The West Catching Up With the East: High-Magnification NBI Is Accurate for the Diagnosis of Gastric Neoplasia in a Western Population

Abstract

Background and Aim

Accurate endoscopic prediction of histology is key to recognition of early gastric neoplasia and selection of appropriate resection techniques. Narrow-band imaging with magnification (M-NBI) has proven to be highly accurate for gastric lesions in eastern countries; however, we sought to examine whether it can be effectively utilized in the west where evidence is scarce.

Methods

This is an analysis of a prospective database of gastric lesions at a single Australian center from 2009 to 2023. All lesions were assessed endoscopically using M-NBI and a determination made whether the lesion was neoplastic or non-neoplastic, as well as prediction of histological subtype. This was then correlated with final histology.

Results

A total of 232 lesions in 183 patients were included: 135 non-neoplastic and 97 neoplastic lesions. Thirty-five were adenomas, 29 early gastric cancers, and 6 advanced adenocarcinomas. For differentiating neoplastic versus non-neoplastic lesions, M-NBI had a sensitivity of 97.9% (CI 92.6%–99.7%) and specificity of 97.1% (CI 92.7%–99.2%). M-NBI was also highly accurate (97.0%, CI 93.9%–98.8%) for identifying lesions suitable for endoscopic resection. The observed agreement between the M-NBI predicted histology and the final pathology was 91.8% with a derived kappa statistic of 0.87, indicating excellent agreement. Comparatively, prior biopsies had an observed agreement of 40.4% with final histology, with a derived kappa statistic of 0.27.

Conclusions

M-NBI can be used with a high degree of accuracy in a western population. M-NBI can effectively differentiate neoplastic from non-neoplastic gastric lesions and delineate histological subtypes with superior accuracy to previous biopsies.