI) is effective for the diagnosis of early gastric cancer (EGC). However, magnifying endoscopy is not yet popular globally because of the required level of skill and lack of availability. To overcome these problems, dualfocus endoscopy (standard-and near-focus (NF) modes) has been developed. In this study, we evaluated the diagnostic performance of NF with second-generation (2G)-NBI (NF-NBI) for the diagnosis of EGC.Methods This was a secondary analysis of a multicenter randomized controlled trial of 4523 high-risk patients who underwent gastroscopies at 13 institutions in Japan. Patients were randomly assigned to white-light imaging (WLI) followed by 2G-NBI or to 2G-NBI followed by WLI. Lesions suspicious for EGC, newly detected by nonmagnifying WLI or 2G-NBI, were subsequently observed with NF-NBI. All detected lesions were biopsied or resected. The diagnostic performance of NF-NBI was compared with the final histology. Results A total of 870 detected lesions (145 EGC, 725 non-EGC) were analyzed. Overall diagnostic performance for EGC using NF-NBI was accuracy 87.7%, sensitivity 60.7%, specificity 93.1%, positive predictive value 63.8%,

Diagnostic ability of magnification endoscope with narrow‐band imaging in screening esophagogastroduodenoscopy

“…In our study, M‐NBI helped to distinguish cancerous lesions from non‐cancerous ones, especially in the stomach and the duodenum, and to determine whether a biopsy was required. Similar to our results, recent studies reported that the diagnostic performance of ME with near‐focus ME tended to be high in patients with a high risk of gastric cancer 19,20 . Improving PPV with M‐NBI can contribute to the reduction of unnecessary biopsies, thereby making it possible to reduce the risk of biopsy‐related complications and improving time, cost, and labor requirements for formal histological analyses.…”

Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction

“…The classification system based on surface mucosal and vessel pattern is well established 353. In recent well-designed controlled studies, however, the second-generation NBI was not superior to high-definition WL endoscopy in detecting early GC 354 355. In contrast, considerably higher performance in detecting gastric neoplasia with another IEE modality, LCI has been reported from different institutions and countries,356–358 indicating promising role of this IEE in early gastric cancer surveillance.…”

Proposal of minimum elements for screening and diagnosis of gastric cancer by an international Delphi consensus

“…Several prospective studies have reported the efficacy of magnification endoscopy with NBI during screening or surveillance endoscopy in a real-time setting. [47][48][49][50][51][52] For newly detected suspicious lesions, the accuracy of diagnosis for GC was 88%-99%, sensitivity was 60%-93%, and specificity was 93%-100%. [47][48][49][50][51][52] A previous report showed that the use of magnification endoscopy improved positive predictive value for biopsy in routine EGD, which included many patients with surveillance EGD following endoscopic resection for early GC.…”

“…Several prospective studies have reported the efficacy of magnification endoscopy with NBI during screening or surveillance endoscopy in a real‐time setting 47–52 . For newly detected suspicious lesions, the accuracy of diagnosis for GC was 88%–99%, sensitivity was 60%–93%, and specificity was 93%–100% 47–52 .…”

“…[47][48][49][50][51][52] For newly detected suspicious lesions, the accuracy of diagnosis for GC was 88%-99%, sensitivity was 60%-93%, and specificity was 93%-100%. [47][48][49][50][51][52] A previous report showed that the use of magnification endoscopy improved positive predictive value for biopsy in routine EGD, which included many patients with surveillance EGD following endoscopic resection for early GC. 53 Diagnosis using magnification endoscopy with NBI has become an essential diagnostic modality in pre-treatment assessment in regards of characterization and to determine tumor extent.…”