Related Experiment Video
Updated: May 12, 2026
Establishment and Evaluation of a Risk Prediction Model for Pathological Escalation of Gastric Low-Grade Intraepithelial Neoplasia
Published on: February 16, 2024
Endoscopic grading of gastric intestinal metaplasia and microvascular pattern for assessing gastric cancer risk: a
Xueling Zhang1, Jinxin Shi1, Weijia Wang1
1International Medical Services Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Background And Aims:
The endoscopic grading of gastric intestinal metaplasia (EGGIM) has not been comprehensively validated. Microvascular (MV) pattern abnormalities are critical for diagnosing gastric neoplastic transformation. The present study aims to validate the diagnostic accuracy of EGGIM for identifying high-risk GIM patients and to develop a modified EGGIM model incorporating microvascular pattern, evaluating its diagnostic performance for risk stratification of GC development in GIM patients.
Methods:
All patients underwent EGGIM scoring and microvascular pattern evaluation. Targeted or random biopsies were performed at the antrum, incisura, and corpus, followed by operative link on gastric intestinal metaplasia assessment (OLGIM). The sensitivity, specificity, positive likelihood ratios (PLR), and positive predictive values (PPV) of both EGGIM and the modified EGGIM model for assessing GC risk in GIM patients were validated.
Results:
A total of 144 patients were enrolled. The area under curve (AUC) of the receiver operating characteristic of EGGIM for diagnosing OLGIM III-IV was 0.885 (95% CI 0.837-0.943). At the cutoff value ≥4, the sensitivity, specificity, PLR, and PPV were 90.90%, 73%, 3.36, and 50%, respectively. Altered microvascular pattern was identified as a risk factor for high-risk GC development in GIM (p < 0.001; odds ratio [OR] = 4.696; 95% CI 2.792-7.896). The modified EGGIM model achieved an AUC of 0.921 (95% CI 0.873-0.968) for identifying OLGIM III-IV; at the cutoff value ≥ 2.5, the sensitivity, specificity, PLR, and PPV were 97%, 66.70%, 2.91, and 46.4%, respectively. After incorporating MV, the AUC of the EGGIM score increased from 0.885 to 0.921, suggesting improved diagnostic performance.
Conclusions:
Microvascular pattern serves as a significant independent predictor for OLGIM III-IV. The modified EGGIM demonstrated good diagnostic performance for OLGIM III-IV, suggesting its potential as a non-invasive endoscopic tool for assessing the risk stratification of GC development.
Insights
The modified endoscopic grading of gastric intestinal metaplasia (EGGIM) model, incorporating microvascular patterns, accurately identifies high-risk patients for gastric cancer (GC) development. This enhanced EGGIM tool improves risk stratification for gastric intestinal metaplasia (GIM).
Area of Science:
- Gastroenterology
- Oncology
- Endoscopic Imaging
Background:
- The endoscopic grading of gastric intestinal metaplasia (EGGIM) requires validation for its diagnostic accuracy.
- Microvascular (MV) pattern abnormalities are crucial indicators of gastric neoplastic transformation.
Purpose of the Study:
- To validate the diagnostic accuracy of EGGIM in identifying high-risk gastric intestinal metaplasia (GIM) patients.
- To develop and evaluate a modified EGGIM model incorporating microvascular patterns for improved risk stratification of gastric cancer (GC) development.
Main Methods:
- Patients underwent EGGIM scoring and microvascular pattern evaluation.
- Biopsies were taken for operative link on gastric intestinal metaplasia assessment (OLGIM) analysis.
- Diagnostic performance metrics (sensitivity, specificity, PLR, PPV) were calculated for EGGIM and the modified model.
Main Results:
- The original EGGIM showed an AUC of 0.885 for diagnosing OLGIM III-IV.
- Altered microvascular patterns were a significant risk factor for GC development (OR=4.696).
- The modified EGGIM model achieved an AUC of 0.921, demonstrating improved diagnostic performance.
Conclusions:
- Microvascular pattern is a significant independent predictor for OLGIM III-IV.
- The modified EGGIM model shows potential as a non-invasive endoscopic tool for GC risk stratification in GIM patients.
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