A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions

• Type: Article in International Scientific Journal
• Date: 2016

Authors

Pedro Pimentel-Nunes (Author) FMUP; Libanio, D (Author) FMUP; Lage, J (Author) Other; Abrantes, D (Author) Other; Coimbra, M (Author) FCUP; Esposito, G (Author) Other; Hormozdi, D (Author) Other; Pepper, M (Author) Other; Drasovean, S (Author) Other; White, JR (Author) Other; Dobru, D (Author) Other; Buxbaum, J (Author) Other; Ragunath, K (Author) Other; Annibale, B (Author) Other; Mario Dinis Ribeiro (Author) FMUP

Journal

Title: Endoscopy

Vol. 48

Pages: 723-730

ISSN: 0013-726X

Publisher: Thieme

Indexing

ISI Web of Knowledge - 146 Citations

Scopus - 155 Citations

Other information

Authenticus ID: P-00K-VYS

DOI: 10.1055/s-0042-108435

Abstract (EN): Background and aim: Some studies suggest that narrow-band imaging (NBI) can be more accurate at diagnosing gastric intestinal metaplasia and dysplasia than white-light endoscopy (WLE) alone. We aimed to assess the real-time diagnostic validity of high resolution endoscopy with and without NBI in the diagnosis of gastric premalignant conditions and to derive a classification for endoscopic grading of gastric intestinal metaplasia (EGGIM). Methods: A multicenter prospective study (five centers: Portugal, Italy, Romania, UK, USA) was performed involving the systematic use of high resolution gastroscopes with image registry with and without NBI in a centralized informatics platform (available online). All users used the same NBI classification. Histologic result was considered the diagnostic gold standard. Results: A total of 238 patients and 1123 endoscopic biopsies were included. NBI globally increased diagnostic accuracy by 11 percentage points (NBI 94% vs. WLE 83%; P<0.001) with no difference in the identification of Helicobacter pylori gastritis (73% vs. 74%). NBI increased sensitivity for the diagnosis of intestinal metaplasia significantly (87% vs. 53%; P<0.001) and for the diagnosis of dysplasia (92% vs. 74%). The added benefit of NBI in terms of diagnostic accuracy was greater in OLGIM III/IV than in OLGIM I/II (25 percentage points vs. 15 percentage points, respectively; P<0.001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for EGGIM in the identification of extensive metaplasia was 0.98. Conclusions: In a real-time scenario, NBI demonstrates a high concordance with gastric histology, superior to WLE. Diagnostic accuracy higher than 90% suggests that routine use of NBI allows targeted instead of random biopsy samples. EGGIM also permits immediate grading of intestinal metaplasia without biopsies and merits further investigation.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 8