Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Beijing, 100038, China,
Dig Dis Sci. 2014 Jul;59(7):1513-9. doi: 10.1007/s10620-014-3027-4. Epub 2014 Feb 1.
To evaluate the accuracy of diagnosing gastric antral lesions in routine clinical practice using magnifying endoscopy with narrow-band imaging (M-NBI) as a real-time diagnosing technique.
Consecutive patients undergoing upper endoscopy were selected for the study. In each patient, the mucosa of the gastric antrum was observed by M-NBI, and the gastric microstructure was categorized into five types (A-E). Based on these patterns, histological types were predicted in a real-time manner. The accuracy of these predictions was evaluated based on histological findings. Inter-observer agreement was also assessed.
A total of 207 sites in 90 patients were examined by M-NBI. Compared with type A gastric microstructure, types B and C gastric microstructure showed a significantly higher degree of inflammation (P < 0.001). The sensitivity, specificity and accuracy of types B + C microstructure as a predictor of gastric inflammation were 85.4, 81.7 and 83.1 %, respectively. Similarly, the sensitivity, specificity and accuracy of type D microstructure as a predictor of gastric intestinal metaplasia were 71.8, 95.2 and 90.8 %, respectively, and those of type E microstructure as a predictor of early gastric cancer were 80.0, 98.9 and 97.6 %, respectively. The sensitivity and specificity of type B alone, type C alone and types B + C combined for the detection of Helicobacter pylori infection were 52.2 and 87.0 %, 22.8 and 92.2 %, 75.0 and 79.1 %, respectively. The kappa value for the inter-observer agreement was 0.715 (95 % confidence interval 0.655-0.895).
In conclusion, M-NBI can significantly improve the accuracy of the prediction of histopathology of gastric antral lesions in vivo, implying the possibility of using M-NBI as an effective diagnosis technique.
评估使用窄带成像放大内镜（M-NBI）作为实时诊断技术诊断常规临床实践中胃窦病变的准确性。
连续选择接受上内窥镜检查的患者进行研究。在每个患者中，使用 M-NBI 观察胃窦的黏膜，将胃的微观结构分为五种类型（A-E）。基于这些模式，实时预测组织学类型。根据组织学发现评估这些预测的准确性。还评估了观察者间的一致性。
共对 90 例患者的 207 个部位进行了 M-NBI 检查。与 A 型胃微观结构相比，B 型和 C 型胃微观结构的炎症程度明显更高（P<0.001）。B+C 微观结构作为炎症预测因子的敏感性、特异性和准确性分别为 85.4%、81.7%和 83.1%。同样，D 型微观结构作为胃肠化生预测因子的敏感性、特异性和准确性分别为 71.8%、95.2%和 90.8%，E 型微观结构作为早期胃癌预测因子的敏感性、特异性和准确性分别为 80.0%、98.9%和 97.6%。B 型单独、C 型单独和 B+C 联合检测幽门螺杆菌感染的敏感性和特异性分别为 52.2%和 87.0%、22.8%和 92.2%、75.0%和 79.1%。观察者间一致性的 Kappa 值为 0.715（95%置信区间为 0.655-0.895）。
总之，M-NBI 可以显著提高体内胃窦病变组织病理学预测的准确性，暗示了将 M-NBI 用作有效诊断技术的可能性。
