Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2015; 21(25): 7884-7894
Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7884
Diagnostic performance of magnifying narrow-band imaging for early gastric cancer: A meta-analysis
Ying-Ying Hu, Qing-Wu Lian, Zheng-Hua Lin, Jing Zhong, Meng Xue, Liang-Jing Wang
Ying-Ying Hu, Qing-Wu Lian, Jing Zhong, Meng Xue, Liang-Jing Wang, Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Ying-Ying Hu, Zheng-Hua Lin, Jing Zhong, Meng Xue, Liang-Jing Wang, Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Qing-Wu Lian, Department of Gastroenterology, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
Zheng-Hua Lin, Department of Gastroenterology, Sir Runrun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Wang LJ, Lian QW and Hu YY designed the research; Hu YY and Lin ZH performed the analysis and interpretation of the data; Hu YY wrote the manuscript; Wang LJ, Zhong J and Xue M reviewed the manuscript.
Supported by National Natural Science Foundation of China, No. 81302070 and No. 81372623; Zhejiang Provincial Natural Science Foundation of China, No. LY13H160019; and Zhejiang Province Key Science and Technology Innovation Team, No. 2013TD13.
Conflict-of-interest statement: The authors declare they have no conflict of interests.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at wanglj76@hotmail.com. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Liang-Jing Wang, MD, Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 866 Yuhangtang Road, Hangzhou 310009, Zhejiang Province, China. wanglj76@hotmail.com
Telephone: +86-571-86006788 Fax: +86-571-86006788
Received: December 8, 2014
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
Processing time: 211 Days and 19 Hours
Abstract

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.

Keywords: Narrow-band imaging; Early gastric cancer; Magnifying endoscopy; Meta-analysis; Conventional white-light imaging

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.