Unified magnifying endoscopic classification for esophageal, gastric and colonic lesions: a feasibility pilot study

Abstract

Background and study aims Image-enhanced magnifying endoscopy allows optimization of the detection and diagnosis of lesions found in the gastrointestinal tract. Current organ-specific classifications are well-accepted by specialized endoscopists but may pose confusion for general gastroenterologists. To address this, our group proposed the Unified Magnifying Endoscopic Classification (UMEC) which can be applied either in esophagus, stomach, or colon. The aim of this study was to evaluate the diagnostic performance and clinical applicability of UMEC.

Patients and methods A single-center, feasibility pilot study was conducted. Two endoscopists with experience in magnifying narrow band imaging (NBI), blinded to white-light and non-magnifying NBI findings as well as histopathological diagnosis, independently reviewed and diagnosed all images based on UMEC. In brief, UMEC is divided into three categories: non-neoplasia, intramucosal neoplasia, and deep submucosal invasive cancer. The diagnostic performance of UMEC was assessed while using the gold standard histopathology as a reference.

Results A total of 303 gastrointestinal lesions (88 esophageal squamous lesions, 90 gastric lesions, 125 colonic lesions) were assessed. The overall accuracy for both endoscopists in the diagnosis of esophageal squamous cell cancer, gastric cancer, and colorectal cancer were 84.7 %, 89.5 %, and 83.2 %, respectively. The interobserver agreement for each organ, Kappa statistics of 0.51, 0.73, and 0.63, was good.

Conclusions UMEC appears to be a simple and practically acceptable classification, particularly to general gastroenterologists, due to its good diagnostic accuracy, and deserves further evaluation in future studies.

