An efficient diagnostic strategy for small, depressed early gastric cancer with magnifying narrow-band imaging: a post-hoc analysis of a prospective randomized controlled trial.
BACKGROUND
We previously reported that magnifying narrow-band imaging (M-NBI) is a high-performance diagnostic tool for small, depressed gastric cancer. However, an efficient diagnostic strategy using endoscopic findings has not been fully elucidated.


OBJECTIVE
To identify the endoscopic findings that contribute to accurate diagnosis of small, depressed gastric cancer and to propose the ideal diagnostic approach to such lesions.


METHODS
Post-hoc analysis of a prospective, randomized, controlled trial.


METHODS
Nine hospitals.


METHODS
Three hundred fifty-three patients with small, depressed gastric lesions.


METHODS
In the M-NBI group (n = 177), cancer diagnosis was made with diagnostic criteria including a demarcation line (DL) and an irregular microvascular pattern (IMVP). In the conventional white-light imaging (C-WLI) group (n = 176), diagnostic criteria were both an irregular margin and a spiny depressed area. In the C-WLI group, M-NBI was performed after C-WLI diagnosis.


METHODS
The diagnostic performance of each criterion in M-NBI alone, C-WLI, and M-NBI after C-WLI was investigated.


RESULTS
M-NBI after C-WLI ultimately showed the best diagnostic performance in each diagnostic criterion. In M-NBI after C-WLI, evaluation of DL is technically easier than that of IMVP, and DL alone had a high sensitivity (95%) and negative predictive value (99%). The IMVP in M-NBI after C-WLI had a high sensitivity and specificity (95% and 96%, respectively) for diagnosis of cancer.


CONCLUSIONS
Lesions were limited to the small, depressed type.


CONCLUSIONS
For a diagnosis using M-NBI after C-WLI, identification of DL is the first step, and subsequent inspection of IMVP diagnosed by DL is an efficient strategy.
Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
Shinya
S
Yamada
Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
Hisashi
H
Doyama
Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Kenshi
K
Yao
Department of Gastrointestinal Oncology, Osaka Medical Cancer for Cancer and Cardiovascular Diseases, Osaka, Japan.
Noriya
N
Uedo
Department of Multidisciplinary Cancer Treatment, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Yasumasa
Y
Ezoe
Department of Gastroenterology, National Cancer Center Hospital, Tokyo, Japan.
Ichiro
I
Oda
Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan.
Kazuhiro
K
Kaneko
Division of Endoscopy, Okayama University, Okayama, Japan.
Yoshiro
Y
Kawahara
Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan.
Chizu
C
Yokoi
Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan.
Yasushi
Y
Sugiura
Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hideki
H
Ishikawa
Department of Gastrointestinal Oncology, Osaka Medical Cancer for Cancer and Cardiovascular Diseases, Osaka, Japan.
Yoji
Y
Takeuchi
Department of Gastroenterology, National Cancer Center Hospital, Tokyo, Japan.
Yutaka
Y
Saito
Department of Gastroenterology and Hepatology, Graduate school of Medicine, Kyoto University, Kyoto, Japan.
Manabu
M
Muto
D000368:Aged; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D062048:Narrow Band Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology
C-WLI; DL; ESD; IM; IMVP; M-NBI; SDA; conventional white-light imaging; demarcation line; endoscopic submucosal dissection; irregular margin; irregular microvascular pattern; magnifying narrow-band imaging; spiny depressed area