Gastroenterology

Gastroenterology

Volume 141, Issue 6, December 2011, Pages 2017-2025.e3
Gastroenterology

Original Research
Clinical—Alimentary Tract
Magnifying Narrowband Imaging Is More Accurate Than Conventional White-Light Imaging in Diagnosis of Gastric Mucosal Cancer

https://doi.org/10.1053/j.gastro.2011.08.007Get rights and content

Background & Aims

It is difficult to accurately diagnose patients with depressed gastric mucosal cancer based on conventional white-light imaging (C-WLI) endoscopy. We compared the real-time diagnostic yield of C-WLI for small, depressed gastric mucosal cancers with that of magnifying narrow-band imaging (M-NBI).

Methods

We performed a multicenter, prospective, randomized, controlled trial of patients with undiagnosed depressed lesions ≤10 mm in diameter identified by esophagogastroduodenoscopy. Patients were randomly assigned to groups that were analyzed by C-WLI (n = 176) or M-NBI (n = 177) immediately after detection; the C-WLI group received M-NBI after C-WLI. We compared the diagnostic accuracy, sensitivity, and specificity between C-WLI and M-NBI and assessed the diagnostic yield of M-NBI conducted in conjunction with C-WLI.

Results

Overall, 40 gastric cancers (20 in each group) were identified. The median diagnostic values for M-NBI and C-WLI were as follows: accuracy, 90.4% and 64.8%; sensitivity, 60.0% and 40.0%; and specificity, 94.3% and 67.9%, respectively. The accuracy and specificity of M-NBI were greater than those of C-WLI (P < .001); the difference in sensitivity was not significant (P = .34). The combination of M-NBI with C-WLI significantly enhanced performance compared with C-WLI alone; accuracy increased from (median) 64.8% to 96.6% (P < .001), sensitivity increased from 40.0% to 95.0% (P < .001), and specificity increased from 67.9% to 96.8% (P < .001).

Conclusions

M-NBI, in conjunction with C-WLI, identifies small, depressed gastric mucosal cancers with 96.6% accuracy, 95.0% sensitivity, and 96.8% specificity. These values are better than for C-WLI or M-NBI alone.

Section snippets

Study Design and Participants

This randomized, controlled, open-label, multicenter trial was conducted at 9 centers in Japan. This study was conducted according to the Standards for the Reporting of Diagnostic Accuracy Studies (STARD) initiative16 and the Declaration of Helsinki.

The frequency of synchronous or metachronous multiple gastric cancers was reported as 3 to 5 per 100 patient-years,17, 18, 19 which is higher than the incidence of gastric cancer in the general population. In other words, patients with gastric

Results

Between June 2008 and May 2010, 1365 patients were enrolled in the study. Eight patients refused to participate and 4 were registered twice; therefore, the remaining 1353 patients were registered correctly and underwent endoscopic screening. Screening was discontinued for 2 patients because of a large amount of residual digesta in the stomach and a severe vomiting reflex. Endoscopic screening was completed for the remaining 1351 patients.

Of the screened patients, 362 (26.8%) had newly detected

Discussion

In this multicenter randomized trial, we compared the diagnostic yield of C-WLI with that of M-NBI for small gastric cancers. The primary aim of this study was to compare directly the real-time diagnostic accuracy of 2 randomly assigned endoscopic modalities. One was the worldwide standard method of C-WLI; the other was M-NBI, which is the most advanced imaging method at present. This end point is the most important aspect of this study, because if C-WLI proves superior to M-NBI, such advanced

Acknowledgments

Gastric NBI Study Investigators in Japan include the following: Noriya Uedo, Yoji Takeuchi (Osaka Medical Cancer for Cancer and Cardiovascular Diseases, Osaka); Hisashi Doyama, Yoshibumi Kaneko, Kenichi Takemura, Kazuhiro Miwa, Shinya Yamada (Ishikawa Prefectural Central Hospital, Ishikawa); Yutaka Saito, Ichiro Oda, Shigetaka Yoshinaga, Satoru Nonaka, Shusei Fukunaga (National Cancer Center Hospital, Tokyo); Manabu Muto, Yasumasa Ezoe, Shuko Morita, Takahiro Horimatsu (Kyoto University,

References (29)

  • H. Ono et al.

    Endoscopic mucosal resection for treatment of early gastric cancer

    Gut

    (2001)
  • T. Gotoda et al.

    Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers

    Gastric Cancer

    (2000)
  • S.M. Everett et al.

    Early gastric cancer in Europe

    Gut

    (1997)
  • T. Hirasawa et al.

    Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer

    Gastric Cancer

    (2009)
  • Cited by (321)

    View all citing articles on Scopus

    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by a part of grant-in-aid for cancer research from the Ministry of Health (H21-009), Labor, and Welfare of Japan.

    View full text