Magnifying narrow-band imaging endoscopy is superior in diagnosis of early gastric cancer.
OBJECTIVE
To evaluate the diagnostic effectiveness of white light endoscopy, magnifying endoscopy (ME), and magnifying narrow-band imaging endoscopy (ME-NBI) in detecting early gastric cancer (EGC).


METHODS
From March 2010 to June 2012, a total of 3616 patients received screening for gastric cancer by magnifying endoscopy. There were 3675 focal gastric lesions detected using conventional high definition white light endoscopy (HD-WLE) in four different referential hospitals that were recruited for further investigation using ME and ME-NBI. The images obtained from HD-WLE, ME, and ME-NBI were reviewed by four experienced endoscopists to evaluate their diagnostic effectiveness for EGC. The diagnosis of cancerous and non-cancerous lesions was conducted by evaluating the microvascular and microsurface patterns using the VS classification system. The final endoscopic diagnosis of each lesion was determined by consultation when a disagreement occurred. We used histopathological results as the gold standard for the diagnosis of EGC.


RESULTS
Among the 3675 lesions found, 1508 were validated by pathological findings as chronic gastritis, 1279 as chronic gastritis with intestinal metaplasia, 631 as low-grade neoplasia, and 257 as EGC. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of HD-WLE for the diagnosis of EGC were 71.2%, 99.1%, 85.5%, 97.9% and 97.1%, respectively. The results of ME for diagnosing EGC were 81.3%, 98.8%, 83.3%, 98.6% and 97.6%, respectively. The results of ME-NBI for the diagnosis of EGC were 87.2%, 98.6%, 82.1%, 99.0% and 97.8%, respectively. The diagnostic sensitivity and accuracy of paired ME and ME-NBI were significantly better than those of HD-WLE (P < 0.05).


CONCLUSIONS
HD-WLE has a relatively high accuracy for diagnosing EGC and is an effective screening tool. Further investigations of ME and ME-NBI are required to achieve superior accuracy.
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Hang
H
Yu
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Ai-Ming
AM
Yang
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Xing-Hua
XH
Lu
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Wei-Xun
WX
Zhou
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Fang
F
Yao
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Gui-Jun
GJ
Fei
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Tao
T
Guo
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Li-Qing
LQ
Yao
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Li-Ping
LP
He
Hang Yu, Ai-Ming Yang, Xing-Hua Lu, Fang Yao, Gui-Jun Fei, Tao Guo, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Bang-Mao
BM
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002681:China; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005773:Gastroscopy; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000473:pathology*
Early diagnosis; Gastric cancer; Gastric mucosa; Magnifying endoscopy; Narrow-band imaging