Premium
Differentiation between duodenal neoplasms and non‐neoplasms using magnifying narrow‐band imaging – Do we still need biopsies for duodenal lesions?
Author(s) -
Yamasaki Yasushi,
Takeuchi Yoji,
Kanesaka Takashi,
Kanzaki Hiromitsu,
Kato Minoru,
Ohmori Masayasu,
Tonai Yusuke,
Hamada Kenta,
Matsuura Noriko,
Iwatsubo Taro,
Akasaka Tomofumi,
Hanaoka Noboru,
Higashino Koji,
Uedo Noriya,
Ishihara Ryu,
Okada Hiroyuki,
Iishi Hiroyasu
Publication year - 2020
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13485
Subject(s) - medicine , duodenum , histology , biopsy , lesion , endoscopy , radiology , narrow band imaging , pathology , gastroenterology
Objectives Endoscopic biopsies for nonampullary duodenal epithelial neoplasms ( NADEN s) can induce submucosal fibrosis, making endoscopic resection difficult. However, no biopsy‐free method exists to distinguish between NADEN s and non‐neoplasms. We developed a diagnostic algorithm for duodenal neoplasms based on magnifying endoscopy findings and evaluated the model's diagnostic ability. Methods Magnified endoscopic images and duodenal lesion histology were collected consecutively between January 2015 and April 2016. Diagnosticians classified the surface patterns as pit, groove or absent. In cases of nonvisible surface patterns, the vascular pattern was evaluated to determine regularity or irregularity. The correlation between our algorithm (pit‐type or absent with irregular vascular pattern) and the lesion histology were evaluated. Four evaluators, who were blinded to the histology, also classified the endoscopic findings and evaluated the diagnostic performance and interobserver agreement. Results Endoscopic images of 114 lesions were evaluated (70 NADEN s and 44 non‐neoplasms, 31 in the superior and 83 in the descending and horizontal duodenum). Of the NADEN surface patterns, 88% (62/70) were pit‐type, while 79% (35/44) of the non‐neoplasm surface patterns were groove‐type. Our diagnostic algorithm for differentiating NADEN s from non‐neoplasms was high (sensitivity 96%, specificity 95%) in the descending and horizontal duodenum. The evaluators’ diagnostic performances were also high, and interobserver agreement for the algorithm was good between each diagnostician and evaluator ( κ = 0.60–0.76). Conclusion Diagnostic performance of our algorithm sufficiently enabled eliminating endoscopic biopsies for diagnosing the descending and horizontal duodenum.