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Thématique :
- Endoscopie/Imagerie
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Originalité :
Intermédiaire
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| Doit faire évoluer notre pratique : |
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Immédiatement
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Nom du veilleur :
Docteur Edouard Chabrun
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Endoscopy
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2016/06
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2016 Jun 9
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A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions.
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Pimentel-Nunes P, Libânio D, Lage J, Abrantes D, Coimbra M, Esposito G, Hormozdi D, Pepper M, Drasovean S, White JR, Dobru D, Buxbaum J, Ragunath K, Annibale B, Dinis-Ribeiro M
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http://www.ncbi.nlm.nih.gov/pubmed/27280384
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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.
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Etude multicentrique prospective évaluant le NBI pour le diagnostic des lésions gastriques pré-cancéreuses par rapport à la lumière blanche.
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238 patients et 1123 biopsies analysées. Globalement, le NBI améliore le diagnostic de 11% par rapport à la lumière blanche. Pour la métaplasie intestinale, la différence est grande : 87% versus 53%, p<0.001. Pour la dysplasie également : 92% versus 74%.
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Cette étude confirme que le NBI est un bon outil diagnostic dans l’estomac pour les lésions pré-cancéreuses, avec une bonne concordance avec l’histologie. Il fait mieux que la lumière blanche.
Une étude intéressante serait de comparer les différents modèles de coloration numérique proposée par les firmes.
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