Potential Value Of Clinical And Endoscopic Characteristics In The Diagnosis Of Early Gastric Cancer

Background and Aim: Some differences in pathologic diagnosis of early gastric cancer(EGC)are found between endoscopic forceps biopsy and endoscopic resection.Additionally,it is also difficult to identify EGC and pathological type based on the colors and morphologies only by using traditional endoscopy.Therefore,the purpose of the present study is to investigate the diagnostic value of endoscopic characteristics of white light endoscopy(WLE)and blue laser imaging(BLI)for distinguishing between EGC and gastric intraepithelial neoplasia(GIN),as well as between differentiated-type EGC and undifferentiated-type EGC.Methods: The information of patients with suspected EGC were collected retrospectively from May 2015 to June 2019 in Zhongda Hospital affiliated to Southeast University,and all patients had received BLI examination and endoscopic resection.Simultaneously,the clinicopathological and endoscopic data of patients were recorded,and the final histological diagnosis was confirmed from resected specimens.Logistic regression analysis was used to evaluate the association between clinical endoscopic factors and final pathologic diagnosis,and calculated the ability of the factors to diagnosis EGC with accuracy,sensitivity,specificity,positive likelihood ratio and negative likelihood ratio.Result: A total of 231 patients were included in this study,of which 141 were finally diagnosed as EGC by endoscopic resection specimens and 90 patients as GIN.Multivariate logistic regression showed that older age(> 68 years)(OR = 3.107,95% CI = 1.536-6.285,P = 0.002),presence of erosion or ulceration(OR = 2.637,95% CI = 1.185-5.872,P = 0.018),and a positive blue laser imaging with magnifying endoscopy(ME-BLI)finding(OR = 12.226,95% CI =5.856-25.525,P < 0.001)were independent predictive factors for the histological diagnosis of EGC.Furthermore,positive ME-BLI finding showed the higher sensitivity and positive likelihood ratio for histological diagnosis of EGC(88.60% and 2.22,respectively).In addition,among 141 EGC,120 patients were diagnosed as differentiated-type EGC,and 21 patients as undifferentiated-type EGC.The results of logistic regression showed that male(OR = 0.190,95% CI = 0.068-0.533,P = 0.012)and elevated type(OR = 5.496,95% CI = 1.712-17.651,P= 0.004)were predictive factors of differentiated-type EGC.Conclusions: Older age(> 68 years),presence of erosion or ulceration and positive ME-BLI finding are predictive factors for the histological diagnosis of EGC.Furthermore,male and elevated type are predictive factors for the histological diagnosis of differentiated-type EGC.Taken together,it is necessary to pay more attention to these predictive factors of before endoscopic resection,which would contribute to improving the accuracy of diagnosis and guiding the endoscopic treatment of EGC.