Trimodal imaging endoscopy may improve diagnostic accuracy of early gastric neoplasia: a feasibility study
Received 30 September 2008; accepted 27 March 2009. published online 13 July 2009.
Background
A considerable number of superficial gastric neoplasias are overlooked with conventional white light imaging (WLI) endoscopy.
Objective
The aim was to investigate the diagnostic potential of trimodal imaging endoscopy (TME), which combines WLI, autofluorescence imaging (AFI), and narrow-band imaging (NBI), for superficial gastric neoplasia.
Design
Feasibility study.
Setting
Single academic center.
Patients
Sixty-two patients with or without gastric neoplasia.
Intervention
Each patient serially assessed with WLI, AFI, and magnifying endoscopy with NBI (ME-NBI) by an endoscopist blinded for clinical information. ME-NBI over WLI and AFI was designated as TME. Histopathology of biopsy and ESD specimens was evaluated and used as the gold standard.
Main Outcome Measurements
Sensitivity and specificity of endoscopic diagnosis of pathology-proven neoplasia by per-patient and per-lesion analyses.
Results
The study included 47 pathology-proven neoplasias and 44 pathology-proven nonneoplasias that were detected as neoplasias with any of the modalities. By a per-lesion analysis, the sensitivity of TME (89.4%) was higher than that of WLI (76.6%) and AFI (68.1%). The specificity of TME (98.0%) was higher than that of WLI (84.3%) and AFI (23.5%). By a per-patient analysis, the sensitivity of TME (90.9%) was higher than that of WLI (75%) and AFI (68.2%). The specificity of TME (100%) was higher than that of WLI (72.2%) and AFI (44.4%).
Limitations
Case-enriched population at a single center.
Conclusions
Higher diagnostic accuracy of TME over conventional WLI indicates the feasibility of TME for the efficacious diagnosis of early gastric neoplasia.
Current affiliations: Department of Endoscopy (M. Kato, M. Kaise, J.Y., K.G., H. Toyoizumi, N.Y., Y.Y., M.K., H. Tajiri), Department of Gastroenterology and Hepatology (H. Tajiri), Jikei University School of Medicine, Tokyo, Japan
Reprint requests: Mitsuru Kaise, MD, Department of Endoscopy, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact him at masa-kato@jikei.ac.jp.
ABSTRACT