- Email: [email protected]
Tu1697 Usefulness of Magnifying Endoscopy With Narrow Band Imaging (M-NBI) for Diagnosis of Early Gastric Cancer Before Endoscopic Submucosal Dissection
Abstracts
when combined with CA variables in our model. We postulate however that with further multivariate analysis, H-D may be even more closely predicted from EUS and CA analysis.
The sensitivity, specificity and accuracy of different modalities for discriminating malignancy in stomach WLE ME-WLI ME-NBI
Sensitivity(95%CI)
Specificity(95%CI)
accuracy
61.9%(56.5%-67.3%) 75.2% (69.8%-79.4%) 87.0% (82.6%-90.1%)
96.8%(96.3%-97.3%) 97.3%(96.8%-97.8%) 97.7%(97.2%-98.2%)
94.3% 95.7% 97.9%
* sensitivity(McNemar test): WLE vs ME-NBI:p!0.0001, ME-WLI vs ME-NBI: p !0.0001, WLE vs MEWLI:p !0.0001 * specificity(McNemar test): WLE vs ME-NBI:p!0.0001, ME-WLI vs ME-NBI: pZ0.0077, WLE vs MEWLI:p Z0.0012
The clinical characteristics of 315 cases of malignancy characteristics Location Location Location Macroscopic type
Diameter Histologic type
Figure 1. ROC curve to compare diagnostic accuracy of suspicious or high risk endosonographic and cyst aspirate features, either individually or in combination, to predict benign vs premalignant or malignant histology at surgery.
Tu1696 The Diagnostic Utility of Me-NBI in Differentiating Malignant Gastric Mucosal Lesions Comparing With Wle and ME-WLIda Prospective Multicentre Study Fang Yao*1, Dong Wu1, Xi Wu1, Tao Guo1, Aiming Yang1, Li Wang2, Liping He3, Bangmao Wang4, Yingcai Ma5, Liqing Yao6, Xinghua Lu1 1 Gastroenterology, Peking Union Medical College Hospital, Beijing, China; 2Epidemiology, Institute of Basic Medicine, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China; 3Gastroenterology, Fujian Provincial Hospital, Fuzhou, China; 4 Gastroenterology, General Hospital of TianJin Medical University, Tianjin, China; 5Gastroenterology, Qinghai provincial people’s hospital, Xining, China; 6Surgical, Zhongshan Hospital of Fudan University, Shanghai, China Aims: To compare the diagnostic accuracy of focal gastric lesions by ME-NBI (Narrow Band Imaging combined with magnifying endoscopy) against ME-WLI (White Light Imaging combined with magnifying endoscopy) and reveal the diagnostic utility of NBI-ME in differentiating gastric mucosal malignancy. Methods: A prospective multicentre study was conducted during Mar 1st, 2010 to Aug 31th, 2012, Chinese patients from the gastrointestinal outpatient department, aged over 40 years, with informed consents were enrolled. All the subjects underwent conventional diagnostic upper gastrointestinal endoscopy of WLE (White Light Endoscopy ) firstly, the detected focal lesions were evaluated by ME-WLI and followed NBI-ME. All lesions observed were biopsied for pathological evaluation. Images for the whole procedures were recorded and then reviewed by at least three experienced endoscopists. Endoscopic diagnosis was made according to Kenshi Yao’s classification of VS system. Taking histologic results as the golden standard, the diagnostic accuracy of WLE, ME-WLI and ME-NBI were evaluated and compared. Results: 4091 patients were recruited (2415males, 1676 females, mean age 55.2 10.3) in five centers. 4384 lesions were detected, among these 315 cancerous lesions (7.2%) were confirmed by pathologic results. The diagnostic sensitivity, specificity and accuracy of WLE for discriminating malignancy were 61.9%, 96.8% and 94.3% respectively. Those of ME-WLI were 75.2%, 97.3% and 95.7%，respectively. For ME-NBI , the results were 87.0%, 97.7% and 97.9% respectively. The differences are statistically significant. And the results also revealed that the location, macroscopic type, size and histologic type of lesions would affect the detective rate of ME-NBI. IIb type lesions were more difficult to be detected and bigger-size lesions were easier to be recognized. Conclusion: Comparing with WLE and ME-WLI, NBI-ME has a better ability to differentiate the malignant gastric mucosal lesions from the benign.
www.giejournal.org
characteristics
number
Percentage (%)
Upper third Middle third Lower third I IIa IIb IIc III O 2cm % 2cm Differentiated adenocarcinoma Undifferentiated adenocarcinoma
57 77 181 25 65 25 161 39 111 204 261 54
18.1 24.4 57.5 7.9 20.6 7.9 51.5 12.4 35.2 64.8 82.9 17.1
Tu1697 Usefulness of Magnifying Endoscopy With Narrow Band Imaging (M-NBI) for Diagnosis of Early Gastric Cancer Before Endoscopic Submucosal Dissection Hogara Nishisaki*, Shinsuke Yahata Internal Medicine, Hyogo prefectural Kaibara Hospital, Tanba, Japan Background: Detection and lateral extent diagnosis for early gastric cancers are important before endoscopic submucosal dissection (ESD). Conventional whitelight imaging (C-WLI) endoscopy, chromoendoscopy (CE) and magnifying endoscopy with narrow band imaging (M-NBI) have been widely performed for diagnosis of gastric cancer in Japan. Aim: To clarify usefulness and the point at issue of M-NBI for diagnosis of early gastric cancer before ESD. It was compared with C-WLI and CE. Patients: A series of early gastric cancer cases resected en bloc by ESD at our hospital between April 2013 and September 2014. Method: We evaluated retrospectively detection rate and lateral extent diagnosis rate for early gastric cancer , in C-WLI ,CE and M-NBI. Diagnosis for gastric cancer of M-NBI is performed in Yao criteria (lesions presenting an irregular microvascular pattern with demarcation line or an irregular microsurface pattern with demarcation line were diagnosed as cancers). Final diagnoses were made after histopathological examination of biopsy or endoscopically resected specimens. Result: 41 cases 48 lesions, gender; male/femaleZ31/ 10, age ;range 53-91(mean 69), lesion number per case;1/2/3(lesions)Z35/5/1(case), location；U/M/LZ4/24/20、size(mm);-5/6-10/11-15/16-20/21-Z9/13/13/5/8, new or known lesions; new/known＝23/25, form; elevated/flat/depressed＝19/2/27, color; discoloration/same color /reddishZ20/6/22, ulcer formation；-/+Z42/6、white coat;-/+＝39/9、cancer detection rate:C-WLI/CE/M-NBI＝25(52%)/32(67%)/ 43(90%), lateral extent detection rate；C-WLI/CE/M-NBIZ31(65%)/35(73%)/ 45(94%). Cancer detection rate and lateral extent detection rate were significantly higher for M-NBI than for C-WLI (P!0.05) or CE (P!0.05). Indication criteria for ESD; guide line(GL)/expand GLZ35/13, Curability; curative resection/ curative resection for tumor of expanded indications/non-curative resectionZ35/9/4、Noncurative factor; SM2/Ly+Z2/3(overlapping). Conclusion: M-NBI is better than C-WLI or CE in both detection and lateral extent diagnosis for early gastric cancer before endoscopic submucosal dissection. However, cancer lesions with white coat, cancer spreading in middle mucosal layer without surface lesion or minute lesions are not detected, and lateral extent diagnosis is difficult in these lesions. Limitation of this study is retrospective study at single institute.
Tu1698 Easily Recognizable Non-Magnification Endoscopic Features Help to Predict the Presence of Dysplasia in Macroscopically Evident Gastric Intestinal Metaplasia Pablo Luna*1, Estanislao J. Gómez1, Lisandro Pereyra1, Mariana Omodeo1, Adriana Mohaidle1, Raquel González1, José M. Mella1, Marcelo F. Amante2, Silvia C. Pedreira1, Daniel G. Cimmino1, Luis A. Boerr1 1 Gastroenterology, Hospital Alemán, Buenos Aires, Argentina; 2 Pathology, Hospital Alemán, Buenos Aires, Argentina Background: The presence of dysplasia in gastric intestinal metaplasia (GIM) requires a closer follow up and in some cases a different therapeutic approach.