Publikationsverlauf

Eingereicht: 05. Oktober 2020

Angenommen: 20. April 2021

Artikel online veröffentlicht:
16. August 2021

• References

• 1 Tsurudome I, Miyahara R, Funasaka K. et al. In vivo histological diagnosis for gastric cancer using endocytoscopy. World J Gastroenterol 2017; 23: 6894-6901
• 2 Abad MRA, Inoue H, Ikeda H. et al. Utilizing fourth-generation endocytoscopy and the ‘enlarged nuclear sign’ for in vivo diagnosis of early gastric cancer. Endosc Int Open 2019; 7: E1002-e1007
• 3 Yao K, Anagnostopoulos GK, Ragunath K. Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy 2009; 41: 462-467
• 4 Muto M, Yao K, Kaise M. et al. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2016; 28: 379-393
• 5 Machida H, Sano Y, Hamamoto Y. et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy 2004; 36: 1094-1098
• 6 Sano Y, Horimatsu T, Fu KI. et al. Magnifying observation of microvascular architecture of colorectal lesions using a narrow-band imaging system. Digest Endosc 2006; 18: S44-S51
• 7 Kanao H, Tanaka S, Oka S. et al. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc 2009; 69: 631-636
• 8 Wada Y, Kudo SE, Kashida H. et al. Diagnosis of colorectal lesions with the magnifying narrow-band imaging system. Gastrointest Endosc 2009; 70: 522-531
• 9 Nikami T, Saito S, Tajiri H. et al. The evaluation of histological atypia and depth of invasion of colorectal lesions using magnified endoscopy with narrow-band imaging. Gastroenterol Endosc 2009; 51: 10-19
• 10 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599-607
• 11 Hayashi N, Tanaka S, Hewett DG. et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78: 625-632
• 12 Sano Y, Tanaka S, Kudo SE. et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Digest Endosc 2016; 28: 526-533
• 13 Kirch W. Encylopedia of Public Health. Springer Netherlands; 2008
• 14 Inoue H. Endoscopic diagnosis of tissue atypism (EA) in the pharyngeal and esophageal squamous epithelium; IPCL pattern classification and ECA classification. Kyobu Geka 2007; 60: 768-775
• 15 Inoue H, Kaga M, Ikeda H. et al. Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification. Ann Gastroenterol 2015; 28: 41-48
• 16 Yu T, Geng J, Song W. et al. Diagnostic accuracy of magnifying endoscopy with narrow band imaging and its diagnostic value for invasion depth staging in esophageal squamous cell carcinoma: a systematic review and meta-analysis. BioMed Res Int 2018; 2018: 8591387
• 17 Lee CT, Chang CY, Lee YC. et al. Narrow-band imaging with magnifying endoscopy for the screening of esophageal cancer in patients with primary head and neck cancers. Endoscopy 2010; 42: 613-619
• 18 Nagai K, Ishihara R, Ishiguro S. et al. Endoscopic optical diagnosis provides high diagnostic accuracy of esophageal squamous cell carcinoma. BMC Gastroenterol 2014; 14: 141
• 19 Goda K, Tajiri H, Ikegami M. et al. Magnifying endoscopy with narrow band imaging for predicting the invasion depth of superficial esophageal squamous cell carcinoma. Dis Esophagus 2009; 22: 453-460
• 20 Ebi M, Shimura T, Yamada T. et al. Multicenter, prospective trial of white-light imaging alone versus white-light imaging followed by magnifying endoscopy with narrow-band imaging for the real-time imaging and diagnosis of invasion depth in superficial esophageal squamous cell carcinoma. Gastrointest Endosc 2015; 81: 1355-361.e1352
• 21 Lee MW, Kim GH, Hoseok I. et al. Predicting the invasion depth of esophageal squamous cell carcinoma: comparison of endoscopic ultrasonography and magnifying endoscopy. Scand J Gastroenterol 2014; 49: 853-861
• 22 Oyama T, Inoue H, Arima M. et al. Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society. Esophagus 2017; 14: 105-112
• 23 Ezoe Y, Muto M, Horimatsu T. et al. Magnifying narrow-band imaging versus magnifying white-light imaging for the differential diagnosis of gastric small depressive lesions: a prospective study. Gastrointest Endosc 2010; 71: 477-484
• 24 Ezoe Y, Muto M, Uedo N. et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology 2011; 141: 2017-2025.e2013
• 25 Yao K, Doyama H, Gotoda T. et al. Diagnostic performance and limitations of magnifying narrow-band imaging in screening endoscopy of early gastric cancer: a prospective multicenter feasibility study. Gastric Cancer 2014; 17: 669-679
• 26 Abe S, Oda I, Shimazu T. et al. Depth-predicting score for differentiated early gastric cancer. Gastric Cancer 2011; 14: 35-40
• 27 Choi J, Kim SG, Im JP. et al. Endoscopic prediction of tumor invasion depth in early gastric cancer. Gastrointest Endosc 2011; 73: 917-927
• 28 Li HY, Dai J, Xue HB. et al. Application of magnifying endoscopy with narrow-band imaging in diagnosing gastric lesions: a prospective study. Gastrointest Endosc 2012; 76: 1124-1132
• 29 Kobara H, Mori H, Fujihara S. et al. Prediction of invasion depth for submucosal differentiated gastric cancer by magnifying endoscopy with narrow-band imaging. Oncol Rep 2012; 28: 841-847
• 30 Uedo N, Fujishiro M, Goda K. et al. Role of narrow band imaging for diagnosis of early-stage esophagogastric cancer: current consensus of experienced endoscopists in Asia-Pacific region. Digest Endosc 2011; 23: 58-71
• 31 Hirata M, Tanaka S, Oka S. et al. Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc 2007; 65: 988-995
• 32 Sano Y, Hirata D, Saito Y. Japan NBI Expert Team classification: Narrow-band imaging magnifying endoscopic classification of colorectal tumors. Dig Endosc 2018; 30: 543-545
• 33 Komeda Y, Kashida H, Sakurai T. et al. Magnifying narrow band imaging (NBI) for the diagnosis of localized colorectal lesions using the Japan NBI Expert Team (JNET) classification. Oncology 2017; 93: 49-54
• 34 Sumimoto K, Tanaka S, Shigita K. et al. Clinical impact and characteristics of the narrow-band imaging magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Gastrointest Endosc 2017; 85: 816-821
• 35 Sakamoto T, Nakajima T, Matsuda T. et al. Comparison of the diagnostic performance between magnifying chromoendoscopy and magnifying narrow-band imaging for superficial colorectal neoplasms: an online survey. Gastrointest Endosc 2018; 87: 1318-1323