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Trimodal imaging endoscopy may improve diagnostic accuracy of early gastric neoplasia: a feasibility study
Masayuki Kato1, Mitsuru Kaise, Jin Yonezawa
1Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan. masa-kato@jikei.ac.jp
Background:
A considerable number of superficial gastric neoplasias are overlooked with conventional white light imaging (WLI) endoscopy.
Objective:
The aim was to investigate the diagnostic potential of trimodal imaging endoscopy (TME), which combines WLI, autofluorescence imaging (AFI), and narrow-band imaging (NBI), for superficial gastric neoplasia.
Design:
Feasibility study.
Setting:
Single academic center.
Patients:
Sixty-two patients with or without gastric neoplasia.
Intervention:
Each patient serially assessed with WLI, AFI, and magnifying endoscopy with NBI (ME-NBI) by an endoscopist blinded for clinical information. ME-NBI over WLI and AFI was designated as TME. Histopathology of biopsy and ESD specimens was evaluated and used as the gold standard.
Main Outcome Measurements:
Sensitivity and specificity of endoscopic diagnosis of pathology-proven neoplasia by per-patient and per-lesion analyses.
Results:
The study included 47 pathology-proven neoplasias and 44 pathology-proven nonneoplasias that were detected as neoplasias with any of the modalities. By a per-lesion analysis, the sensitivity of TME (89.4%) was higher than that of WLI (76.6%) and AFI (68.1%). The specificity of TME (98.0%) was higher than that of WLI (84.3%) and AFI (23.5%). By a per-patient analysis, the sensitivity of TME (90.9%) was higher than that of WLI (75%) and AFI (68.2%). The specificity of TME (100%) was higher than that of WLI (72.2%) and AFI (44.4%).
Limitations:
Case-enriched population at a single center.
Conclusions:
Higher diagnostic accuracy of TME over conventional WLI indicates the feasibility of TME for the efficacious diagnosis of early gastric neoplasia.
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