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB563
when combined with CA variables in our model. We postulate however that with further multivariate analysis, H-D may be even more closely predicted from EUS and CA analysis.
The sensitivity, specificity and accuracy of different modalities for discriminating malignancy in stomach WLE ME-WLI ME-NBI
Sensitivity(95%CI)
Specificity(95%CI)
accuracy
61.9%(56.5%-67.3%) 75.2% (69.8%-79.4%) 87.0% (82.6%-90.1%)
96.8%(96.3%-97.3%) 97.3%(96.8%-97.8%) 97.7%(97.2%-98.2%)
94.3% 95.7% 97.9%
* sensitivity(McNemar test): WLE vs ME-NBI:p!0.0001, ME-WLI vs ME-NBI: p !0.0001, WLE vs MEWLI:p !0.0001 * specificity(McNemar test): WLE vs ME-NBI:p!0.0001, ME-WLI vs ME-NBI: pZ0.0077, WLE vs MEWLI:p Z0.0012
The clinical characteristics of 315 cases of malignancy characteristics Location Location Location Macroscopic type
Diameter Histologic type
Figure 1. ROC curve to compare diagnostic accuracy of suspicious or high risk endosonographic and cyst aspirate features, either individually or in combination, to predict benign vs premalignant or malignant histology at surgery.
Tu1696 The Diagnostic Utility of Me-NBI in Differentiating Malignant Gastric Mucosal Lesions Comparing With Wle and ME-WLIda Prospective Multicentre Study Fang Yao*1, Dong Wu1, Xi Wu1, Tao Guo1, Aiming Yang1, Li Wang2, Liping He3, Bangmao Wang4, Yingcai Ma5, Liqing Yao6, Xinghua Lu1 1 Gastroenterology, Peking Union Medical College Hospital, Beijing, China; 2Epidemiology, Institute of Basic Medicine, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China; 3Gastroenterology, Fujian Provincial Hospital, Fuzhou, China; 4 Gastroenterology, General Hospital of TianJin Medical University, Tianjin, China; 5Gastroenterology, Qinghai provincial people’s hospital, Xining, China; 6Surgical, Zhongshan Hospital of Fudan University, Shanghai, China Aims: To compare the diagnostic accuracy of focal gastric lesions by ME-NBI (Narrow Band Imaging combined with magnifying endoscopy) against ME-WLI (White Light Imaging combined with magnifying endoscopy) and reveal the diagnostic utility of NBI-ME in differentiating gastric mucosal malignancy. Methods: A prospective multicentre study was conducted during Mar 1st, 2010 to Aug 31th, 2012, Chinese patients from the gastrointestinal outpatient department, aged over 40 years, with informed consents were enrolled. All the subjects underwent conventional diagnostic upper gastrointestinal endoscopy of WLE (White Light Endoscopy ) firstly, the detected focal lesions were evaluated by ME-WLI and followed NBI-ME. All lesions observed were biopsied for pathological evaluation. Images for the whole procedures were recorded and then reviewed by at least three experienced endoscopists. Endoscopic diagnosis was made according to Kenshi Yao’s classification of VS system. Taking histologic results as the golden standard, the diagnostic accuracy of WLE, ME-WLI and ME-NBI were evaluated and compared. Results: 4091 patients were recruited (2415males, 1676 females, mean age 55.2 10.3) in five centers. 4384 lesions were detected, among these 315 cancerous lesions (7.2%) were confirmed by pathologic results. The diagnostic sensitivity, specificity and accuracy of WLE for discriminating malignancy were 61.9%, 96.8% and 94.3% respectively. Those of ME-WLI were 75.2%, 97.3% and 95.7%，respectively. For ME-NBI , the results were 87.0%, 97.7% and 97.9% respectively. The differences are statistically significant. And the results also revealed that the location, macroscopic type, size and histologic type of lesions would affect the detective rate of ME-NBI. IIb type lesions were more difficult to be detected and bigger-size lesions were easier to be recognized. Conclusion: Comparing with WLE and ME-WLI, NBI-ME has a better ability to differentiate the malignant gastric mucosal lesions from the benign.
