Endoscopic Fine Examination for Early Cancer Screening in Patients With Gastric Low-grade Intraepithelial Neoplasia / 胃肠病学

ABSTRACT

Background: There are limitations in diagnosis based on common white light endoscopy (C-WLE) and guided forcep biopsy, which may lead to missing or misdiagnosis of early cancer. Aims: To evaluate the value of endoscopic fine examination for early cancer screening in patients with low-grade intraepithelial neoplasia (LGIN). Methods: Fifty patients with gastric LGIN diagnosed by C-WLE-based pathology from Aug. 2016 to Feb. 2019 at Changzhou Hospital of Traditional Chinese Medicine were enrolled. All the patients were reexamined three months later, of them 30 patients with typical morphological changes of Ⅱa, Ⅱc and Ⅱa+Ⅱc underwent endoscopic fine examination with magnifying endoscopy and narrow-band imaging (ME-NBI) for screening of early cancer. Endoscopic submucosal dissection (ESD) was also performed. Results: According to VS classification, 15 of the 30 patients having endoscopic fine examination performed were diagnosed as early cancer and the other 15 were diagnosed as non-cancerous lesions. Pathology based on biopsy under endoscopic fine examination revealed 10 high-grade intraepithelial neoplasia (HGIN)/gastric cancer and 20 LGIN/chronic inflammation. Pathology based on ESD revealed 14 HGIN/gastric cancer and 16 LGIN/chronic inflammation. Taken ESD pathology as the gold standard, the sensitivity and negative predictive value of endoscopic fine examination for diagnosis of early gastric cancer both were 100%, significantly higher than those of C-WLE- and ME-NBI-biopsy pathology (P<0.05). Conclusions: Endoscopic fine examination with ME-NBI can improve the detection of early cancer and prevent missing diagnosis in patients with gastric LGIN indicated by C-WLE-biopsy.