Magnifying endoscopy with narrow-band imaging achieves superior accuracy in the differential diagnosis of superficial gastric lesions identified with white-light endoscopy: a prospective study

Background: Conventional, white-light imaging endoscopy (WLE) results in a significant number of misdiagnoses in early gastric cancer. Magnifying endoscopy combined with narrow-band imaging (ME-NBI) is more accurate in the diagnosis of gastric cancer when the diagnostic triad of the disappearance of fine mucosal structure, microvascular dilation, and heterogeneity is used. Objective: The aim of the present study was to evaluate the superiority of ME-NBI in the differential diagnosis of superficial gastric lesions identified with conventional WLE. Design: Prospective, comparative study. Setting: Single academic center. Patients: This study involved patients who underwent WLE and ME-NBI for surveying synchronous or metachronous cancers because they had a high risk of gastric cancer. Intervention: Patients with superficial gastric lesions that were diagnosed by WLE as cancer or non-cancer with a slight suspicion of cancer were prospectively enrolled in the study. ME-NBI was used to further characterize lesions picked up with WLE. Main Outcome Measurements: Sensitivity and specificity for the diagnosis of gastric cancer, with pathology as the criterion standard. Results: A total of 201 lesions (mean diameter [+/- SD] 7.0 +/- 4.0 mm) from 111 patients (98 men, 13 women; mean age 66.3 years) were evaluated. Fourteen of the 201 lesions were pathologically proven as gastric cancer; the others were noncancerous lesions. The sensitivity and specificity for ME-NBI diagnosis with the use of the triad (92.9% and 94.7%, respectively) were significantly better than for WLE (42.9% and 61.0%, respectively; P < .0001). Limitations: Single center and a highly selected population at high risk for gastric cancer. Conclusion: ME-NBI achieved superior accuracy in the differential diagnosis of superficial gastric lesions identified with WLE. Thus, ME-NBI may increase the diagnostic value of endoscopy in a population at high risk of gastric cancer. (Gastrointest Endosc 2010;72:523-9.)