A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions

Pedro Pimentel-Nunes; Diogo Libânio; Jorge Lage; Diogo Abrantes; Miguel Coimbra; Gianluca Esposito; David Hormozdi; Mike Pepper; Silvia Drasovean; Jonathan R. White; Daniela Dobru; James Buxbaum; Krish Ragunath; Bruno Annibale; Mário Dinis-Ribeiro

doi:10.1055/s-0042-108435

Endoscopy, Table of Contents

Endoscopy 2016; 48(08): 723-730
DOI: 10.1055/s-0042-108435

Original article

A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions

Pedro Pimentel-Nunes

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

²Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal

,

Diogo Libânio

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

,

Jorge Lage

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

,

Diogo Abrantes

³Instituto de Telecomunicações, Faculty of Sciences of the University of Porto, Porto, Portugal

,

Miguel Coimbra

³Instituto de Telecomunicações, Faculty of Sciences of the University of Porto, Porto, Portugal

,

Gianluca Esposito

⁴Department of Medicine, Surgery and Translational Medicine, University Hospital Sant'Andrea, University Sapienza Roma, Rome, Italy

,

David Hormozdi

⁵Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

,

Mike Pepper

⁵Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

,

Silvia Drasovean

⁶University of Medicine and Pharmacy TG., Mures, Romania

,

Jonathan R. White

⁷NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom

,

Daniela Dobru

⁶University of Medicine and Pharmacy TG., Mures, Romania

,

James Buxbaum

⁵Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

,

Krish Ragunath

⁷NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom

,

Bruno Annibale

⁴Department of Medicine, Surgery and Translational Medicine, University Hospital Sant'Andrea, University Sapienza Roma, Rome, Italy

,

Mário Dinis-Ribeiro

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

²Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal

› Author Affiliations

Abstract

Background and aim: Some studies suggest that narrow-band imaging (NBI) can be more accurate at diagnosing gastric intestinal metaplasia and dysplasia than white-light endoscopy (WLE) alone. We aimed to assess the real-time diagnostic validity of high resolution endoscopy with and without NBI in the diagnosis of gastric premalignant conditions and to derive a classification for endoscopic grading of gastric intestinal metaplasia (EGGIM).

Methods: A multicenter prospective study (five centers: Portugal, Italy, Romania, UK, USA) was performed involving the systematic use of high resolution gastroscopes with image registry with and without NBI in a centralized informatics platform (available online). All users used the same NBI classification. Histologic result was considered the diagnostic gold standard.

Results: A total of 238 patients and 1123 endoscopic biopsies were included. NBI globally increased diagnostic accuracy by 11 percentage points (NBI 94 % vs. WLE 83 %; P < 0.001) with no difference in the identification of Helicobacter pylori gastritis (73 % vs. 74 %). NBI increased sensitivity for the diagnosis of intestinal metaplasia significantly (87 % vs. 53 %; P < 0.001) and for the diagnosis of dysplasia (92 % vs. 74 %). The added benefit of NBI in terms of diagnostic accuracy was greater in OLGIM III/IV than in OLGIM I/II (25 percentage points vs. 15 percentage points, respectively; P < 0.001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for EGGIM in the identification of extensive metaplasia was 0.98.

Conclusions: In a real-time scenario, NBI demonstrates a high concordance with gastric histology, superior to WLE. Diagnostic accuracy higher than 90 % suggests that routine use of NBI allows targeted instead of random biopsy samples. EGGIM also permits immediate grading of intestinal metaplasia without biopsies and merits further investigation.

Full Text

References

References
1 Jemal A, Bray F, Center MM et al. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90
2 Leja M, You W, Camargo MC et al. Implementation of gastric cancer screening – the global experience. Best Pract Res Clin Gastroenterol 2014; 28: 1093-1106
3 Dinis-Ribeiro M, Areia M, de Vries AC et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy 2012; 44: 74-94
4 Pimentel-Nunes P, Dinis-Ribeiro M, Soares JB et al. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy 2012; 44: 236-246
5 Kikuste I, Marques-Pereira R, Monteiro-Soares M et al. Systematic review of the diagnosis of gastric premalignant conditions and neoplasia with high-resolution endoscopic technologies. Scand J Gastroenterol 2013; 48: 1108-1117
6 Dias-Silva D, Pimentel-Nunes P, Magalhaes J et al. The learning curve for narrow-band imaging in the diagnosis of precancerous gastric lesions by using Web-based video. Gastrointest Endosc 2014; 79: 910-920 ; quiz 983 e911, 983 e914
7 Capelle LG, de Vries AC, Haringsma J et al. The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis. Gastrointest Endosc 2010; 71: 1150-1158
8 Chen XY, van der Hulst RW, Bruno MJ et al. Interobserver variation in the histopathological scoring of Helicobacter pylori related gastritis. J Clin Pathol 1999; 52: 612-615
9 el-Zimaity HM, Graham DY, al-Assi MT et al. Interobserver variation in the histopathological assessment of Helicobacter pylori gastritis. Hum Pathol 1996; 27: 35-41
10 Offerhaus GJ, Price AB, Haot J et al. Observer agreement on the grading of gastric atrophy. Histopathology 1999; 34: 320-325
11 den Hoed CM, Holster IL, Capelle LG et al. Follow-up of premalignant lesions in patients at risk for progression to gastric cancer. Endoscopy 2013; 45: 249-256
12 Xirouchakis E, Laoudi F, Tsartsali L et al. Screening for gastric premalignant lesions with narrow band imaging, white light and updated Sydney protocol or both?. Dig Dis Sci 2013; 58: 1084-1090
13 Capelle LG, Haringsma J, de Vries AC et al. Narrow band imaging for the detection of gastric intestinal metaplasia and dysplasia during surveillance endoscopy. Dig Dis Sci 2010; 55: 3442-3448
14 Ang TL, Pittayanon R, Lau JY et al. A multicenter randomized comparison between high-definition white light endoscopy and narrow band imaging for detection of gastric lesions. Eur J Gastroenterol Hepatol 2015; 27: 1473-1478
15 Lage J, Pimentel-Nunes P, Figueiredo PC et al. Light-NBI to identify high-risk phenotypes for gastric adenocarcinoma: do we still need biopsies?. Scand J Gastroenterol 2016; 51: 501-506
16 Ezoe Y, Muto M, Uedo N et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology 2011; 141: 2017-2025 e2013
17 Dinis-Ribeiro M, Kuipers EJ. Identification of gastric atrophic changes: from histopathology to endoscopy. Endoscopy 2015; 47: 533-537
18 Annibale B, Aprile MR, D’Ambra G et al. Cure of Helicobacter pylori infection in atrophic body gastritis patients does not improve mucosal atrophy but reduces hypergastrinemia and its related effects on body ECL-cell hyperplasia. Aliment Pharmacol Ther 2000; 14: 625-634
19 Correa P, Fontham ET, Bravo JC et al. Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-Helicobacter pylori therapy. J Natl Cancer Inst 2000; 92: 1881-1888
20 De Vries AC, Kuipers EJ. Review article: Helicobacter pylori eradication for the prevention of gastric cancer. Aliment Pharmacol Ther 2007; 26 (Suppl. 02) 25-35
21 Mera R, Fontham ET, Bravo LE et al. Long term follow up of patients treated for Helicobacter pylori infection. Gut 2005; 54: 1536-1540
22 Satoh K, Kimura K, Takimoto T et al. A follow-up study of atrophic gastritis and intestinal metaplasia after eradication of Helicobacter pylori. Helicobacter 1998; 3: 236-240
23 Wang J, Xu L, Shi R et al. Gastric atrophy and intestinal metaplasia before and after Helicobacter pylori eradication: a meta-analysis. Digestion 2011; 83: 253-260