Shinya Yamada1, Hisashi Doyama1, Kenshi Yao2, Noriya Uedo3, Yasumasa Ezoe4, Ichiro Oda5, Kazuhiro Kaneko6, Yoshiro Kawahara7, Chizu Yokoi8, Yasushi Sugiura9, Hideki Ishikawa10, Yoji Takeuchi3, Yutaka Saito5, Manabu Muto11. 1. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan. 2. Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan. 3. Department of Gastrointestinal Oncology, Osaka Medical Cancer for Cancer and Cardiovascular Diseases, Osaka, Japan. 4. Department of Multidisciplinary Cancer Treatment, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 5. Department of Gastroenterology, National Cancer Center Hospital, Tokyo, Japan. 6. Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan. 7. Division of Endoscopy, Okayama University, Okayama, Japan. 8. Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan. 9. Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan. 10. Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan. 11. Department of Gastroenterology and Hepatology, Graduate school of Medicine, Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: We previously reported that magnifying narrow-band imaging (M-NBI) is a high-performance diagnostic tool for small, depressed gastric cancer. However, an efficient diagnostic strategy using endoscopic findings has not been fully elucidated. OBJECTIVE: To identify the endoscopic findings that contribute to accurate diagnosis of small, depressed gastric cancer and to propose the ideal diagnostic approach to such lesions. DESIGN: Post-hoc analysis of a prospective, randomized, controlled trial. SETTING: Nine hospitals. PATIENTS: Three hundred fifty-three patients with small, depressed gastric lesions. INTERVENTIONS: In the M-NBI group (n = 177), cancer diagnosis was made with diagnostic criteria including a demarcation line (DL) and an irregular microvascular pattern (IMVP). In the conventional white-light imaging (C-WLI) group (n = 176), diagnostic criteria were both an irregular margin and a spiny depressed area. In the C-WLI group, M-NBI was performed after C-WLI diagnosis. MAIN OUTCOME MEASUREMENTS: The diagnostic performance of each criterion in M-NBI alone, C-WLI, and M-NBI after C-WLI was investigated. RESULTS: M-NBI after C-WLI ultimately showed the best diagnostic performance in each diagnostic criterion. In M-NBI after C-WLI, evaluation of DL is technically easier than that of IMVP, and DL alone had a high sensitivity (95%) and negative predictive value (99%). The IMVP in M-NBI after C-WLI had a high sensitivity and specificity (95% and 96%, respectively) for diagnosis of cancer. LIMITATIONS: Lesions were limited to the small, depressed type. CONCLUSIONS: For a diagnosis using M-NBI after C-WLI, identification of DL is the first step, and subsequent inspection of IMVP diagnosed by DL is an efficient strategy.
RCT Entities:
BACKGROUND: We previously reported that magnifying narrow-band imaging (M-NBI) is a high-performance diagnostic tool for small, depressed gastric cancer. However, an efficient diagnostic strategy using endoscopic findings has not been fully elucidated. OBJECTIVE: To identify the endoscopic findings that contribute to accurate diagnosis of small, depressed gastric cancer and to propose the ideal diagnostic approach to such lesions. DESIGN: Post-hoc analysis of a prospective, randomized, controlled trial. SETTING: Nine hospitals. PATIENTS: Three hundred fifty-three patients with small, depressed gastric lesions. INTERVENTIONS: In the M-NBI group (n = 177), cancer diagnosis was made with diagnostic criteria including a demarcation line (DL) and an irregular microvascular pattern (IMVP). In the conventional white-light imaging (C-WLI) group (n = 176), diagnostic criteria were both an irregular margin and a spiny depressed area. In the C-WLI group, M-NBI was performed after C-WLI diagnosis. MAIN OUTCOME MEASUREMENTS: The diagnostic performance of each criterion in M-NBI alone, C-WLI, and M-NBI after C-WLI was investigated. RESULTS:M-NBI after C-WLI ultimately showed the best diagnostic performance in each diagnostic criterion. In M-NBI after C-WLI, evaluation of DL is technically easier than that of IMVP, and DL alone had a high sensitivity (95%) and negative predictive value (99%). The IMVP in M-NBI after C-WLI had a high sensitivity and specificity (95% and 96%, respectively) for diagnosis of cancer. LIMITATIONS: Lesions were limited to the small, depressed type. CONCLUSIONS: For a diagnosis using M-NBI after C-WLI, identification of DL is the first step, and subsequent inspection of IMVP diagnosed by DL is an efficient strategy.