title: Extending magnifying NBI diagnosis of intestinal metaplasia in the stomach: the white opaque substance marker.
abstract: Background and aimsIntestinal metaplasia (IM) of the stomach is associated with an increased risk of differentiated gastric cancer. While it is important to diagnose IM endoscopically, it can be difficult to observe by white-light endoscopy. In magnifying endoscopy with narrow-band imaging (M-NBI) of the stomach, a light-blue crest (LBC) is widely known to be a useful marker in the endoscopic diagnosis of IM. However, IM that exhibits only white opaque substance (WOS) without an LBC can also occur. The aim of this study was to elucidate whether the presence of WOS on M-NBI of the stomach could serve as a marker of IM in the same way that an LBC does.MethodsThe subjects were 40 consecutive patients who underwent M-NBI between July and December 2014. The primary endpoint in this study was to evaluate the diagnostic performance of M-NBI for histologically observed IM in WOS- and LBC-positive mucosa.ResultsThe sensitivity and specificity of WOS for histologically diagnosed IM were 50.0 % (95 % confidence interval [CI] 40.0 % - 50.0 %) and 100.0 % (95 %CI 85.0 % - 100.0 %), respectively. Meanwhile, the sensitivity and specificity of LBC were 62.5 % (95 %CI 51.1 % - 65.9 %) and 93.8 % (95 %CI 76.7 % - 98.9 %), respectively. The sensitivity and specificity of WOS and/or LBC (WOS positive and LBC positive, WOS positive and LBC negative, or WOS negative and LBC positive) for histologically diagnosed IM were 87.5 % (95 %CI 76.9 % - 90.9 %) and 93.8 % (95 %CI 77.9 % - 98.9 %), respectively.ConclusionsLBC and WOS are both useful markers for endoscopic diagnosis of IM. Combining both markers improves the sensitivity.Clinical trial number: UMINCTR000014453.
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Kanemitsu
authors.affiliation: Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Yao
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagahama
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Imamura
authors.affiliation: Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ueki
authors.affiliation: Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Chuman
authors.affiliation: Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanabe
authors.affiliation: Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Ota
authors.initials: O
authors.lastname: Atsuko
authors.affiliation: Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Iwashita
authors.affiliation: Department of Interdisciplinary Research, Wakayama Medical University, Wakayama, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Shimokawa
authors.affiliation: Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan.
authors.forename: Kunihisa
authors.initials: K
authors.lastname: Uchita
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanesaka
mesh_terms: D000368:Aged; D015415:Biomarkers; D001706:Biopsy; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005753:Gastric Mucosa / Q000000981:diagnostic imaging* / Q000473:pathology*; D005757:Gastritis, Atrophic / Q000000981:diagnostic imaging / Q000473:pathology; D005773:Gastroscopy / Q000379:methods*; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000000981:diagnostic imaging; D008875:Middle Aged; D062048:Narrow Band Imaging; D015588:Observer Variation
chemical_list: D015415:Biomarkers