Magnifying endoscopy with narrow-band imaging achieves superior accuracy in the differential diagnosis of superficial gastric lesions identified with white-light endoscopy: a prospective study

Gastrointest Endosc. 2010 Sep;72(3):523-9. doi: 10.1016/j.gie.2010.04.041. Epub 2010 Jul 3.


Background: Conventional, white-light imaging endoscopy (WLE) results in a significant number of misdiagnoses in early gastric cancer. Magnifying endoscopy combined with narrow-band imaging (ME-NBI) is more accurate in the diagnosis of gastric cancer when the diagnostic triad of the disappearance of fine mucosal structure, microvascular dilation, and heterogeneity is used.

Objective: The aim of the present study was to evaluate the superiority of ME-NBI in the differential diagnosis of superficial gastric lesions identified with conventional WLE.

Design: Prospective, comparative study.

Setting: Single academic center.

Patients: This study involved patients who underwent WLE and ME-NBI for surveying synchronous or metachronous cancers because they had a high risk of gastric cancer.

Intervention: Patients with superficial gastric lesions that were diagnosed by WLE as cancer or non-cancer with a slight suspicion of cancer were prospectively enrolled in the study. ME-NBI was used to further characterize lesions picked up with WLE.

Main outcome measurements: Sensitivity and specificity for the diagnosis of gastric cancer, with pathology as the criterion standard.

Results: A total of 201 lesions (mean diameter [+/- SD] 7.0 +/- 4.0 mm) from 111 patients (98 men, 13 women; mean age 66.3 years) were evaluated. Fourteen of the 201 lesions were pathologically proven as gastric cancer; the others were noncancerous lesions. The sensitivity and specificity for ME-NBI diagnosis with the use of the triad (92.9% and 94.7%, respectively) were significantly better than for WLE (42.9% and 61.0%, respectively; P < .0001).

Limitations: Single center and a highly selected population at high risk for gastric cancer.

Conclusion: ME-NBI achieved superior accuracy in the differential diagnosis of superficial gastric lesions identified with WLE. Thus, ME-NBI may increase the diagnostic value of endoscopy in a population at high risk of gastric cancer.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / blood supply*
  • Adenocarcinoma / diagnosis*
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Adenoma / blood supply*
  • Adenoma / diagnosis*
  • Adenoma / pathology
  • Adenoma / surgery
  • Aged
  • Diagnosis, Differential
  • Dissection
  • Female
  • Fluorescence
  • Gastric Mucosa / blood supply*
  • Gastric Mucosa / pathology*
  • Gastric Mucosa / surgery
  • Gastroscopes*
  • Humans
  • Image Enhancement / instrumentation*
  • Male
  • Microvessels / pathology
  • Middle Aged
  • Precancerous Conditions / blood supply*
  • Precancerous Conditions / diagnosis*
  • Precancerous Conditions / pathology
  • Precancerous Conditions / surgery
  • Prospective Studies
  • Stomach Neoplasms / blood supply*
  • Stomach Neoplasms / diagnosis*
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery