title: Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer.
abstract: OBJECTIVE
  It is difficult to accurately diagnose patients with depressed gastric mucosal cancer based on conventional white-light imaging (C-WLI) endoscopy. We compared the real-time diagnostic yield of C-WLI for small, depressed gastric mucosal cancers with that of magnifying narrow-band imaging (M-NBI).
  
  
  METHODS
  We performed a multicenter, prospective, randomized, controlled trial of patients with undiagnosed depressed lesions ≤10 mm in diameter identified by esophagogastroduodenoscopy. Patients were randomly assigned to groups that were analyzed by C-WLI (n = 176) or M-NBI (n = 177) immediately after detection; the C-WLI group received M-NBI after C-WLI. We compared the diagnostic accuracy, sensitivity, and specificity between C-WLI and M-NBI and assessed the diagnostic yield of M-NBI conducted in conjunction with C-WLI.
  
  
  RESULTS
  Overall, 40 gastric cancers (20 in each group) were identified. The median diagnostic values for M-NBI and C-WLI were as follows: accuracy, 90.4% and 64.8%; sensitivity, 60.0% and 40.0%; and specificity, 94.3% and 67.9%, respectively. The accuracy and specificity of M-NBI were greater than those of C-WLI (P < .001); the difference in sensitivity was not significant (P = .34). The combination of M-NBI with C-WLI significantly enhanced performance compared with C-WLI alone; accuracy increased from (median) 64.8% to 96.6% (P < .001), sensitivity increased from 40.0% to 95.0% (P < .001), and specificity increased from 67.9% to 96.8% (P < .001).
  
  
  CONCLUSIONS
  M-NBI, in conjunction with C-WLI, identifies small, depressed gastric mucosal cancers with 96.6% accuracy, 95.0% sensitivity, and 96.8% specificity. These values are better than for C-WLI or M-NBI alone.
authors.affiliation: Department of Multidisciplinary Cancer Treatment, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Ezoe
authors.forename: Manabu
authors.initials: M
authors.lastname: Muto
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Hisashi
authors.initials: H
authors.lastname: Doyama
authors.forename: Kenshi
authors.initials: K
authors.lastname: Yao
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kaneko
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kawahara
authors.forename: Chizu
authors.initials: C
authors.lastname: Yokoi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sugiura
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Yoshibumi
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging / Q000379:methods*; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis*