Standardized Magnifying Endoscopy with Narrow-Band Imaging-Guided Targeted Biopsy Workflow For Upper Gastrointestinal Precancerous Lesions

Summary

This protocol presents a standardized targeted biopsy workflow for upper gastrointestinal precancerous lesions using magnifying endoscopy with narrow-band imaging (ME-NBI). The goal is to systematically identify high-risk focal mucosal abnormalities based on predefined microscopic criteria, thereby enhancing diagnostic accuracy, improving biopsy efficiency, and minimizing unnecessary sampling.

Abstract

Although early detection of upper gastrointestinal precancerous lesions is vital, subtle mucosal variations often limit conventional endoscopic screening. To address this limitation, we present a standardized targeted biopsy protocol using magnifying endoscopy with narrow-band imaging (ME-NBI). This systematic workflow integrates key microstructural and microvascular criteria—specifically demarcation lines, irregular microsurfaces, atypical microvasculature, and marked glandular distortion—to identify high-risk focal areas for mucosal sampling. In a prospective clinical evaluation involving 161 patients, this standardized ME-NBI workflow was compared with a conventional white-light endoscopic assessment. The application of this protocol significantly enhanced the first-pass positive rate, overall biopsy positivity, and the diagnostic yield of high-risk lesions per biopsy sample, while simultaneously reducing the total number of biopsy samples required per patient. Furthermore, the standardized workflow demonstrated high diagnostic performance, achieving an area under the curve (AUC) of 0.928, and yielded strong interobserver agreement. By establishing objective criteria for target selection, this reproducible workflow reduces operator subjectivity, supports early neoplasia detection, and provides a practical framework for clinical implementation.

Introduction

Esophageal and gastric cancers remain leading causes of gastrointestinal cancer-related mortality worldwide^1,2. Despite recent advancements in diagnostic and therapeutic modalities, early detection remains the most critical factor in improving patient survival and quality of life³. The accurate identification and timely management of upper gastrointestinal precancerous lesions—spanning mild, moderate, and severe dysplasia—are therefore essential⁴. However, under conventional endoscopy, these precursor lesions frequently present with only subtle mucosa....

Protocol

This prospective investigation received formal approval from the Institutional Review Board and Ethics Committee of the Central Hospital Affiliated to Shandong First Medical University (Approval No. XAU7781902). Written informed consent was obtained from all individual participants or their legal guardians prior to initiating any endoscopic examinations or mucosal biopsy procedures.

1. Patient enrollment and case selection

1. Recruit patients aged over 18 years who are referred for a diagnostic upper gastrointestinal endoscopy.
2. Ensure the enrolled patients present with upper gastrointestinal mucosal abnor....

Results

Baseline clinicopathological and lesion characteristics
Prior to formal enrollment, 25 candidates were specifically excluded from the initial eligibility pool of 186 patients due to preexisting conditions precluding safe and meaningful targeted biopsies, namely a previous diagnosis of upper gastrointestinal tract malignancy, active gastrointestinal bleeding, or severe thrombocytopenia. A total of 161 patients were included in the study. Of these, 79 underwent conventional endoscopic evaluation, and 8.......

Discussion

Accurate assessment of upper gastrointestinal precancerous lesions is vital for early diagnosis and improved patient outcomes. Historically, the lack of uniform criteria for targeted sampling and unstandardized biopsy procedures resulted in highly variable diagnostic yields and operator dependencies¹⁶. The standardized ME-NBI protocol detailed here addresses this deficiency by defining a clear, reproducible reference point for biopsy selection. A critical step in this method involves the systemati.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Disposable Biopsy Forceps	Olympus Medical Systems	EndoJaw FB-230U	Collection of targeted mucosal biopsy specimens from high-risk areas identified by ME-NBI
Excel	Microsoft Corporation	Microsoft 365 (https://www.microsoft.com)	Data entry, organization, and management of endoscopic, pathological, and clinical variables
Hematoxylin and Eosin Stain Kit	Vector Laboratories	Catalog Number: H-3502	Histopathological staining and morphological evaluation of tissue sections
Magnifying Gastroscope	Olympus Medical Systems	GIF-H290Z	Detailed assessment of lesion borders, microsurface patterns, microvascular patterns, and glandular architecture for targeted biopsy
Materials / Software	Provider	Version / Identifier	Purpose
Rotary Microtome	Leica Biosystems	RM2235	Preparation of serial tissue sections for histological examination
SPSS Statistics Software	IBM Corporation	Version 26.0 (https://www.ibm.com/spss)	Statistical comparisons, logistic regression, ROC curve analysis, inter-observer agreement analysis, and correlation analysis
Tissue Embedding Paraffin	Leica Biosystems	Catalog Number: 39601006	Tissue dehydration, embedding, and preparation for sectioning
Video System Center	Olympus Medical Systems	EVIS LUCERA ELITE CV-290	Routine upper gastrointestinal examination and initial identification of suspicious mucosal lesions