Fujiwara Shoko, Yao Kenshi, Nagahama Takashi, Uchita K, Kanemitsu Takao, Tsurumi Kozue, Takatsu Noritaka, Hisabe Takashi, Tanabe Hiroshi, Iwashita Akinori, Matsui Toshiyuki
Department of Endoscopy, Fukuoka University Chikushi Hospital, Zokumyoin, Chikushino-shi, Fukuoka, 818-8502, Japan.
Gastric Cancer. 2015 Jul;18(3):590-6. doi: 10.1007/s10120-014-0399-2. Epub 2014 Jul 9.
Chromoendoscopy (CE) is relatively ineffective at identifying the cancer-specific morphological characteristics of minute gastric cancers less than or equal to 5 mm in diameter, and on its own is insufficient to make an accurate diagnosis. The aim of this study is to assess the diagnostic performance of magnifying endoscopy with narrow band imaging (M-NBI) for minute gastric cancers.
The minute cancer group comprised consecutive endoscopic submucosal dissection-resected minute gastric cancers histologically measured as no larger than 5 mm in diameter. The non-cancer group comprised consecutive non-cancer lesions no larger than 5 mm in diameter. The two groups were subject to retrospective analysis to evaluate the diagnostic ability (sensitivity, specificity, and diagnostic accuracy) and reproducibility of CE and M-NBI.
The results for CE versus M-NBI were as follows: sensitivity 43.7 % (95 % CI, 26.5-61.0 %) versus 78.0 % (95 % CI, 64.0-92.0 %); specificity 81.6 % (95 % CI, 72.6-90.6 %) versus 92.9 % (95 % CI, 87.0-98.9 %); and diagnostic accuracy 69.9 % (95 % CI, 61.0-78.6 %) versus 88.3 % (95 % CI, 82.0-94.5 %). The sensitivity and diagnostic accuracy were, therefore, significantly higher for M-NBI than for CE. The inter-observer variability was κ = 0.08 for CE and κ = 0.56 for M-NBI, while the intra-observer variability was κ = 0.38 and κ = 0.65, respectively.
M-NBI has greater sensitivity and reproducibility than CE for the diagnosis of minute gastric cancers.
色素内镜检查（CE）在识别直径小于或等于5mm的微小胃癌的癌症特异性形态特征方面相对无效，仅凭其自身不足以做出准确诊断。本研究的目的是评估窄带成像放大内镜（M-NBI）对微小胃癌的诊断性能。
微小癌组包括连续的经内镜黏膜下剥离术切除的组织学测量直径不大于5mm的微小胃癌。非癌组包括连续的直径不大于5mm的非癌病变。对两组进行回顾性分析，以评估CE和M-NBI的诊断能力（敏感性、特异性和诊断准确性）及可重复性。
CE与M-NBI的结果如下：敏感性分别为43.7%（95%CI，26.5-61.0%）和78.0%（95%CI，64.0-92.0%）；特异性分别为81.6%（95%CI，72.6-90.6%）和92.9%（95%CI，87.0-98.9%）；诊断准确性分别为69.9%（95%CI，61.0-78.6%）和88.3%（95%CI，82.0-94.5%）。因此，M-NBI的敏感性和诊断准确性显著高于CE。观察者间的一致性系数，CE为κ=0.08，M-NBI为κ=0.56；观察者内的一致性系数分别为κ=0.38和κ=0.65。
对于微小胃癌的诊断，M-NBI比CE具有更高的敏感性和可重复性。
