Magnifying endoscopy combined with narrow-band imaging for differential diagnosis of superficial depressed gastric lesions

Background and aim:Magnifying endoscopy combined with narrow-band imaging (ME-NBI) has been used for differential diagnosis of various focal lesions. The aim of our study was to evaluate ME-NBI criteria for cancer diagnosis in superficial depressed gastric lesions in comparison to conventional white light endoscopy (WLE).

Patients and methods:ME-NBI and WLE images of 100 superficial gastric depressions (55 depressed cancers, 45 benign depressions) were independently evaluated by 11 endoscopists blinded to the diagnosis in each case. The presence or absence of predefined ME-NBI findings relating to microvasculature and fine mucosal structure (FMS) was recorded. A general diagnosis of benign or malignant also had to be given on the basis of a general assessment of features of color and shape as shown in the ME-NBI and WLE images, respectively, without regard to any prespecified criteria.

Results:Multivariate and ROC analysis demonstrated that the triad of FMS disappearance, microvascular dilation, and heterogeneity appeared to be the best combination for diagnosis of gastric cancer. ME-NBI diagnosis with the triad attained a good specificity (85 %, theoretically calculated if all of the triad were positive), which was significantly (P < 0.001) superior to WLE general diagnosis (65 %), and comparable with ME-NBI general diagnosis (80 %). The sensitivities of the three diagnoses (ME-NBI with the triad 69 %, WLE general diagnosis 71 %, ME-NBI general diagnosis 72 %) were comparably moderate. The κ values (interobserver concordance) for ME-NBI diagnosis with the triad (0.47) and ME-NBI general diagnosis (0.48) were superior to the κ value for WLE diagnosis (0.34).

Conclusion:The triad of FMS disappearance, microvascular dilation, and heterogeneity has good specificity for the diagnosis of superficial depressed gastric carcinoma, but the sensitivity needs to be improved.

References

• 1 Tajiri H, Matsuda K, Fujisaki J. What can we see with the endoscope? Present status and future perspectives.  Dig Endosc. 2004;  14 131-137
• 2 Sakaki N, Iida Y, Okazaki Y. et al . Magnifying endoscopic observation of the gastric mucosa, particularly in patients with atrophic gastritis.  Endoscopy. 1978;  10 269-274
• 3 Yoshida T, Inoue H, Usui S. et al . Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions.  Gastrointest Endosc. 2004;  59 288-295
• 4 Goda K, Tajiri H, Ikegami M. et al . Usefulness of magnifying endoscopy with narrow band imaging for detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett’s adenocarcinoma.  Gastrointest Endosc. 2007;  65 36-46
• 5 Nakayoshi T, Tajiri H, Matsuda K. et al . Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video).  Endoscopy. 2004;  36 1080-1084
• 6 Hirata M, Tanaka S, Oka S. et al . Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors.  Gastrointest Endosc. 2007;  65 988-995
• 7 Tamai N, Kaise M, Nakayoshi T. et al . Clinical and endoscopic characterization of depressed gastric adenoma.  Endoscopy. 2006;  38 391-394
• 8 Yao K, Oishi T, Matsui T. et al . Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer.  Gastrointest Endosc. 2002;  56 279-284
• 9 Japanese Gastric Cancer Association . Japanese Classification of Gastric Carcinoma: 2nd English edition.  Gastric Cancer. 1998;  1 10-24
• 10 Dixon M F. Gastrointestinal epithelial neoplasia: Vienna revisited.  Gut. 2002;  51 130-131
• 11 Inoue H, Kudo S, Shiokawa A. Novel endoscopic imaging techniques toward in vivo observation of living cancer cells in the gastrointestinal tract.  Clin Gastroenterol Hepatol. 2005;  3 61-63
• 12 Fujishiro M, Takubo K, Sato Y. et al . Potential and present limitation of endocytoscopy in the diagnosis of esophageal squamous-cell carcinoma: a multicenter ex vivo pilot study.  Gastrointest Endosc. 2007;  66 551-555
• 13 MacAulay C, Lane P, Richards-Kortum R. In vivo pathology: microendoscopy as a new endoscopic imaging modality.  Gastrointest Endosc Clin N Am. 2004;  14 595-620
• 14 Kiesslich R, Goetz M, Angus E M. et al . Identification of epithelial gaps in human small and large intestine by confocal endomicroscopy.  Gastroenterology. 2007;  133 1769-1778
• 15 Sumiyama K, Kaise M, Nakayoshi T. et al . Combined use of a magnifying endoscope with a narrow band imaging system and a multibending endoscope for en bloc EMR of early stage gastric cancer.  Gastrointest Endosc. 2004;  60 79-84
• 16 Ohashi A, Niwa Y, Ohmiya N. et al . Quantitative analysis of the microvascular architecture observed on magnification endoscopy in cancerous and benign gastric lesions.  Endoscopy. 2005;  37 1215-1219
• 17 Adachi Y, Mori M, Enjoji M. Microvascular architecture of early gastric carcinoma.  Cancer. 1993;  72 32-36
• 18 Morikawa S, Peter B, Kaidoh T. et al . Abnormalities in pericytes on blood vessels and endothelial sprouts in tumors.  Am J Pathol. 2002;  160 985-1000
• 19 Landis J R, Koch G G. The measurement of observer agreement for categorical data.  Biometrics. 1977;  33 159-174
• 20 Siegel S, Castellan N J. Nonparametric statistics for the behavioral sciences. 2nd ed. New York; McGraw-Hill 1988
• 21 Amano Y, Ishimura N, Furuta K. Which landmark results in a more consistent diagnosis of Barrett’s esophagus, the gastric folds or the palisade vessels?.  Gastrointest Endosc. 2006;  64 206-211