The Value Of Magnifying Endoscopy Combined With Narrowband Imaging(ME-NBI) In The Diagnosis Of Gastric Lesions

Background:Gastric cancer is the second commonest leading cause of cancer deaths worldwide. Early detection and diagnosis of gastric cancer is crucial for the prognosis of gastric cancer. Endoscopic treatment is the first selection for early gastric cancer, but whether to accept early treatment depends on early detection, this study is trying to use the ME-NBI to improve the diagnostic rate of early gastric cancer.AIM: Evaluate the value of magnifying endoscopy combined with narrow-band imaging(ME-NBI) in the diagnosis of ECG(early gastric cancer) and the guiding significance for clinical treatment decisions.METHODS: This retrospective study collected 62 patients’ data including 63 lesions of gastric mucosal which were tested by White light endoscopic and ME-NBI in the first affiliated hospital of Dalian medical university in August 2013- February 2015. The patients with local advanced cancer、submucosal lesions and the history of gastrectomy were excluded from this study. Treated the pathology results as a diagnostic gold standard. With reference to the 1998 revision of the Vienna gastrointestinal epithelial tumor pathologic classification standards and the WHO criterion, we divided the 63 gastric lesions into early cancer group and non cancerous group at first, including 31 early gastric cancer and 32 non cancerous lesions. And comparing the WLE’S and MENBI’s sensitivity degree, specific degree, positive predictive value, negative predictive value and diagnosis accuracy for early cancer. We observed the characteristic of microsurface and microvessels’ distribution and morphology of the 31 early gastric cancer(including 25 intramucosal carcinoma and 6 submucosal carcinoma) under the ME- NBI,exploring the relationship between the invasion depth and microvascular and microsurface’s shape and distribution.RESULTS:1.WLE’S diagnosis for early gastric cancer: among the 63 lesions, 29 lesions were treated to carcinoma lesions and 34 lesions were treated to no carcinoma lesions by the WLE, the degree of sensitivity, specific, positive predictive value, negativepredictive value and accuracy of diagnosis is 67.7%( 21/31) 、 75.0%(24/32) 、72.4%(21/29)、70.6%(24/34)、71.4%(45/63);2. ME-NBI’s diagnosis for early gastric cancer: among the 63 lesions, 33 lesions were treated to cancerous lesions and 30 lesions were treated to no-cancerous lesions by the ME-NBI, the degree of sensitivity, specific, positive predictive value, negative predictive value and accuracy of diagnosis is 93.5%(29/31) 、 87.5%(28/32) 、87.9%(29/33)、93.3%(28/30)、90.5%(57/63),the sensitivity, negative predictive value and the diagnosis accuracy of ME- NBI are significantly higher than the WLE’s;3. The relationship between the invasion depth of early gastric cancer and the microsurface under the ME-NBI: Among the 25 intramucosal carcinoma, 18 lesions has no microsurface and 7 has irregular microsuface; Among the 6 submucosal carcinoma,all the lesions has no microsurface, there were no statistically significant differences between the invasion depth and microsurface, P=0.293;4. The relationship between the invasion depth of early gastric cancer and the microvessels under the ME-NBI: Among the 25 intramucosal carcinomas, 9 lesions had microvessels missed partly and 16 did not have microvessels missed partly; Among the6 submucosal carcinomas, 5 lesions had microsurface missed partly and 1 did not have microvessels missed partly, there were no statistically significant differences between the invasion depth and microvessels, P=0.067;5.The relationship between the invasion depth and microvessel’s distribution and shape in ME-NBI: Among the 25 intramucosal carcinomas, 2 lesions had isolated and dilated microvessels and 23 lesions had no isolated and dilated microvessels, Among the 6submucosal carcinomas,5 lesions had isolated and dilated microvessels and 1 lesions had no isolated and dilated microvessels, there was statistically significant difference between the invasion depth of early gastric cancer and weather there are isolated and dilated vessels, P=0.01. The accuracy of isolated and dilated microvessels for judging the depth of early gastric cancer is 90.3%.CONCLUSIONS:1.MENBI in diagnosis of early gastric carcinoma has higher diagnostic accuracy than W-LE, so ME-NBI is supposed to be promoted to early gastric cancer’s diagnosis;2.Weather the microsurface and the microvessel partly missing or not under the MENBI can’t be the criterion to judge the invasion depth. But the distribution anddiameter of the microvessel seem to judge the invasion depth and be useful for clinical decision making. But owing to the limited number of cases this study collected, it is not enough to form an exact diagnosis standard, so we need to make large sample and multicenter randomized controlled study in the future.