Imaging Combo May Diagnose Gastric Cancer Without Biopsy

CHICAGO – The combination of white light endoscopy and magnifying narrow-band imaging shows promise for achieving accurate diagnosis of early gastric cancer, based on a prospective, randomized, controlled trial conducted in Japan.

"Magnifying narrow-band imaging improved [the] diagnostic performance of white light endoscopy for discriminating gastric cancer from benign small depressed lesions," said Dr. Noriya Uedo, the principal investigator. "Adding magnifying narrow-band imaging to white light endoscopy could make accurate diagnosis of early gastric cancer [possible] without biopsy."

Currently, a diagnosis is made primarily via biopsy, said Dr. Uedo at the annual Digestive Disease Week.

Narrow-band imaging (NBI) is a novel optical technology for examining the surface structure and vascular architecture in the superficial mucosa. "Using magnifying endoscopy, it enables us to evaluate detailed morphological features of both epithelium and vasculature corresponding to histology," he said.

This study was designed to compare the real-time diagnostic performance of conventional white light endoscopy vs. magnifying NBI for gastric lesions no larger than 1 cm.

The trial included patients with a history of endoscopic treatment of early gastric cancer who were at high risk for developing recurrent gastric cancer. The study’s primary objective was to contrast the diagnostic accuracy of the two modalities.

On enrollment, patients were screened with white light endoscopy, and those who were found to have a previously undiagnosed small depressed lesion were randomized to either the white light group or the magnifying NBI group. In the white light group, after the endoscopic finding was documented, the lesion was then evaluated with magnifying NBI.

Between June 2008 and May 2010, 1,365 patients were enrolled, and 362 were found to have small depressed lesions. These patients were randomized to the white light endoscopy group or the magnifying narrow-band imaging group. There were 20 patients with gastric carcinoma in each group.

Language Impairment Eligibility: Which test should I use ...

The current language eligibility guidelines provided by TSHA, and many districts across the state, consider students with a language disorder eligible for Speech Language Pathology services in the schools when their standard scores on a language battery fall 1.5 standard deviations below the mean.  This is consistent with eligibility criteria for many other states, as well as many researchers in the field (Spaulding, Plante, and Farinella, 2006); yet, how do we know that children with language disorders will have a score that low or lower on any given language test?  This is the question that Spaulding, Plante and Farinella asked in their 2006 article in Language, Speech and Hearing Services in the Schools .   They were interested in 2 things in their study of a large number of language tests:  (1) Did children with language disorders typically score at the low end of “normal” for those on whom the test was normed? (2) Which tests provided information on specificity (i.e., percentage of typical children diagnosed as having typical language) and sensitivity (i.e., percentage of disordered children diagnosed as having a language impairment) in their test manuals.