title: [Clinical value of different magnifying chromoendoscopy methods in screening gastric precancerous lesions and early cancers].
abstract: OBJECTIVE
  To prospectively evaluate the clinical value of different magnifying chromoendoscopy(MCE) methods in screening gastric precancerous lesions and early cancers.
  
  
  METHODS
  Between March 2010 and October 2011, among all the patients aged over 40 who received esophagogastroduodenoscopy at Zhongshan hospital, Fudan University, suspicious lesion was detected in 699 patients, who were randomly assigned to three groups: epinephrine dye(n=240), indigo carmine dye(n=246), and acetic acid-indigo carmine mixture dye(n=213). Diagnosis was made according to surface patterns and microvessels of the lesion. Pathological diagnosis was used as the gold standard. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement(Kappa) test. McNemar Paired chi-square test was used to compare the concordance of three MCE methods, regular white light, magnification alone, and NBI magnifier before and after MCE.
  
  
  RESULTS
  Pathological examination showed inflammatory lesions in 415 patients, intestinal metaplasia in 190, low grade intra-epithelial neoplasia in 17, and high grade intra-epithelial neoplasia or early cancer in 77. The percentage of patients with consistent endoscopic and pathological diagnosis was 77.1%(185/240) for epinephrine dye, 80.5%(198/246) for indigo carmine dye, and 81.2%(173/213) for acetic acid-indigo carmine mixture dye. Kappa values were 0.579, 0.502, and 0.667 respectively(all P<0.01). For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 84.0%, 83.3%, and 92.9%, respectively, and the specificities were 98.6%, 97.3%, and 98.4%. All the three chromoendoscopy methods improved the diagnostic accuracy for precancerous lesions compared with conventional gastroscopic observation with white light(all P<0.01). Indigo carmine and acid-indigo carmine mixture dye improved the diagnostic accuracy of magnification alone(both P<0.05). There was no significant difference in diagnostic accuracy between each MCE method and magnifying NBI observation(all P>0.05).
  
  
  CONCLUSIONS
  NBI magnification and all the three MCE methods may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.
authors.affiliation: Fudan University, Shanghai, China.
authors.forename: Wei-feng
authors.initials: WF
authors.lastname: Chen
authors.forename: Quan-lin
authors.initials: QL
authors.lastname: Li
authors.forename: Ping-hong
authors.initials: PH
authors.lastname: Zhou
authors.forename: Mei-dong
authors.initials: MD
authors.lastname: Xu
authors.forename: Yi-qun
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Yun-shi
authors.initials: YS
authors.lastname: Zhong
authors.forename: Li-li
authors.initials: LL
authors.lastname: Ma
authors.forename: Wen-zheng
authors.initials: WZ
authors.lastname: Qin
authors.forename: Jian-wei
authors.initials: JW
authors.lastname: Hu
authors.forename: Ming-yan
authors.initials: MY
authors.lastname: Cai
authors.forename: Li-qing
authors.initials: LQ
authors.lastname: Yao
mesh_terms: D019342:Acetic Acid; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D004837:Epinephrine; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013194:Staining and Labeling / Q000379:methods*; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology
chemical_list: D004396:Coloring Agents; D007203:Indigo Carmine; D019342:Acetic Acid; D004837:Epinephrine