Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia

• Type: Article in International Scientific Journal
• Date: 2003

Authors

Mario Dinis Ribeiro (Author) Other; Costa-Pereira A (Author) FMUP; Lopes, C (Author) ICBAS; Lucio Lara Santos (Author) Other; Macedo G (Author) Other; Moreira Dias, L (Author) Other; Lomba Viana, H (Author) Other; Ribeiro, A (Author) Other; Santos, C (Author) Other; Soares, J (Author) Other; Mesquita, N (Author) Other; Silva, R (Author) Other; Lomba Viana, R (Author) Other

Journal

Title: Gastrointestinal Endoscopy

Vol. 57

Pages: 498-504

ISSN: 0016-5107

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 115 Citations

Scopus - 157 Citations

Other information

Authenticus ID: P-000-H5Z

DOI: 10.1067/mge.2003.145

Abstract (EN): Background: The aim of this study was to define the reproducibility and accuracy of magnification chromoendoscopy for the diagnosis of lesions associated with gastric cancer (intestinal metaplasia and dysplasia). Methods: A total of 136 patients with previously diagnosed lesions and 5 gastrectomy specimens were studied. Endoscopic examination was performed with a magnification endoscope after methylene blue (1%) spraying. According to differences in color and mucosal pattern, groups and subgroups of endoscopic images were defined, and biopsies taken (n = 462). Five endoscopists were asked to classify individually 2 endoscopic images per subgroup on 2 separate occasions. Results: Three groups of endoscopic images were defined: nonmetaplastic, nondysplastic mucosa (I); metaplastic mucosa (II); and dysplastic mucosa (III). Ten subgroups were defined according to pit pattern: round small (IA), round and tubular small (IB), coarse round (IC), and course round pits with a straight pit (ID); blue irregular marks (IIA), blue round and tubular pits (IIB), blue villi (IIC), and blue small pits (IIB); and loss of clear pattern, with depression (IIIA) or with slight elevation (IIIB). The kappa statistic for intraobserver agreement on the classification of endoscopic images in groups was 0.86; for interobserver agreement, it was 0.74. For classification into subgroups, kappa values ranged from 0.48 to 0.78. For 85% of the areas classified endoscopically as Group I (n = 146), no mucosal lesions or gastritis was described at histologic examination; for 83% of those in Group 11 (n = 198), intestinal metaplasia was found. Subgroups IIA and IIB were more often associated with complete intestinal metaplasia (62%), and IIC and IID with incomplete metaplasia (67%); in Group III (n = 118), dysplasia was diagnosed histopathologically in 33%. For the diagnosis of dysplasia, specificity was 81% (95% Cl [77%, 85%]) and negative predictive value 99% (95% Cl [99%, 100%]). Conclusions: Gastric endoscopic patterns with chromoendoscopy and magnification seem reproducible and valid for the diagnosis of lesions associated with gastric cancer. This procedure may improve the follow-up of individuals at high-risk of gastric cancer, at least for the exclusion of severe lesions.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7