Diagnostic accuracy and interobserver agreement for prediction of gastric preneoplastic lesions with fourth-generation endocytoscopy: Pilot study

Abstract

Background and study aims

Early detection of gastric preneoplastic lesions (GPL) is essential to prevent gastric cancer. Endocytoscopy may improve optical diagnosis through in vivo histologic assessment of mucosa. We assessed diagnostic performance of endocytoscopy and interobserver agreement for GPL diagnosis compared with reference histopathology.

Patients and methods

Eighty gastric areas (36 antrum, 44 corpus) from 25 prospectively recruited patients were assessed by endocytoscopy and classified as non-preneoplastic, preneoplastic, or dysplastic/neoplastic by an expert endoscopist. Targeted biopsies from each area served for histopathological assessment. High-quality images/videos were recorded for independent review by three additional observers (1 expert, 2 non-experts), blinded to endoscopic and histological findings.

Results

Histologically, 25 gastric areas (31.3%) showed GPL, 14 (17.5%) atrophic gastritis, and 11 (13.8%) intestinal metaplasia. Gastric cancer was found in three cases (3.8%). Combined sensitivity, specificity, and accuracy for endocytoscopic diagnosis of GPL or dysplasia were 89.3%, 94.2%, and 92.5% among expert endocytoscopists and 85.7%, 68.3%, and 74.4%, among non-experts, respectively. Interobserver agreement was substantial (κ-value 0.79) between experts and fair (κ-value 0.30) between non-experts.

Conclusions

New-generation endocytoscopy has potential to identify GPL with high diagnostic accuracy, reliability, and reproducibility. Training and clinical experience with endocytoscopy are required to maximize diagnostic performance.

Keywords

Endoscopy Upper GI Tract - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE) - Ulcers (peptic and other)

Publication History

Received: 06 November 2024

Accepted after revision: 28 May 2025

Accepted Manuscript online:
23 June 2025

Article published online:
24 July 2025

• References

• 1 Rugge M, Genta RM, Malfertheiner P. et al. RE.GA.IN.: the Real-world Gastritis Initiative-updating the updates. Gut 2024; 73: 407-441
• 2 Pimentel-Nunes P, Libânio D, Marcos-Pinto R. et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy 2019; 51: 365-388
• 3 van der Laan JJH, van der Putten JA, Zhao X. et al. Optical biopsy of dysplasia in Barrett's oesophagus assisted by artificial intelligence. Cancers (Basel) 2023; 15
• 4 Kudo S-e, Maeda Y, Ogata N. et al. Combined endocytoscopy with pit pattern diagnosis in ulcerative colitis-associated neoplasia: Pilot study. Dig Endosc 2022; 34: 133-143
• 5 Barua I, Mori Y, Bretthauer M. Colorectal polyp characterization with endocytoscopy: Ready for widespread implementation with artificial intelligence?. Best Pract Res Clin Gastroenterol 2021; 52-53
• 6 Kaise M, Ohkura Y, Iizuka T. et al. Endocytoscopy is a promising modality with high diagnostic accuracy for gastric cancer. Endoscopy 2015; 47: 19-25
• 7 Vasapolli R, Neuhaus L, Schirra J. et al. Microscopic alterations of the gastric mucosa in preneoplastic lesions as assessed by new-generation endocytoscopy. Endoscopy 2023; 55: E998-e1000
• 8 World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA 2013; 310: 2191-2194
• 9 Dixon MF, Genta RM, Yardley JH. et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181
• 10 Kudo SE, Wakamura K, Ikehara N. et al. Diagnosis of colorectal lesions with a novel endocytoscopic classification - a pilot study. Endoscopy 2011; 43: 869-875
• 11 Abad MRA, Inoue H, Ikeda H. et al. Utilizing fourth-generation endocytoscopy and the 'enlarged nuclear sign' for in vivo diagnosis of early gastric cancer. Endosc Int Open 2019; 7: E1002-e1007
• 12 Noda H, Kaise M, Higuchi K. et al. Convolutional neural network-based system for endocytoscopic diagnosis of early gastric cancer. BMC Gastroenterol 2022; 22: 237
• 13 Kaise M, Kimura R, Nomura K. et al. Accuracy and concordance of endocytoscopic atypia for the diagnosis of gastric cancer. Endoscopy 2014; 46: 827-832
• 14 Tsurudome I, Miyahara R, Funasaka K. et al. In vivo histological diagnosis for gastric cancer using endocytoscopy. World J Gastroenterol 2017; 23: 6894-6901
• 15 Sato H, Inoue H, Ikeda H. et al. In vivo gastric mucosal histopathology using endocytoscopy. World J Gastroenterol 2015; 21: 5002-5008
• 16 Sato H, Inoue H, Hayee B. et al. In vivo histopathology using endocytoscopy for non-neoplastic changes in the gastric mucosa: a prospective pilot study (with video). Gastrointest Endosc 2015; 81: 875-881
• 17 Chiu PW, Ng EK, To KF. et al. Recognition of goblet cells upon endocytoscopy indicates the presence of gastric intestinal metaplasia. Dig Endosc 2014; 26: 52-56
• 18 Horiuchi Y, Hirasawa T, Ishizuka N. et al. Diagnostic performance in gastric cancer is higher using endocytoscopy with narrow-band imaging than using magnifying endoscopy with narrow-band imaging. Gastric Cancer 2021; 24: 417-427
• 19 Horiuchi Y, Hirasawa T, Ishizuka N. et al. Evaluation of microvascular patterns alone using endocytoscopy with narrow-band imaging for diagnosing gastric cancer. Digestion 2022; 103: 159-168
• 20 Dekker E, Houwen B, Puig I. et al. Curriculum for optical diagnosis training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2020; 52: 899-923
• 21 Rodríguez-Carrasco M, Esposito G, Libânio D. et al. Image-enhanced endoscopy for gastric preneoplastic conditions and neoplastic lesions: a systematic review and meta-analysis. Endoscopy 2020; 52: 1048-1065
• 22 Iwagami H, Uedo N, Yip H-C. et al. Ultra-magnifying narrow-band imaging for endoscopic diagnosis of gastric intestinal metaplasia: a pilot image analysis study. Endosc Int Open 2021; 9: E522-E529
• 23 Horiuchi Y, Hirasawa T, Ishizuka N. et al. Diagnostic performance in gastric cancer is higher using endocytoscopy with narrow-band imaging than using magnifying endoscopy with narrow-band imaging. Gastric Cancer 2021; 24: 417-427
• 24 Yoo I, Park JC, Lee H. et al. A comparative study of magnifying endoscopy with narrow-band image and endocytoscopy in the diagnosis of gastric neoplasm: a pilot study. Eur J Gastroenterol Hepatol 2023; 35: 530-536