| Objective: To investigate the diagnostic accuracy of conventional white-light imaging(C-WLI) biopsy and targeting biopsy of magnifying endoscopy combined with narrow-band imaging(ME-NBI) for suspected lesions of esophagus.Methods: The endoscopic examination was performed on 65 patients between January 2013 and January 2015, and the patients were allocated into two groups with crossover design. Group A: patients received C-WLI biopsy, further endoscopy was conducted using ME-NBI target biopsy 4-6 weeks later. Group B: firstly, patients received ME-NBI target biopsy, further endoscopy was conducted using C-WLI biopsy 4-6 weeks later. Outcomes of C-WLI biopsy and ME-NBI target biopsy were compared.Results:A total of 58 patients completed the study, with 38 male( 24-82 years old,mean age 55.6±13.3) and 20 female( 27-74 years old, mean age 54.7±11.3). 74 lesions were detected in 58 patients, 68 of them were selected as research objects. The diagnostic accuracy of C-WLI biopsy for neoplastic lesions were as follows: sensitivity 70%,specificity 100%, positive predictive value 100%, negative predictive value 95.1%. While those of ME-NBI target biopsy were as follows: sensitivity 90%, specificity 100%, positive predictive value 100%, negative predictive value 98.3%. Sensitivity of ME-NBI target biopsy was superior to C-WLI biopsy in diagnosis of neoplastic lesions( P<0.05). The mean number of biopsies in C-WLI was larger than that in ME-NBI(3.7 vs.2.2,P <0.05).Conclusions: ME-NBI is superior to WLI in diagnosis of superficial esophageal neoplastic lesions, and also helps to decrease the biopsy quantities.Objective:To assess the value of ME-NBI in the follow-up of Barrett’s esophagus.Methods: A total of 96 patients with Barrett ’ s esophagus were enrolled and biopsied between September 2012 and May 2015. With paired crossover design, the patients were randomly allocated to receive a WLI or ME-NBI, they would receive a second-look endoscopy with the opposite way. Outcomes of ME-NBI and WLI were compared with histology of biopsy specimen, and the biopsy quantities were also contrasted.Results:A total of 88 patients completed the study, with 56 male(mean age 52.4±12.0)and 32 female(mean age 51.7 ± 13.3).We detected 16 cases of LGIN(Low grade intraepithelial neoplasia) and 3 HGIN(High grade intraepithelial neoplasia) by WLI. The incidence of intraepithelial neoplasia was 21.6%, diagnostic accuracy 88.6%. The incidence of Specialized intestinal metaplasia(SIM) was 92.2%(81 cases) with WLI. By ME-NBI, We detected 23 cases of LGIN and 5 cases of HGIN.The incidence of intraepithelial neoplasia was 31.8%, diagnostic accuracy 98.8%. The incidence of SIM was92.0%(81 cases) with ME-NBI. We observed SIM in all the lesions with intraepithelial neoplasia. The incidence of intraepithelial neoplasia of ME-NBI is higher than that of WLI(21.6% VS 31.8%,P<0.05), diagnostic accuracy of ME-NBI is higher than that of WLI(88.6%vs 98.8%,P<0.05).Conclusions:ME-NBI can detect more lesions of intraepithelial neoplasia than WLI in the follow-up of Barrett’s esophagus, and fewer biopsy specimens needed.Objective:To investigate the value of reformed Vessel plus surface classification forearly gastric neoplastic lesions.Methods:From September 2012 to May 2015, a total of 124 patients with suspected superficial gastric neoplastic lesions by WLI were enrolled in the study,With 87 male( 40-83 years old, mean age 63.2 ± 7.9) and 37 female( 46-77 years old, mean age62.6±8.2). We enrolled 30 healthy cases as control group. All the patients enrolled received endoscopy examination and ME-NBI followed WLI were performed. Vessel plus surface classification and reformed Vessel plus surface classification with ME-NBI were recorded and biopsies were taken after the whole endoscopy examination. Patients received ESD or surgery according to histology results. Using immunohistochemistry(IHC), expression level of Ki67 and MVD were evaluated among different excision specimens. WLI, Vessel plus surface classification, Reformed Vessel plus surface classification and its histology result were analyzed statistically.Results:A total of 118 patients completed the study, 162 lesions were detected, and161 of them were analyzed statistically, which consisted of 84 low-grade intraepithelial neoplasia(LGIN), 63 high-grade intraepithelial neoplasia(HGIN), 7 intramucosal cancer,5 SM1(submucosal) and 2 SM2. IIc、III is common in early gastric neoplastic lesions,which accounts for 57.1%. The incidence of DL, MS, irregular-microvascular pattern(IV),gland tube density and microvessel density was significantly higher in dysplastic than non-dysplastic lesions( P<0.05). The expression level of Ki67 was higher in HGIN and early gastric cancer than that in LGIN and cancer adjacent tissues( P<0.05). MDV was higher in gastric dysplasia(LGIN, HGIN and early gastric cancer) than that in healthy group( P<0.05). Meanwhile, MDV in LGIN and cancer adjacent tissues was lower than that in early gastric cancer( P<0.05). IP ratio between dysplastic lesions and adjacent normal tissues was 1.57, while IP ratio between non-dysplastic lesions and adjacent normal tissues was 1.05, the difference had statistical significance( P<0.01). The diagnostic accuracy of C-WLI for early gastric cancer were as follows: sensitivity 89.6%, specificity61.9%, and area under the curve(AUC) 0.84. The diagnostic accuracy of ME-NBI for early gastric cancer were as follows: sensitivity 94.8%, specificity 83.3%, and area under the curve(AUC) 0.93. The diagnostic accuracy of ME-NBI is higher than that of WLI( P<0.05). The diagnostic accuracy of Vessel plus surface classification for early gastric cancer were as follows: sensitivity 90.9%, specificity 81.0%, and area under the curve(AUC) 0.89. The diagnostic accuracy of Reformed Vessel plus surface classificationfor early gastric cancer were as follows: sensitivity94.8%, specificity 83.3%, and area under the curve(AUC) 0.93. The diagnostic sensitivity of reformed Vessel plus surface classification is higher than that of Vessel plus surface classification( P<0.01).Conclusions:Expression level of Ki67 and MDV was significantly higher in early gastric dysplastic lesions. Gland tube density and microvessel density with ME-NBI may become markers to assess the gastric lesions. The diagnostic accuracy of reformed Vessel plus surface classification for early gastric neoplastic lesions was high, and has a good prospect in clinical application. |
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