Diagnostic value of magnifying endoscopy with blue laser imaging versus narrow band imaging for early upper gastrointestinal cancer

Objective To compare the diagnostic performance of magnifying endoscopy with blue laser imaging (BLI-ME) versus narrowband imaging (NBI-ME) for early upper gastrointestinal cancer. Methods This study was carried out among 466 patients with suspected early upper gastrointestinal cancer (472 lesions) screened by conventional white light endoscopy (WLE). Among these patients, 227 received subsequent examinations by BLI-ME and 239 were examined by NBI-ME. Endoscopic submucosal dissection (ESD) was performed in all the patients with confirmed cancers or highly suspected early cancer under endoscopy. The definite diagnoses were established according to the pathological results following ESD. The consistency between the endoscopic and pathological diagnoses was evaluated using Kappa agreement test, and the detection rate, sensitivity and specificity of the 2 techniques for diagnosis of early upper gastrointestinal cancer were analyzed. Results The pathological results confirmed 269 inflammatory lesions, 127 lesions of atrophy or intestinal metaplasia, 17 lesions of low-grade intraepithelial neoplasia, and 59 lesions of early cancers (with multicentric esophageal cancer). BLI-ME and NBI-ME had consistency rates of 85.2% and 85.1% with the pathological diagnoses, with Kappa values of 0.756 and 0.759, respectively. For early upper gastrointestinal cancer, the detection rates by BLI-ME and NBI-ME was 12.2% and 12.8%, respectively, and their diagnostic sensitivity was 89.3% and 90.3% with a diagnostic specificity of 97.0% and 96.2%, a consistency rate (with the pathological results) of 96.1% and 95.5%, and a Kappa value of 0.810 and 0.825, respectively. Conclusion Both BLI-ME and NBI-ME have high diagnostic value for upper gastrointestinal cancer with comparable diagnostic performances.