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Diagnosis of histological type of early gastric cancer by magnifying narrow‐band imaging: A multicenter prospective study
Toshio Shimokawa1  Kensei Ohtsu2  Kenshi Yao2  Takashi Nagahama2  Naohiro Yoshida3  Hisashi Doyama3  Hiroya Ueyama4  Yoichi Akazawa4  Koji Kojima5  Kunihisa Uchita5  Haruhiko Takahashi6  Tetsuya Ueo6  Noriya Uedo7  Takashi Kanesaka7 
[1] Clinical Study Support Center Wakayama Medical University Hospital Wakayama Japan;Department of Endoscopy Fukuoka University Chikushi Hospital Fukuoka Japan;Department of Gastroenterology Ishikawa Prefectural Central Hospital Ishikawa Japan;Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan;Department of Gastroenterology Kochi Red Cross Hospital Kochi Japan;Department of Gastroenterology Oita Red Cross Hospital Oita Japan;Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan;
关键词: diagnosis;    endoscopy;    gastric cancer;    prospective study;   
DOI  :  10.1002/deo2.61
来源: DOAJ
【 摘 要 】

Abstract Objectives Distinguishing undifferentiated‐type from differentiated‐type early gastric cancers (EGC) is crucial for determining the indication of endoscopic resection. We aimed to investigate the diagnostic performance of white‐light endoscopy (WLE) and magnifying narrow‐band imaging (M‐NBI) for the histological type of EGC. Methods In this multicenter prospective study, patients with histologically proven cT1 EGC, macroscopically depressed or flat type, size ≥5 mm, and without erosion/ulcer, were recruited. The diagnostic criterion of WLE for undifferentiated‐type EGC was pale color. The M‐NBI algorithm was created based on microsurface and microvascular patterns, and lesions with absent microsurface pattern and opened‐loop microvascular patterns were diagnosed as undifferentiated‐type. The center of the lesion was defined as the evaluation point and was initially evaluated by WLE, then by M‐NBI, and a biopsy specimen was taken as a reference standard. The primary and key secondary endpoints were overall diagnostic accuracy and specificity, respectively. Results In total, 167 lesions (122 differentiated‐type and 45 undifferentiated‐type EGCs) in 167 patients were analyzed. The overall accuracy, sensitivity, specificity, and positive likelihood ratio of WLE for undifferentiated‐type cancer were 80%, 69%, 84%, and 4.4, respectively, and those of M‐NBI were 82%, 53%, 93%, and 7.2, respectively. There was no significant difference in overall accuracy (p = 0.755), but specificity was significantly higher in M‐NBI (p = 0.041). Conclusions The use of M‐NBI did not improve the accuracy of WLE for the diagnosis of depressed/flat undifferentiated‐type EGCs but improved the specificity. It may reduce surgical overtreatment by preventing misdiagnosis of differentiated‐type EGC as undifferentiated‐type.

【 授权许可】

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