Usefulness of Non-Magnifying Narrow-Band Imaging in Screening of Early Esophageal Squamous Cell Carcinoma: A Prospective Comparative Study Using Propensity Score Matching

Abstract

OBJECTIVES:The usefulness of non-magnifying endoscopy with narrow-band imaging (NBI; NM-NBI) in the screening of early esophageal squamous cell carcinoma (SCC) and high-grade intraepithelial neoplasia (HGIN) remains unclear. Here, we aimed to compare NM-NBI and chromoendoscopy with iodine staining (CE-Iodine) in terms of the diagnostic performance, and to evaluate the usefulness of NM-NBI in detecting early esophageal SCC.METHODS:We prospectively enrolled 202 consecutive patients (male/female=180/22; median age, 67 years) with high-risk factors for esophageal SCC. All patients received endoscopic examination with NM-NBI and CE-Iodine to screen for early esophageal SCC or HGIN. We conducted the examinations sequentially, and calculated the accuracy, sensitivity, and specificity through a per-lesion-based analysis. A propensity score matching analysis was performed to reduce the effects of selection bias, and we compared the respective outcomes according to NM-NBI and CE-Iodine after matching.RESULTS:The accuracy, sensitivity, and specificity of NM-NBI were 77.0, 88.3, and 75.2%, respectively, and those for unstained areas by CE-Iodine were 68.0, 94.2, and 64.0, respectively. The accuracy and specificity of NM-NBI were superior to those of CE-Iodine (P=0.03 and P=0.01, respectively). However, the sensitivity did not significantly differ between NM-NBI and CE-Iodine (P=0.67). The accuracy and specificity of NM-NBI before matching were superior to those of CE-Iodine after matching (P=0.04 and P=0.03).CONCLUSIONS:NM-NBI was useful and reliable for the diagnosis of esophageal SCC and can be a promising screening strategy for early esophageal SCC.

Routine endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma: a prospective study

“…Recent advances in image‐enhanced endoscopy, such as NBI and LCE, enabled the early detection of esophageal cancer and dysplasia, which can be treated with endoscopic resection . NBI is a useful and noninvasive tool for detecting ESCN, with benefits of enhanced visualization of intrapapillary capillary loop patterns . LCE can be used to detect dysplastic lesions that go unnoticed with conventional WLE, which could alter the treatment plan for some patients .…”

An Asian consensus on standards of diagnostic upper endoscopy for neoplasia

“…When non-magnifying NBI was compared with iodine chromoendoscopy for the detection of oesophageal SCC, NBI demonstrated higher accuracy (77% vs 68%, P=0.03) and specificity (75.2% vs 64%, P=0.01) 95. In the opinion of the expert panel, IEE can achieve better delineation of the tumour extent for superficial oesophageal neoplasia.…”

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

“…Indeed, NBI seems to have a better sensitivity for superficial esophageal SCC when compared with WL imaging (97 vs. 55%, p < 0.01) [12-14]. Regarding the comparison between NBI and Lugol chromoendoscopy, three studies found that NBI and ME-NBI have an increased accuracy and specificity when compared with Lugol, although the sensitivity is similar between the two techniques [15-17]. These findings were also confirmed in two recent meta-analyses [18].…”