| Background and Objective:Magnifying endoscopy with narrow-band imaging(M-NBI)is a diagnostic method of upper gastrointestinal endoscopy.Through the combined application of magnifying endoscopy and narrow-band imaging technology,microvascular pattern and microsurface pattern of mucosal structure can be observed more clearly by examining physicians,which can be used as a tool of "optical biopsy" and "targeted biopsy" in endoscopy,and which is helpful for the early diagnosis of upper gastrointestinal neoplasms.Compared with the conventional white-light imaging(C-WLI),its advantages in identifying the benign/malignant lesions,assessing the invasive depth and boundary of early upper gastrointestinal neoplasms or suspected tumor lesions before meticulous preoperative examination have been confirmed by previous studies.However,its practical application value in the detection of early upper gastrointestinal neoplasms in general population has not been clarified.Therefore,we conducted a single-center retrospective study on patients who underwent upper gastrointestinal endoscopy in our hospital to evaluate the diagnostic value of M-NBI in population detection of early epithelial upper gastrointestinal neoplasms(including early carcinoma and precancerous lesions).Methods:A total of 8010 patients who underwent upper gastrointestinal endoscopy at the Digestive Endoscopy Center of the Second Affiliated Hospital of the Army Medical University from August to October 2018 were selected as the research objects.The selected cases were grouped according to the different endoscope and mode of examination,M-NBI group received M-NBI checking and conventional white-light imaging(C-WLI)group received CWLI checking.Moreover,the M-NBI group was divided into two subgroups according to the different magnification of endoscopy.The patients underwent H260 Z endoscopy examination were divided into the high-power magnifying endoscopy with narrow-band imaging(HMNBI group)and the patients underwent HQ290 endoscopy were divided into the low-power magnifying endoscopy with narrow-band imaging(LM-NBI group).The biopsy positive rate,detection rate of early epithelial upper gastrointestinal neoplasms,and the biopsy rate were statistically analyzed between M-NBI group and C-WLI group,as well as between HM-NBI group and LM-NBI subgroup to evaluate the diagnostic value.When the distribution of baseline conditions was not balanced between groups,R language was used to conduct a 1:n propensity score matching(PSM)based on covariates in baseline characteristics.Univariate unconditional logistic regression analysis was used to evaluate the differences in biopsy rate,early epithelial upper gastrointestinal neoplasms detection rate and biopsy positive rate in groups and subgroups.Results:1.Based on inclusion/exclusion criteria,a total of 8010 cases were included(7161 cases in M-NBI group and 849 cases in C-WLI group).In the clinical baseline characteristics of the included cases,the distribution of age,gender and patient source were evenly distributed between the two groups(P > 0.05),while the distribution of examination physician experience,HP infection,endoscopically diagnosed chronic atrophic gastritis,positive pathological diagnosis,and biopsy cases was not balanced between the two groups(P < 0.05).2.Direct comparison between M-NBI group and C-WLI group: The overall detection rate of upper gastrointestinal neoplasms in M-NBI group was significantly higher than that in C-WLI group(4.64% vs.3.06%,P < 0.05).There was no significant difference in the detection rate of advanced carcinoma between M-NBI group and C-WLI group(2.26% vs.2.36%,P > 0.05).The detection rate of early epithelial upper gastrointestinal neoplasms in MNBI group was significantly higher than that in C-WLI group(2.43% vs.0.82%,P < 0.05).There were differences in the detection rate of early epithelial upper gastrointestinal neoplasms in different age stratified populations.In cases who ≥45 years old,the detection rate of M-NBI group was significantly higher than that of C-WLI group(3.37% vs.1.28%,P< 0.05).In cases who <45 years old,the difference was not statistically significant(0.54% vs.0.00%,P > 0.05).3.Comparison between M-NBI and C-WLI groups before/after matching: Multiple covariates in the included cases of M-NBI and C-WLI group showed uneven distribution before matching.Therefore,a 1:4 propensity score matching was performed to equalize confounding variables,and which were evenly distributed after matching(SMD< 0.1).The results show that: In terms of the detection rate of early epithelial upper gastrointestinal neoplasms,the detection rate of M-NBI group was significantly higher than that of C-WLI group(2.43% vs.0.82%,P < 0.05)before matching,and the difference was still significant(1.85% vs.0.83%,P < 0.05)after matching,the odds ratio of M-NBI detection rate was 2.27 compared with C-WLI.In terms of biopsy rate,the M-NBI group had a higher biopsy rate before matching(19.69% vs.14.49%,P < 0.05),while there was no significant difference between the two groups after matching(16.60% vs.14.40%,P > 0.05).In terms of biopsy positive rate,the distribution of covariates between biopsy patients in two groups was balanced and comparable(P > 0.05),direct comparison results showed that there was no significant difference in detecting advanced carcinoma from biopsy cases(P > 0.05),as for the detecting of early epithelial upper gastrointestinal neoplasms,M-NBI group was higher than that in C-WLI group(12.34% vs.5.69%,P < 0.05).4.For comparison between HM-NBI and LM-NBI subgroups,5318 cases were included in HM-NBI subgroup and 1843 cases were included in LM-NBI subgroup before matching.There was unbalanced distribution of covariates between subgroups,so a 1:2 propensity score matching was performed to equalize confounding variables,and which were evenly distributed after matching(SMD< 0.1).The results showed that there was no significant difference in the detection rate of early epithelial upper gastrointestinal neoplasms between the two subgroups before matching(2.61% vs.1.90%,P > 0.05)and after matching(2.33% vs.1.90%,P > 0.05).In terms of biopsy rate,the HM-NBI subgroup had a higher biopsy rate before matching(20.65% vs.16.93%,P < 0.05),but there was no significant difference between the two subgroups after matching(19.87% vs.16.84%,P > 0.05).In terms of detecting early epithelial upper gastrointestinal neoplasms in biopsy cases,there was no significant difference in comparison of the biopsy positive rate between the two subgroups neither before matching(12.66% vs.11.22%,P > 0.05)nor after matching(13.89% vs.10.97%,P > 0.05).Conclusion:1.The diagnostic performance between magnifying endoscopy with narrow-band imaging and conventional white-light imaging in detecting advanced cancer was consistent,while in the detecting of early epithelial upper gastrointestinal neoplasms,M-NBI has a higher detection rate and the biopsy positive rate,and does not significantly increase the biopsy rate,shows that it can better recognize and detect the subtle characteristics of the early carcinoma and precancerous lesions.Therefore,M-NBI has better application value and is more suitable for early detection of upper gastrointestinal neoplasms in the population.2.HM-NBI and LM-NBI have comparable biopsy rate,early epithelial upper gastrointestinal neoplasms detection rate and biopsy positive rate in the detection of upper gastrointestinal tumors,both of them are suitable for the early detection of upper gastrointestinal neoplasms in the population. |
PDF Full Text Request