Endoscopy 2018; 50(06): 566-576
DOI: 10.1055/s-0044-100790
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Delineation of the extent of early gastric cancer by magnifying narrow-band imaging and chromoendoscopy: a multicenter randomized controlled trial

Takashi Nagahama
1  Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
,
Kenshi Yao
1  Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
,
Noriya Uedo
2  Department of Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan
,
Hisashi Doyama
3  Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
,
Tetsuya Ueo
4  Department of Gastroenterology, Oita Red Cross Hospital, Oita, Japan
,
Kunihisa Uchita
5  Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
,
Hideki Ishikawa
6  Department of Molecular-targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
,
Takashi Kanesaka
2  Department of Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan
,
Yasuhito Takeda
3  Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
,
Kurato Wada
4  Department of Gastroenterology, Oita Red Cross Hospital, Oita, Japan
,
Kentaro Imamura
1  Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
,
Hisatomi Arima
7  Department of Preventive Medicine and Public Health, Fukuoka University Hospital, Fukuoka, Japan
,
Toshio Shimokawa
8  Department of Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
› Author Affiliations
TRIAL REGISTRATION: multicenter, randomized, controlled study UMIN000014628 at http://www.umin.ac.jp
Further Information

Publication History

submitted 23 March 2017

accepted after revision 19 December 2017

Publication Date:
13 February 2018 (eFirst)

Abstract

Background Accurate delineation of tumor margins is necessary for curative resection of early gastric cancer (EGC). The objective of this multicenter, randomized, controlled study was to compare the accuracy with which magnifying narrow-band imaging (M-NBI) and indigo carmine chromoendoscopy delineate EGC margins.

Methods Patients with EGC ≥ 10 mm undergoing endoscopic or surgical resection were enrolled. The oral-side margins of the lesions were first evaluated with conventional white-light endoscopy in both groups and then delineated by either chromoendoscopy or M-NBI. Biopsies were taken from noncancerous and cancerous mucosa, each at 5 mm from the margin. Accurate delineation was judged to have been achieved when the histological findings in all biopsy samples were consistent with endoscopic diagnoses. The primary end point was the difference in rate of accurate delineation between the two techniques.

Results Data on 343 patients were analyzed. The accurate delineation rate (95 % confidence interval) was 85.7 % (80.4 – 91.0) in the chromoendoscopy group (n = 168), and 88.0 % (83.2 – 92.8) in the M-NBI group (n = 175; P = 0.63). Lower third tumor location (odds ratio [OR] 2.9; P = 0.01), nonflat macroscopic type (OR 4.4; P < 0.01), and high diagnostic confidence (OR 3.6; P < 0.001) were associated with accurate delineation, whereas use of M-NBI was not (OR 1.2; P = 0.39). Even after adjustment for identified confounders, the difference in accurate delineation between the groups was not significant (OR 1.0; P = 0.82).

Conclusions M-NBI does not offer superior delineation of EGC margins compared with chromoendoscopy; the two methods appear to be clinically equivalent.

Supplemental Fig. e6