Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7884
Peer-review started: December 9, 2014
First decision: January 22, 2015
Revised: February 2, 2015
Accepted: April 17, 2015
Article in press: April 17, 2015
Published online: July 7, 2015
AIM: To investigate the performance of magnifying endoscopy with narrow-band imaging (ME-NBI) in the diagnosis of early gastric cancer (EGC).
METHODS: Systematic literature searches were conducted until February 2014 in PubMed, EMBASE, Web of Science, Ovid, Scopus and the Cochrane Library databases by two independent reviewers. Meta-analysis was performed to calculate the pooled sensitivity, specificity and diagnostic odds ratio and to construct a summary receiver operating characteristic (ROC) curve. Subgroup analyses were performed based on the morphology type of lesions, diagnostic standard, the size of lesions, type of assessment, country and sample size to explore possible sources of heterogeneity. A Deeks’ asymmetry test was used to evaluate the publication bias.
RESULTS: Fourteen studies enrolling 2171 patients were included. The pooled sensitivity, specificity and diagnostic odds ratio for ME-NBI diagnosis of EGC were 0.86 (95%CI: 0.83-0.89), 0.96 (95%CI: 0.95-0.97) and 102.75 (95%CI: 48.14-219.32), respectively, with the area under ROC curve being 0.9623. Among the 14 studies, six also evaluated the diagnostic value of conventional white-light imaging, with a sensitivity of 0.57 (95%CI: 0.50-0.64) and a specificity of 0.79 (95%CI: 0.76-0.81). When using “VS” (vessel plus surface) ME-NBI diagnostic systems in gastric lesions of depressed macroscopic type, the pooled sensitivity and specificity were 0.64 (95%CI: 0.52-0.75) and 0.96 (95%CI: 0.95-0.98). For the lesions with a diameter less than 10 mm, the sensitivity and specificity were 0.74 (95%CI: 0.65-0.82) and 0.98 (95%CI: 0.97-0.98).
CONCLUSION: ME-NBI is a promising endoscopic tool in the diagnosis of early gastric cancer and might be helpful in further target biopsy.
Core tip: This is the first meta-analysis to systematically evaluate the diagnostic performance of magnifying endoscopy with narrow-band imaging (ME-NBI) for early gastric cancer (EGC) and the pooled results showed that ME-NBI was an effective endoscopic tool in EGC diagnosis, which has a better performance than conventional white-light imaging. Moreover, the morphology type of lesions, diagnostic standard and the size of lesions might influence the diagnostic value of ME-NBI.