Diagnosis of histological type of early gastric cancer by magnifying narrow‐band imaging: A multicenter prospective study

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.

The effect of incorporating domain knowledge with deep learning in identifying benign and malignant gastric whitish lesions: A retrospective study

“…Most undifferentiated GCs (including poorly differentiated cancers and SRCCs), some differentiated GCs, and some MALTs present as whitish tone under WLE. 4,5,11 Some benign lesions such as scarring, atrophic gastritis, and so on also show whitish discoloration under WLE. Therefore, in this study, we included various types of neoplastic lesions, including EGC (poorly differentiated adenocarcinoma, SRCC, and well-differentiated adenocarcinoma), high-grade intraepithelial neoplasia, low-grade intraepithelial neoplasia and MALT; non-neoplastic lesions including chronic inflammation, atrophy (without intestinal metaplasia) and intestinal metaplasia.…”

“…8 For example, undifferentiated EGCs, especially early-stage signet-ring-cell carcinoma (SRCC), usually appear as whitish, flat, or slightly depressed lesions under WLE, can be easily overlooked even by experienced endoscopists. 9,10 Besides, some differentiated-type EGC, 5 some gastric mucosa-associated lymphoid tissue (MALT) JXW, XT, CXZ, YJZ, RQJ, LWY, and LLW were involved in data collection. XQZ wrote the report.…”

Clinical Usefulness of Linked Color Imaging for Detection and Characterization of UndifferentiatedType Early Gastric Cancer

“… 31 However, others have reported that the diagnostic accuracy of depressed- or flat-type UD-EGC is not significantly affected. 3 , 32 Although few studies on alternative types of advanced imaging for the diagnosis of UD-EGC exist, the application of LCI for the above purpose has yet to be studied. Generally, it is presumed that the efficacy decreases in the presence of tumor infiltration below the normal mucosa in UD-EGC.…”

Diagnostic ability of magnifying endoscopy compared to biopsy examination for early gastric cancer prior to endoscopic submucosal dissection

“…The criteria for histological diagnosis using ME-NBI or ME-BLI were de ned based on the microarchitecture of the lesions, including the microstructure and microvessels with a demarcation line (DL) [14]. Histological diagnosis was made by referring to the characteristic ndings of microsurface (MS) and microvascular (MV) patterns as follows [15]. The presence of a MS pattern was endoscopically diagnosed as a differentiated adenocarcinoma.…”