Endoscopy 2012; 44(03): 236-246
DOI: 10.1055/s-0031-1291537
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions

P. Pimentel-Nunes*
1   Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
2   Department of Physiology, Cardiovascular Research and Development Unit, Porto Faculty of Medicine, Porto University, Porto, Portugal
,
M. Dinis-Ribeiro*
1   Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
3   CINTESIS/Biostatistics and Medical Informatics, Faculty of Medicine, Porto University, Porto, Portugal
,
J. B. Soares
2   Department of Physiology, Cardiovascular Research and Development Unit, Porto Faculty of Medicine, Porto University, Porto, Portugal
4   Department of Gastroenterology, Hospital de Braga, Braga, Portugal
,
R. Marcos-Pinto
5   Department of Gastroenterology, Centro Hospitalar do Porto, Porto, Portugal
,
C. Santos
3   CINTESIS/Biostatistics and Medical Informatics, Faculty of Medicine, Porto University, Porto, Portugal
,
C. Rolanda
4   Department of Gastroenterology, Hospital de Braga, Braga, Portugal
6   Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
,
R. P. Bastos
7   Department of Gastroenterology, Hospital de São João, Porto, Portugal
,
M. Areia
8   Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
L. Afonso
9   Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
,
J. Bergman
10   Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherland
,
P. Sharma
11   Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri, USA
,
T. Gotoda
12   Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
,
R. Henrique
9   Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
13   Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
,
L. Moreira-Dias
1   Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted 04. März 2011

accepted after revision 14. Oktober 2011

Publikationsdatum:
31. Januar 2012 (online)

Background and study aim: The reliability and external validity of narrow band imaging (NBI) in the stomach have not been described consistently. The aim of the current study was to describe and estimate the accuracy and reliability of a simplified classification system for NBI in the diagnosis of gastric lesions.

Methods: Consecutive patients undergoing NBI endoscopy at two reference centers (n = 85, 33 % with dysplasia) were included in two studies. In total, 224 different areas were biopsied and recorded onto video. In the derivation study, previously described NBI features were analyzed in order to develop a simplified classification. In the validation study the accuracy and reliability of this classification were estimated among three groups of endoscopists with different levels of expertise in NBI.

Results: The reliability/accuracy results from the derivation study allowed the creation of a simplified NBI classification. In the validation study, “regular vessels with circular mucosa” (pattern A) was associated with normal histology (accuracy 83 %; 95 % confidence interval [CI] 75 % – 90 %); “tubulo-villous mucosa” (pattern B) was associated with intestinal metaplasia (accuracy 84 %; 95CI 77 % – 91 %; positive likelihood ratio [LR + ] = 4.75); and “irregular vessels and mucosa” (pattern C) was associated with dysplasia (accuracy 95 %; 95CI 90 % – 99 %; LR + = 44.33). The reproducibility of these patterns was high (k = 0.62). “Light-blue crest” was moderately reliable (k = 0.49) but specific (87 %) for intestinal metaplasia. A variable vascular density (additional pattern + ) was the best feature for Helicobacter pylori gastritis (accuracy 70 %; 95CI 59 % – 80 %) but showed only fair reliability (k = 0.38). Non-experienced endoscopists presented lower agreement (k = 0.6 vs. k = 0.75) and accuracy (74 % vs. 86 %) than international experts/experienced endoscopists.

Conclusion: A simplified NBI classification is accurate and reliable for the diagnosis of intestinal metaplasia and dysplasia. The classification should be further assessed and validated on a per-patient assessment of NBI, and by comparing NBI with other imaging technologies.

* The authors contributed equally to this study and should be considered joint first authors.


Fig.e1 is available online:

