An efficient diagnostic strategy for small, depressed early gastric cancer with magnifying narrow-band imaging: a post-hoc analysis of a prospective randomized controlled trial - 15/12/13
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : C-WLI, DL, ESD, IM, IMVP, M-NBI, SDA
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. Research support for this study was provided in part by a grant-in-aid for cancer research from the Ministry of Health (H21-009), Labor, and Welfare of Japan. |
Vol 79 - N° 1
P. 55-63 - janvier 2014 Retour au numéro
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