ABSTRACT
Objective To investigate the effect of magnifying endoscopy with narrow-band imaging (ME-NBI) in diagnosis of early gastric neoplastic lesion. Methods 151 patients with suspected gastric cancer underwent endoscopic examination in digestive endoscopy center from January 2013 to June 2016 were enrolled the study. They firstly received conventional white light endoscopy (WLE), then ME-NBI (including intervening part) and targeted biopsy. And all patients were divided into early cancer group (high grade intraepithelial neoplasia, intramucosal carcinoma and submucosal carcinoma, n = 72) and non-early cancer group (low grade intraepithelial neoplasia, n = 79). The area under receiver-operating characteristic curve (AUC) was performed to evaluate prognostic value of each index in early cancer. Results The incidences of the demarcation line, irregular microvascular pattern, irregular microsurface pattern and increasing intervening part in early cancer group were significantly higher than that in the non-early cancer group (P < 0.05). The AUC of ME-NBI for early gastric cancer was 0.947 and higher than 0.832 of WLE. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index were 97.2%, 84.8%, 85.4%, 97.1% and 0.820, respectively. The AUC of intervening part for early gastric cancer was 0.907 and higher than 0.889 of the traditional VS classification, and AUC, sensitivity, specificity, PPV, NPV and Youden index of VS type combined with intervening part were 0.933, 95.8%, 83.5%, 84.1%, 95.7% and 0.794, respectively. Conclusions ME-NBI is an important method for diagnosis of early gastric cancer, and intervening part has the advantages of strong objectivity, simple and easy to operate, good repeatability, and it could be used to assist traditional VS classification in judging the nature of lesions.
ABSTRACT
Objective To investigate the value of intervening part (IP)ratio under magnifying endoscopy with narrow-band imaging (ME-NBI )in the diagnosis of early gastric neoplastic lesions. Methods From September 2012 to May 2015 ,a total of 124 patients with suspected superficial gastric neoplastic lesions under white light endoscope (WLI)were enrolled,87 male with mean age of (63.2 ± 7.9)years old and 37 female with mean age of (62.6±8.2)years old.All the enrolled patients received precision endoscopy examination,which were observed under WLI at first followed by ME-NBI.Vessel, surface classification and IP features of the lesions under WLI and ME-NBI were recorded,and targeted biopsies were performed.Patients received endoscopic submucosal dissection (ESD)or surgery according to lesions features,histopathological results.Agreement rate between WLI,VS classification with IP ratio and the histopathological results were analyzed.Chi-square test was performed for rate comparision Receiver operator characteristic (ROC)curve was drawn to compare the diagnostic accuracy in early gastriccancer (EGC)between WLI and ME-NBI.Results Among the 124 patients,a total of 118 patients completed precision endoscopy examination.A total of 162 lesions were detected,and 161 of which were analyzed.A total of 84 low grade intraepithelial neoplasia (LGIN),63 high grade intraepithelial neoplasia (HGIN), seven mucosal cancer and seven submucosal cacinoma were detected. The incidences of demarcation line (32.1 %(27/84)vs 96.1 %(74/77)),irregular microsurface pattern (45 .2%(38/84)vs 87.0%(67/77)),irregular-microvascular pattern (16.7%(14/84)vs 62.3%(48/77 )),increased gland tube density (48.8%(41/84)vs 85 .7%(66/77 ))and increased microvessel density (21 .4%(18/84)vs 80.5 %(62/77))of non-cacinoma lesions (LGIN)were significantly lower than those of cacinoma lesions (including HGIN, mucosa cancer and submucosa cacinoma ), and the differences were statistically significant (χ2 =67.6,29.1 ,33.5 ,22.9,53.7,all P <0.05).The sensitivities of WLI and ME-NBI in EGC diagnosis were 89.6% and 94.8%,respectively;the specificities were 61 .9% and 83.3%, respectively,area under curve (AUC)were 0.84 and 0.93,respectively.The diagnostic accuracy of ME-NBI in early gastric cancer was higher than that of WLI,and the difference was statistically significant (χ2 =49.0, P <0.01).The sensitivities of vessel plus surface (VS)classification and VS classification with IP ratio were 90.9% and 94.8%,respectively;and the specificities were 81 .0% and 83.3%,respectively;AUC were 0.89 and 0.93,respectively.The diagnostic sensitivity of vessel classification with IP ratio was higher than that of simple vessel classification,and the differnce was statistically significant (χ2 =41 .0, P <0.01).Conclusion Compared with WLI,the diagnostic accuracy of ME-NBI is higher in gastric superficial neoplasia lesions,and IP ratio is helpful in diagnosis of gastric superficial neoplasia lesions.