A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions.
OBJECTIVE
Some studies suggest that narrow-band imaging (NBI) can be more accurate at diagnosing gastric intestinal metaplasia and dysplasia than white-light endoscopy (WLE) alone. We aimed to assess the real-time diagnostic validity of high resolution endoscopy with and without NBI in the diagnosis of gastric premalignant conditions and to derive a classification for endoscopic grading of gastric intestinal metaplasia (EGGIM).


METHODS
A multicenter prospective study (five centers: Portugal, Italy, Romania, UK, USA) was performed involving the systematic use of high resolution gastroscopes with image registry with and without NBI in a centralized informatics platform (available online). All users used the same NBI classification. Histologic result was considered the diagnostic gold standard.


RESULTS
A total of 238 patients and 1123 endoscopic biopsies were included. NBI globally increased diagnostic accuracy by 11 percentage points (NBI 94 % vs. WLE 83 %; P < 0.001) with no difference in the identification of Helicobacter pylori gastritis (73 % vs. 74 %). NBI increased sensitivity for the diagnosis of intestinal metaplasia significantly (87 % vs. 53 %; P < 0.001) and for the diagnosis of dysplasia (92 % vs. 74 %). The added benefit of NBI in terms of diagnostic accuracy was greater in OLGIM III/IV than in OLGIM I/II (25 percentage points vs. 15 percentage points, respectively; P < 0.001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for EGGIM in the identification of extensive metaplasia was 0.98.


CONCLUSIONS
In a real-time scenario, NBI demonstrates a high concordance with gastric histology, superior to WLE. Diagnostic accuracy higher than 90 % suggests that routine use of NBI allows targeted instead of random biopsy samples. EGGIM also permits immediate grading of intestinal metaplasia without biopsies and merits further investigation.
Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.
Pedro
P
Pimentel-Nunes
Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.
Diogo
D
Libânio
Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.
Jorge
J
Lage
Instituto de Telecomunicações, Faculty of Sciences of the University of Porto, Porto, Portugal.
Diogo
D
Abrantes
Instituto de Telecomunicações, Faculty of Sciences of the University of Porto, Porto, Portugal.
Miguel
M
Coimbra
Department of Medicine, Surgery and Translational Medicine, University Hospital Sant'Andrea, University Sapienza Roma, Rome, Italy.
Gianluca
G
Esposito
Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
David
D
Hormozdi
Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Mike
M
Pepper
University of Medicine and Pharmacy TG., Mures, Romania.
Silvia
S
Drasovean
NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom.
Jonathan R
JR
White
University of Medicine and Pharmacy TG., Mures, Romania.
Daniela
D
Dobru
Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
James
J
Buxbaum
NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom.
Krish
K
Ragunath
Department of Medicine, Surgery and Translational Medicine, University Hospital Sant'Andrea, University Sapienza Roma, Rome, Italy.
Bruno
B
Annibale
Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.
Mário
M
Dinis-Ribeiro
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001706:Biopsy; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005756:Gastritis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D020699:Gastroscopes; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000145:classification / Q000000981:diagnostic imaging; D008875:Middle Aged; D062048:Narrow Band Imaging; D011230:Precancerous Conditions / Q000000981:diagnostic imaging* / Q000473:pathology*; D011446:Prospective Studies; D012372:ROC Curve; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*