Diagnostic value of blue laser imaging combined with magnifying endoscopy for precancerous lesions and early gastric cancers

Abstract

Objective To evaluate the diagnostic value of blue laser imaging(BLI) combined with magnifying endoscopy for precancerous lesions and early gastric cancers. Methods From September 2015 to May 2016, a total of 249 gastric lesions detected with conventional white light endoscopy (WLE) on the basis of the assessment of mucosal shape and color were enrolled in this study. The pathological results were used as golden standard, and diagnostic accuracy rates of precancerous lesions or early cancers by white light magnification alone, BLI-contrast magnification and BLI-bright magnifier were determined according to the VS criteria. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement (Kappa) test, and diagnostic value was compared with McNemar paired Chi-square test. Results Pathological examination showed chronic gastritis in 149 lesions, intestinal metaplasia in 67, low grade intra-epithelial neoplasia in 8, and high grade intra-epithelial neoplasia or early cancer in 25.The concordance rates of lesions were 76.7% for white light magnification alone, 85.1% for BLI-contrast magnification, and 86.7% for BLI-bright magnification.Kappa values were 0.571, 0.730, and 0.760 respectively.For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 72.0%, 92.0%, and 92.0%, respectively, the specificities were 95.5%, 98.2%, and 99.1%, the consistencies were 93.2%, 97.6%, 98.4%, and the Kappa values were 0.642, 0.871, and 0.911. In contrast to white light magnification alone, the concordance between endoscopic diagnosis and pathological diagnosis of BLI-contrast magnification and BLI-bright magnification was significantly higher(P<0.05). And in the diagnosis of high-grade intraepithelial neoplasia or early gastric cancer, the concordance between endoscopic diagnosis and pathological diagnosis of BLI-contrast magnification and BLI-bright magnification was higher than that of white light magnification alone(P<0.05). Conclusion BLI combined with magnifying endoscopy may improve the diagnostic accuracy of early gastric cancer and precancerous lesions. Key words: Stomach neoplasms; Endoscopy, gastronintestinal; Diagnosis; Blue laser imaging; Magnifying endoscopy