Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia.
BACKGROUND
The aim of this study was to define the reproducibility and accuracy of magnification chromoendoscopy for the diagnosis of lesions associated with gastric cancer (intestinal metaplasia and dysplasia).


METHODS
A total of 136 patients with previously diagnosed lesions and 5 gastrectomy specimens were studied. Endoscopic examination was performed with a magnification endoscope after methylene blue (1%) spraying. According to differences in color and mucosal pattern, groups and subgroups of endoscopic images were defined, and biopsies taken (n = 462). Five endoscopists were asked to classify individually 2 endoscopic images per subgroup on 2 separate occasions.


RESULTS
Three groups of endoscopic images were defined: nonmetaplastic, nondysplastic mucosa (I); metaplastic mucosa (II); and dysplastic mucosa (III). Ten subgroups were defined according to pit pattern: round small (IA), round and tubular small (IB), coarse round (IC), and course round pits with a straight pit (ID); blue irregular marks (IIA), blue round and tubular pits (IIB), blue villi (IIC), and blue small pits (IID); and loss of clear pattern, with depression (IIIA) or with slight elevation (IIIB). The kappa statistic for intraobserver agreement on the classification of endoscopic images in groups was 0.86; for interobserver agreement, it was 0.74. For classification into subgroups, kappa values ranged from 0.48 to 0.78. For 85% of the areas classified endoscopically as Group I (n = 146), no mucosal lesions or gastritis was described at histologic examination; for 83% of those in Group II (n = 198), intestinal metaplasia was found. Subgroups IIA and IIB were more often associated with complete intestinal metaplasia (62%), and IIC and IID with incomplete metaplasia (67%); in Group III (n = 118), dysplasia was diagnosed histopathologically in 33%. For the diagnosis of dysplasia, specificity was 81% (95% CI [77%, 85%]) and negative predictive value 99% (95% CI [99%, 100%]).


CONCLUSIONS
Gastric endoscopic patterns with chromoendoscopy and magnification seem reproducible and valid for the diagnosis of lesions associated with gastric cancer. This procedure may improve the follow-up of individuals at high-risk of gastric cancer, at least for the exclusion of severe lesions.
Dinis-Ribeiro
Mário
M
Instituto Português de Oncologia Francisco Gentil, Centro do Porto, Faculdade de Medicina do Porto, Hospital de S. João, Portugal.
da Costa-Pereira
Altamiro
A
Lopes
Carlos
C
Lara-Santos
Lúcio
L
Guilherme
Mateus
M
Moreira-Dias
Luís
L
Lomba-Viana
Helena
H
Ribeiro
Armando
A
Santos
Costa
C
Soares
José
J
Mesquita
Nuno
N
Silva
Rui
R
Lomba-Viana
Rafael
R
D003116:Color; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D008679:Metaplasia; D015588:Observer Variation; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology