Diagnosis of histological type of early gastric cancer by magnifying narrow-band imaging: A multicenter prospective study.

Abstract

ObjectivesDistinguishing undifferentiated‐type from differentiated‐type early gastric cancers (EGC) is crucial for determining the indication of endoscopic resection. We aimed to investigate the diagnostic performance of white‐light endoscopy (WLE) and magnifying narrow‐band imaging (M‐NBI) for the histological type of EGC.MethodsIn this multicenter prospective study, patients with histologically proven cT1 EGC, macroscopically depressed or flat type, size ≥5 mm, and without erosion/ulcer, were recruited. The diagnostic criterion of WLE for undifferentiated‐type EGC was pale color. The M‐NBI algorithm was created based on microsurface and microvascular patterns, and lesions with absent microsurface pattern and opened‐loop microvascular patterns were diagnosed as undifferentiated‐type. The center of the lesion was defined as the evaluation point and was initially evaluated by WLE, then by M‐NBI, and a biopsy specimen was taken as a reference standard. The primary and key secondary endpoints were overall diagnostic accuracy and specificity, respectively.ResultsIn total, 167 lesions (122 differentiated‐type and 45 undifferentiated‐type EGCs) in 167 patients were analyzed. The overall accuracy, sensitivity, specificity, and positive likelihood ratio of WLE for undifferentiated‐type cancer were 80%, 69%, 84%, and 4.4, respectively, and those of M‐NBI were 82%, 53%, 93%, and 7.2, respectively. There was no significant difference in overall accuracy (p = 0.755), but specificity was significantly higher in M‐NBI (p = 0.041).ConclusionsThe use of M‐NBI did not improve the accuracy of WLE for the diagnosis of depressed/flat undifferentiated‐type EGCs but improved the specificity. It may reduce surgical overtreatment by preventing misdiagnosis of differentiated‐type EGC as undifferentiated‐type.