www.giejournal.org
characteristics
number
Percentage (%)
Upper third Middle third Lower third I IIa IIb IIc III O 2cm % 2cm Differentiated adenocarcinoma Undifferentiated adenocarcinoma
57 77 181 25 65 25 161 39 111 204 261 54
18.1 24.4 57.5 7.9 20.6 7.9 51.5 12.4 35.2 64.8 82.9 17.1
Tu1697 Usefulness of Magnifying Endoscopy With Narrow Band Imaging (M-NBI) for Diagnosis of Early Gastric Cancer Before Endoscopic Submucosal Dissection Hogara Nishisaki*, Shinsuke Yahata Internal Medicine, Hyogo prefectural Kaibara Hospital, Tanba, Japan Background: Detection and lateral extent diagnosis for early gastric cancers are important before endoscopic submucosal dissection (ESD). Conventional whitelight imaging (C-WLI) endoscopy, chromoendoscopy (CE) and magnifying endoscopy with narrow band imaging (M-NBI) have been widely performed for diagnosis of gastric cancer in Japan. Aim: To clarify usefulness and the point at issue of M-NBI for diagnosis of early gastric cancer before ESD. It was compared with C-WLI and CE. Patients: A series of early gastric cancer cases resected en bloc by ESD at our hospital between April 2013 and September 2014. Method: We evaluated retrospectively detection rate and lateral extent diagnosis rate for early gastric cancer , in C-WLI ,CE and M-NBI. Diagnosis for gastric cancer of M-NBI is performed in Yao criteria (lesions presenting an irregular microvascular pattern with demarcation line or an irregular microsurface pattern with demarcation line were diagnosed as cancers). Final diagnoses were made after histopathological examination of biopsy or endoscopically resected specimens. Result: 41 cases 48 lesions, gender; male/femaleZ31/ 10, age ;range 53-91(mean 69), lesion number per case;1/2/3(lesions)Z35/5/1(case), location；U/M/LZ4/24/20、size(mm);-5/6-10/11-15/16-20/21-Z9/13/13/5/8, new or known lesions; new/known＝23/25, form; elevated/flat/depressed＝19/2/27, color; discoloration/same color /reddishZ20/6/22, ulcer formation；-/+Z42/6、white coat;-/+＝39/9、cancer detection rate:C-WLI/CE/M-NBI＝25(52%)/32(67%)/ 43(90%), lateral extent detection rate；C-WLI/CE/M-NBIZ31(65%)/35(73%)/ 45(94%). Cancer detection rate and lateral extent detection rate were significantly higher for M-NBI than for C-WLI (P!0.05) or CE (P!0.05). Indication criteria for ESD; guide line(GL)/expand GLZ35/13, Curability; curative resection/ curative resection for tumor of expanded indications/non-curative resectionZ35/9/4、Noncurative factor; SM2/Ly+Z2/3(overlapping). Conclusion: M-NBI is better than C-WLI or CE in both detection and lateral extent diagnosis for early gastric cancer before endoscopic submucosal dissection. However, cancer lesions with white coat, cancer spreading in middle mucosal layer without surface lesion or minute lesions are not detected, and lateral extent diagnosis is difficult in these lesions. Limitation of this study is retrospective study at single institute.
Tu1698 Easily Recognizable Non-Magnification Endoscopic Features Help to Predict the Presence of Dysplasia in Macroscopically Evident Gastric Intestinal Metaplasia Pablo Luna*1, Estanislao J. Gómez1, Lisandro Pereyra1, Mariana Omodeo1, Adriana Mohaidle1, Raquel González1, José M. Mella1, Marcelo F. Amante2, Silvia C. Pedreira1, Daniel G. Cimmino1, Luis A. Boerr1 1 Gastroenterology, Hospital Alemán, Buenos Aires, Argentina; 2 Pathology, Hospital Alemán, Buenos Aires, Argentina Background: The presence of dysplasia in gastric intestinal metaplasia (GIM) requires a closer follow up and in some cases a different therapeutic approach.
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB563