title: Value of Magnifying Endoscopy With Narrow-Band Imaging and Confocal Laser Endomicroscopy in Detecting Gastric Cancerous Lesions.
abstract: Although the respective potentials of magnifying endoscopy with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE) in predicting gastric cancer has been well documented, there is a lack of studies in comparing the value and diagnostic strategy of these 2 modalities. Our primary aim is to investigate whether CLE is superior to ME-NBI for differentiation between gastric cancerous and noncancerous lesions. A secondary aim is to propose an applicable clinical strategy.We conducted a diagnostic accuracy study involving patients with suspected gastric superficial cancerous lesions. White light endoscopy, ME-NBI, and CLE were performed diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value between ME-NBI and CLE were assessed, as well as agreements between ME-NBI/CLE and histopathology.This study involved 86 gastric lesions in 82 consecutive patients who underwent white light endoscopy, ME-NBI, and CLE before biopsy. The accuracy, sensitivity, and specificity for ME-NBI were 93.75%, 91.67%, and 95.45%, compared with 91.86%, 90%, and 93.48%, respectively, for CLE, for discrimination cancerous/noncancerous lesion (all P > 0.05). For undifferentiated/differentiated adenocarcinoma, CLE had a numerically but not statistically significantly higher accuracy than ME-NBI (81.25% vs 73.33%, P = 0.46). Agreements between ME-NBI/CLE and histopathology were near perfect (ME-NBI, κ = 0.87; CLE, κ = 0.84).CLE is not superior to ME-NBI for discriminating gastric cancerous from noncancerous lesions. Endoscopist could make an optimal choice according to the specific indication and advantages of ME-NBI and CLE in daily practices.
authors.affiliation: From the Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Gong
authors.forename: Han-Bing
authors.initials: HB
authors.lastname: Xue
authors.forename: Zhi-Zheng
authors.initials: ZZ
authors.lastname: Ge
authors.forename: Jun
authors.initials: J
authors.lastname: Dai
authors.forename: Xiao-Bo
authors.initials: XB
authors.lastname: Li
authors.forename: Yun-Jia
authors.initials: YJ
authors.lastname: Zhao
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yun-Jie
authors.initials: YJ
authors.lastname: Gao
authors.forename: Yan
authors.initials: Y
authors.lastname: Song
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis*