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Near-focus magnification and second-generation narrow-band imaging for early gastric cancer in a randomized trial

  • Original Article—Alimentary Tract
  • Published:
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Abstract

Background

Magnifying endoscopy with narrow-band imaging (NBI) is effective for the diagnosis of early gastric cancer (EGC). However, magnifying endoscopy is not yet popular globally because of the required level of skill and lack of availability. To overcome these problems, dual-focus endoscopy (standard- and near-focus (NF) modes) has been developed. In this study, we evaluated the diagnostic performance of NF with second-generation (2G)-NBI (NF-NBI) for the diagnosis of EGC.

Methods

This was a secondary analysis of a multicenter randomized controlled trial of 4523 high-risk patients who underwent gastroscopies at 13 institutions in Japan. Patients were randomly assigned to white-light imaging (WLI) followed by 2G-NBI or to 2G-NBI followed by WLI. Lesions suspicious for EGC, newly detected by non-magnifying WLI or 2G-NBI, were subsequently observed with NF-NBI. All detected lesions were biopsied or resected. The diagnostic performance of NF-NBI was compared with the final histology.

Results

A total of 870 detected lesions (145 EGC, 725 non-EGC) were analyzed. Overall diagnostic performance for EGC using NF-NBI was accuracy 87.7%, sensitivity 60.7%, specificity 93.1%, positive predictive value 63.8%, and negative predictive value 92.2%. There were no significant differences in diagnostic performance between lesions detected by WLI or 2G-NBI. For lesions diagnosed with high (333 lesions) and low (537 lesions) confidences, accuracy was 92.2% and 84.9%, sensitivity was 64.7% and 58.5%, and specificity was 90.5% and 88.8%, respectively.

Conclusion

The diagnostic performance of NF-NBI is good and acceptable for diagnosis of EGC in combination with either WLI or 2G-NBI.

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Abbreviations

EGC:

Early gastric cancer

NBI:

Narrow-band imaging

M-NBI:

Magnifying endoscopy with narrow-band imaging

2G-NBI:

Second-generation narrow-band imaging

NF:

Near-focus mode

NF-NBI:

Near-focus mode with second-generation narrow-band imaging

WLI:

White-light imaging

VS classification system:

Vessel plus surface classification system

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Acknowledgements

We thank all the investigators who conducted the study at 13 participating institutions, and Eri Okuda who supported data management at Medical Research Support (Osaka, Japan).

Funding

This study was funded by joint research funds supplied by Kyoto University and the Olympus Corporation. Conflicts of interest exist between Kyoto University and Olympus Corporation, but not between other participating institutions. The funding source had no role in the conduct of the study; the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the article.

Author information

Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Shizuoka, Suntougun, 411-8777, Japan

    Naomi Kakushima

  2. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan

    Naohiro Yoshida & Hisashi Doyama

  3. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan

    Tomonori Yano

  4. Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Takahiro Horimatsu & Manabu Muto

  5. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

    Noriya Uedo

  6. Department of Gastroenterological Oncology, Hyogo Cancer Center, Hyogo, Japan

    Yoshinobu Yamamoto

  7. Department of Gastroenterology and Hepatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan

    Hiromitsu Kanzaki

  8. Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Ehime, Japan

    Shinichiro Hori

  9. Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan

    Kenshi Yao

  10. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Ichiro Oda

  11. Department of Advanced Medicine Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan

    Satoshi Tanabe

  12. Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan

    Chizu Yokoi

  13. Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan

    Ken Ohata

  14. Department of Biostatistics, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan

    Kenichi Yoshimura

  15. Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Hideki Ishikawa

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  1. Naomi Kakushima
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  2. Naohiro Yoshida
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Corresponding author

Correspondence to Naomi Kakushima.

Ethics declarations

Conflict of interest

Manabu Muto received grants from Olympus during the study period. Tomonori Yano received personal fees and non-financial support from Olympus, outside the submitted work. Other authors have nothing to declare.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent to be included in the study was obtained from all patients.

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Electronic supplementary material

Below is the link to the electronic supplementary material.

535_2020_1734_MOESM1_ESM.pptx

Supplementary file1 Electronic supplementary material 1. Examples of first-generation NBI(A) and 2G-NBI(B) without magnification. (PPTX 1198 kb)

535_2020_1734_MOESM2_ESM.pptx

Supplementary file2 Electronic supplementary material 2. A: A slightly elevated lesion was detected by 2G-NBI standard-focus (green square). The lesion was further observed by near-focus mode (B). (PPTX 486 kb)

535_2020_1734_MOESM3_ESM.pptx

Supplementary file3 Electronic supplementary material 3. A representative figure of EGC observed with NF-NBI. A clear demarcation line can be recognized between the non-tumorous mucosa and depressed area (yellow arrows), with an irregular microsurface pattern within the depressed area, according to the VS classification system. (PPTX 284 kb)

535_2020_1734_MOESM4_ESM.docx

Supplementary file4 Electronic supplementary material 4. Characteristics of detected EGC between differentiated and undifferentiated type. (DOCX 13 kb)

535_2020_1734_MOESM5_ESM.docx

Supplementary file5 Electronic supplementary material 5. Comparison of diagnostic performance of NF-NBI with previous studies of M-NBI. (DOCX 14 kb)

Supplementary file6 Electronic supplementary movie. White-light, 2G-NBI and NF-NBI observation of a depressed type EGC. (MP4 9874 kb)

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Kakushima, N., Yoshida, N., Doyama, H. et al. Near-focus magnification and second-generation narrow-band imaging for early gastric cancer in a randomized trial. J Gastroenterol 55, 1127–1137 (2020). https://doi.org/10.1007/s00535-020-01734-3

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  • DOI: https://doi.org/10.1007/s00535-020-01734-3

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