Trimodal imaging endoscopy may improve diagnostic accuracy of early gastric neoplasia: a feasibility study

Background

A considerable number of superficial gastric neoplasias are overlooked with conventional white light imaging (WLI) endoscopy.

Objective

The aim was to investigate the diagnostic potential of trimodal imaging endoscopy (TME), which combines WLI, autofluorescence imaging (AFI), and narrow-band imaging (NBI), for superficial gastric neoplasia.

Design

Feasibility study.

Setting

Single academic center.

Patients

Sixty-two patients with or without gastric neoplasia.

Intervention

Each patient serially assessed with WLI, AFI, and magnifying endoscopy with NBI (ME-NBI) by an endoscopist blinded for clinical information. ME-NBI over WLI and AFI was designated as TME. Histopathology of biopsy and ESD specimens was evaluated and used as the gold standard.

Main Outcome Measurements

Sensitivity and specificity of endoscopic diagnosis of pathology-proven neoplasia by per-patient and per-lesion analyses.

Results

The study included 47 pathology-proven neoplasias and 44 pathology-proven nonneoplasias that were detected as neoplasias with any of the modalities. By a per-lesion analysis, the sensitivity of TME (89.4%) was higher than that of WLI (76.6%) and AFI (68.1%). The specificity of TME (98.0%) was higher than that of WLI (84.3%) and AFI (23.5%). By a per-patient analysis, the sensitivity of TME (90.9%) was higher than that of WLI (75%) and AFI (68.2%). The specificity of TME (100%) was higher than that of WLI (72.2%) and AFI (44.4%).

Limitations

Case-enriched population at a single center.

Conclusions

Higher diagnostic accuracy of TME over conventional WLI indicates the feasibility of TME for the efficacious diagnosis of early gastric neoplasia.

Abbreviations: AFE, autofluorescence endoscopy, AFI, autofluorescence imaging, BE, Barrett's esophagus, CI, confidence interval, ESD, endoscopic submucosal dissection, FMS, fine mucosal structure, ME-NBI, magnifying endoscopy with narrow-band imaging, NBI, narrow-band imaging, path-neoplasia, pathology-proven neoplasia, TME, trimodal imaging endoscopy, WLI, white light imaging