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Diagnostic efficacy of dual-focus endoscopy with narrow-band imaging using simplified dyad criteria for superficial esophageal squamous cell carcinoma

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Abstract

Background

Our previous studies have shown the diagnostic utility of a newly developed dual-focus endoscope with narrow-band imaging (DF-NBI) and simplified dyad criteria for detection of superficial esophageal squamous cell carcinoma (SESCC). This clinical trial aimed to study the diagnostic efficacy of DF-NBI with dyad criteria for detecting SESCC compared to white light imaging (WLI).

Methods

This was a single-arm prospective comparative trial. We enrolled 170 consecutive high-risk patients for esophageal squamous cell carcinoma. Patients were initially examined with WLI by one independent endoscopist and then the other performed DF-NBI blinded to the WLI diagnosis to avoid a carry-over effect. Lesions showing proliferation and/or various shapes of intrapapillary capillary loops (IPCL) under DF-NBI (i.e., dyad criteria) were endoscopically diagnosed as SESCC including high-grade intraepithelial neoplasia. The primary endpoint was sensitivity of WLI and DF-NBI for detecting SESCC. The secondary endpoints were the diagnostic performance (i.e., specificity and accuracy) and inter/intra-observer concordance of DF-NBI with dyad criteria.

Results

A total 77 SESCCs were detected. The sensitivity of DF-NBI for SESCC was significantly higher than that of WLI (91% vs. 51%, P < 0.001). The specificity and accuracy of WLI and DF-NBI using dyad criteria were 100% vs. 84%, and 86% vs. 86%, respectively. Various shapes and proliferation of IPCL showed the highest value in inter-observer and intra-observer agreements (κ = 0.77 and 0.82, respectively).

Conclusion

DF-NBI combined with dyad criteria may be a promising technique with a high sensitivity for diagnosis of SESCC and high inter/intra-observer agreement.

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Abbreviations

SESCC:

Superficial esophageal squamous cell carcinoma

WLI:

White light imaging

NBI:

Narrow-band imaging

CM-NBI:

Conventional magnification endoscopy with narrow-band imaging

DF-NBI:

Dual-focus endoscopy with narrow-band imaging

IPCL:

Intrapapillary capillary loop

IDN:

Indefinite for neoplasia

LGIN:

Low-grade intraepithelial neoplasia

HGIN:

High-grade intraepithelial neoplasia

LPM:

Lamina propria mucosae

MM:

Muscularis mucosae

SM:

Submucosa

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Authors and Affiliations

  1. Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan

    Akira Dobashi, Kenichi Goda, Hiroto Furuhashi, Hiroaki Matsui, Yuko Hara, Shunsuke Kamba, Masakuni Kobayashi & Kazuki Sumiyama

  2. Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan

    Kenichi Goda

  3. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan

    Shinichi Hirooka, Shigeharu Hamatani & Masahiro Ikegami

  4. Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Akira Dobashi & Elizabeth Rajan

  5. Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo, Japan

    Hisao Tajiri

Authors
  1. Akira Dobashi
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  2. Kenichi Goda
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  3. Hiroto Furuhashi
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  4. Hiroaki Matsui
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  7. Masakuni Kobayashi
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  8. Kazuki Sumiyama
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  13. Hisao Tajiri
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Contributions

Study design, clinical and endoscopic patient management, and manuscript writing: Akira Dobashi. Study design, clinical and endoscopic patient management, manuscript writing, and overall director: Kenichi Goda. Research coordinator: Yuko Hara and Hiroaki Matsui. Research coordinator and data analysis: Hiroto Furuhashi. Clinical patient management: Shunsuke Kamba and Masakuni Kobayashi. Pathological diagnosis: Shinichi Hirooka and Shigeharu Hamatani. Data and analysis review and manuscript editing: Elizabeth Rajan. Supervisor for overall study: Kazuki Sumiyama, Masahiro Ikegami and Hisao Tajiri.

Corresponding author

Correspondence to Akira Dobashi.

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Conflict of interest

Akira Dobashi and Elizabeth Rajan hold a patent on application No. US-62628024. Hisao Tajiri had served on an advisory committee by Eisai. Kazuki Sumiyama is a consultant for Lumendi and Creo Medical. The remaining authors declare no conflict of interest.

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Dobashi, A., Goda, K., Furuhashi, H. et al. Diagnostic efficacy of dual-focus endoscopy with narrow-band imaging using simplified dyad criteria for superficial esophageal squamous cell carcinoma. J Gastroenterol 54, 501–510 (2019). https://doi.org/10.1007/s00535-018-1527-2

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  • DOI: https://doi.org/10.1007/s00535-018-1527-2

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