Advanced endoscopic imaging for early gastric cancer

Considerable numbers of early gastric cancers can be missed or misdiagnosed with conventional white light imaging endoscopy (WLI), thus advanced endoscopic imaging modalities have been applied to overcome the issue. High definition endoscopy can improve diagnostic accuracy, but still misses 20-25% of early gastric cancer. Magnifying endoscopy combined with narrow band imaging (NBI) allows for very high accuracy, with sensitivity and specificity of over 95%. The algorithm for magnifying endoscopy diagnosis of gastric cancer is composed of 1) presence of demarcation line, and 2) presence of irregular microsurface and/or microvascular pattern. Ultra-high magnification of 400 times with endocytoscopy (ECS) can produce images reflecting structural and cellular atypia. Using high grade ECS atypia as the diagnostic criteria for gastric cancer, ECS achieves a high diagnostic accuracy (86% of sensitivity, 100% of specificity) although approximately 10% of target lesions are not assessable because of poor dye staining.