Hesitate between confocal laser endomicroscopy and narrow-band imaging: how to choose a better method in the detection of focal precancerous state of gastric cancer

Yi-Wen Zhou, Le-Yin Zhang, Shu-Ning Ding, An-Lai Zhang, Ying Zhu, Yu-Xuan Chen, Qi-Chen Zhang, Lei-Tao Sun, Jie-Ru Yu, Yi-Wen Zhou, Le-Yin Zhang, Shu-Ning Ding, An-Lai Zhang, Ying Zhu, Yu-Xuan Chen, Qi-Chen Zhang, Lei-Tao Sun, Jie-Ru Yu

Abstract

Background: With a high incidence globally, deaths form gastric cancer (GC) are not rare. Early diagnosis is crucial to ameliorate its prognosis. Confocal laser endomicroscopy (CLE) and narrow band imaging (NBI) have been extensively applied in gastroscopy, particularly when it comes to the detection and management of premalignant gastric lesion. Our meta-analysis intends to appraise the diagnostic capability and compare the efficacy of NBI and CLE for focal precancerous state of gastric cancer.

Methods: We performed a literature search up to November 5, 2020 in online databases and major conferences. Two investigators assessed the methodological bias by QUADAS-2, followed by sophisticated study selection and data exaction to make a comparison between sensitivity, specificity, positive and negative likelihood values, and diagnostic odds ratio. A symmetric summary receiver-operating curve (sROC) and its area under the curve (AUC) were used to estimate threshold effect. Additionally, we evaluated the publication bias by Deeks' asymmetry test.

Results and conclusions: Four studies involved 248 patients and 526 lesions. In analysis drawn from every lesion, the NBI's pooled sensitivity and specificity were 87% (95% CI: 0.80-0.92) and 85% (95% CI: 0.75-0.91), and those of CLE were 90% (95% CI: 0.85-0.91) and 87% (95% CI: 0.83-0.91). CLE illustrated that the pooled two were slightly higher than NBI when compared at the level of every lesion. The AUC for NBI and CLE was 0.92 (0.90-0.94) and 0.95 (0.92-0.96), and there might be a threshold effect, according to the shoulder-like distribution of scatter points in the sROC. We did not find obvious publication bias in our meta-analysis.

Keywords: Focal precancerous state of gastric cancer; confocal laser endomicroscopy; early diagnosis; meta-analysis; narrow-band imaging.

Conflict of interest statement

None.

AJTR Copyright © 2022.

Figures

Figure 1
Figure 1
Flow diagram of the studies identified in the meta-analysis.
Figure 2
Figure 2
Forest plot of diagnostic performance of NBI (A) and CLE (B) for focal precancerous state of gastric cancer in a per-lesion analysis.
Figure 3
Figure 3
Forest diagnostic odds ratio (DOR) of NBI (A) and CLE (B).
Figure 4
Figure 4
The summary receiver operating characteristic (sROC) with 95% confidence interval of NBI (A) and CLE (B) in a per-lesion analysis. AUC, area under the curve.

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