Fundamentals, Diagnostic Capabilities and Perspective of Narrow Band Imaging for Early Gastric Cancer

The development of image-enhanced endoscopy has dramatically improved the qualitative and quantitative diagnosis of gastrointestinal tumors. In particular, narrow band imaging (NBI) has been widely accepted by endoscopists around the world in their daily practice. In 2009, Yao et al. proposed vessel plus surface (VS) classification, a diagnostic algorithm for early gastric cancer using magnifying endoscopy with NBI (ME-NBI), and in 2016, Muto et al. proposed a magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G) based on VS classification. In addition, the usefulness of ME-NBI in the differential diagnosis of gastric cancer from gastritis, diagnosis of lesion extent, inference of histopathological type, and diagnosis of depth has also been investigated. In this paper, we narrative review the basic principles, current status, and future prospects of NBI.

Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis

In recent years, significant progress has been made in improving the early diagnosis of spondyloarthritides (SpA), including axial SpA. Nonetheless, there are still issues related to the application of classification criteria for making the primary diagnosis of SpA in the daily practice. There are substantial conceptional and operational differences between the diagnostic vs classification approach. Although it is not possible to develop true diagnostic criteria for natural reasons as discussed in this review, the main principles of the diagnostic approach can be clearly defined: consider the pre-test probability of the disease, evaluate positive and negative results of the diagnostic test, exclude other entities, and estimate the probability of the disease at the end. Classification criteria should only be applied to patients with an established diagnosis and aimed at the identification of a rather homogeneous group of patients for the conduction of clinical research.

Intracanalicular vestibular schwannomas. Observation, radiosurgery or microsurgery – what to choose?

The review examines the epidemiology of vestibular schwannomas (VS), classification, the pathogenesis of the main clinical symptoms of small tumors located in the internal auditory canal (intracanalicular), the principles of diagnosis and various treatment options. The main directions of curation of patients with intracanalicular VS are analyzed: observation, radiosurgery and microsurgery. The main advantages and disadvantages of the methods used are considered: observation is advisable in the absence of VS growth, with initially safe hearing or with completely lost hearing. Radiosurgery has a high chance of preserving hearing, including functional, and provides control of VS growth in more than 90 %. There is currently insufficient data to recommend microsurgery as the first choice in the treatment of intracanalicular VS.

Image-enhanced endoscopy for gastric preneoplastic conditions and neoplastic lesions: a systematic review and meta-analysis

Background Image-enhanced endoscopy (IEE) improves the accuracy of endoscopic diagnosis. We aimed to assess the value of IEE for gastric preneoplastic conditions and neoplastic lesions. Methods Medline and Embase were searched until December 2018. Studies allowing calculation of diagnostic measures were included. Risk of bias and applicability were assessed using QUADAS-2. Subgroup analysis was performed to explore heterogeneity. Results 44 studies met the inclusion criteria. For gastric intestinal metaplasia (GIM), narrow-band imaging (NBI) obtained a pooled sensitivity and specificity of 0.79 (95 %CI 0.72–0.85) and 0.91 (95 %CI 0.88–0.94) on per-patient basis; on per-biopsy basis, it was 0.84 (95 %CI 0.81–0.86) and 0.95 (95 %CI 0.94–0.96), respectively. Tubulovillous pattern was the most accurate marker to detect GIM and it was effectively assessed without high magnification. For dysplasia, NBI showed a pooled sensitivity and specificity of 0.87 (95 %CI 0.84–0.89) and 0.97 (95 %CI 0.97–0.98) on per-biopsy basis. The use of magnification improved the performance of NBI to characterize early gastric cancer (EGC), especially when the vessel plus surface (VS) classification was applied. Regarding other technologies, trimodal imaging also obtained a high accuracy for dysplasia (sensitivity 0.93 [95 %CI 0.85–0.98], specificity 0.98 [95 %CI 0.92–1.00]). For atrophic gastritis, no specific pattern was noted and none of the technologies reached good diagnostic yield. Conclusion NBI is highly accurate for GIM and dysplasia. The presence of tubulovillous pattern and the VS classification seem to be useful to detect GIM and characterize EGC, respectively. These features should be used in current practice and to standardize endoscopic criteria for other technologies.