 
  • References

  • 1 Parkin DM, Bray F, Ferlay J et al. Estimating the world cancer burden: Globocan 2000. Int J Cancer 2001; 94: 153-156
  • 2 Hundahl SA, Menck HR, Mansour EG et al. The National Cancer Data Base report on gastric carcinoma. Cancer 1997; 80: 2333-2341
  • 3 Correa P. Human gastric carcinogenesis: a multistep and multifactorial process – First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res 1992; 52: 6735-6740
  • 4 deVries AC, van Grieken NC, Looman CW et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology 2008; 134: 945-952
  • 5 Stemmermann GN, Fenoglio-Preiser C. Gastric carcinoma distal to the cardia: a review of the epidemiological pathology of the precusors to a preventable cancer. Pathology 2002; 34: 494-503
  • 6 Lin BR, Shun CT, Wang TH et al. Endoscopic diagnosis of intestinal metaplasia of stomach – accuracy judged by histology. Hepatogastroenterology 1999; 46: 162-166
  • 7 Redeen S, Petersson F, Jonsson KA et al. Relationship of gastroscopic features to histological findings in gastritis and Helicobacter pylori infection in a general population sample. Endoscopy 2003; 35: 946-950
  • 8 Areia M, Amaro P, Dinis-Ribeiro M et al. Estimation of the extent of gastric intestinal metaplasia by methylene blue chromoendoscopy. Eur J Gastroenterol Hepatol 2008; 20: 939-940
  • 9 Areia M, Amaro P, Dinis-Ribeiro M et al. External validation of a classification for methylene blue magnification chromoendoscopy in premalignant gastric lesions. Gastrointest Endosc 2008; 67: 1011-1018
  • 10 Dinis-Ribeiro M, da Costa-Pereira A, Lopes C et al. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest Endosc 2003; 57: 498-504
  • 11 Bansal A, Ulusarac O, Mathur S et al. Correlation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial. Gastrointest Endosc 2008; 67: 210-216
  • 12 Capelle LG, Haringsma J, de Vries AC et al. Narrow band imaging for the detection of gastric intestinal metaplasia and dysplasia during surveillance endoscopy. Dig Dis Sci 2010; 55: 3442-3448
  • 13 Endo T, Nosho K, Arimura Y et al. Study of the tumor vessels in depressed-type early gastric cancers using narrow band imaging magnifying endoscopy and cDNA array analysis. Digestive Endoscopy 2005; 17: 210-217
  • 14 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
  • 15 Kadowaki S, Tanaka K, Toyoda H et al. Ease of early gastric cancer demarcation recognition: a comparison of four magnifying endoscopy methods. J Gastroenterol Hepatol 2009; 24: 1625-1630
  • 16 Kaise M, Kato M, Urashima M et al. Magnifying endoscopy combined with narrow-band imaging for differential diagnosis of superficial depressed gastric lesions. Endoscopy 2009; 41: 310-315
  • 17 Kato M, Kaise M, Yonezawa J et al. Trimodal imaging endoscopy may improve diagnostic accuracy of early gastric neoplasia: a feasibility study. Gastrointest Endosc 2009; 70: 899-906
  • 18 Nakayoshi T, Tajiri H, Matsuda K et al. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy 2004; 36: 1080-1084
  • 19 Tahara T, Shibata T, Nakamura M et al. Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis. Gastrointest Endosc 2009; 70: 246-253
  • 20 Tamai N, Kaise M, Nakayoshi T et al. Clinical and endoscopic characterization of depressed gastric adenoma. Endoscopy 2006; 38: 391-394
  • 21 Uedo N, Ishihara R, Iishi H et al. A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy 2006; 38: 819-824
  • 22 Yao K, Iwashita A, Tanabe H et al. White opaque substance within superficial elevated gastric neoplasia as visualized by magnification endoscopy with narrow-band imaging: a new optical sign for differentiating between adenoma and carcinoma. Gastrointest Endosc 2008; 68: 574-580
  • 23 Alaboudy AA, Elbahrawy A, Matsumoto S et al. Conventional narrow-band imaging has good correlation with histopathological severity of Helicobacter pylori gastritis. Dig Dis Sci 2011; 56: 1127-1130
  • 24 Okubo M, Tahara T, Shibata T et al. Changes in gastric mucosal patterns seen by magnifying NBI during H. pylori eradication. . J Gastroenterol 2011; 46: 175-182
  • 25 Curvers WL, van den Broek FJ, Reitsma JB et al. Systematic review of narrow-band imaging for the detection and differentiation of abnormalities in the esophagus and stomach (with video). Gastrointest Endosc 2009; 69: 307-317
  • 26 Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M et al. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc 2009; 69: 350-355
  • 27 Dixon MF, Genta RM, Yardley JH et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181
  • 28 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
  • 29 Kato M, Kaise M, Yonezawa J et al. 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. Gastrointest Endosc 2010; 72: 523-529
  • 30 Eshmuratov A, Nah JC, Kim N et al. The correlation of endoscopic and histological diagnosis of gastric atrophy. Dig Dis Sci 2010; 55: 1364-1375
  • 31 Gonen C, Simsek I, Sarioglu S et al. Comparison of high resolution magnifying endoscopy and standard videoendoscopy for the diagnosis of Helicobacter pylori gastritis in routine clinical practice: a prospective study. Helicobacter 2009; 14: 12-21
  • 32 Kato M, Kaise M, Yonezawa J et al. Autofluorescence endoscopy versus conventional white light endoscopy for the detection of superficial gastric neoplasia: a prospective comparative study. Endoscopy 2007; 39: 937-941