# Third‐Generation Narrow‐Band Imaging Versus White‐Light Imaging for the Detection of Early Gastric Cancer: A Randomized Controlled Study

## TL;DR

A study compared third-generation narrow-band imaging and white-light imaging for detecting early gastric cancer, finding no significant advantage for the newer imaging method.

## Contribution

This is the first randomized controlled study comparing third-generation narrow-band imaging and white-light imaging for early gastric cancer detection.

## Key findings

- Third-generation narrow-band imaging was not superior to white-light imaging in detecting early gastric cancer.
- The missed lesion rate was 0% in the initial 3G-NBI group compared to 5.6% in the initial WLI group.
- Improved white-light imaging quality may explain the lack of advantage for third-generation narrow-band imaging.

## Abstract

The endoscopic system EVIS X1 with improved image quality has been introduced into clinical practice. We examined whether third‐generation narrow‐band imaging (3G‐NBI) is more effective than white‐light imaging (WLI) for detecting early gastric cancer (EGC).

Our study, performed at a single center, had a parallel‐group, open‐label, two‐arm, randomized, controlled design. Patients who had undergone endoscopic submucosal dissection for EGC were randomly assigned to a group undergoing 3G‐NBI after initial WLI (initial WLI group) or a group undergoing WLI after initial 3G‐NBI (initial 3G‐NBI group). The primary endpoint was the EGC detection rate of the two methods. The secondary endpoints were as follows: proportions of EGC detected and missed lesions, positive predictive value (PPV) for EGC diagnosis, and observation time for WLI and 3G‐NBI.

The EGC detection rate was 9.0% (17/188) in the initial WLI group and 8.5% (16/188) in the initial 3G‐NBI group. The missed lesion rate was 5.6% (1/18) in the initial WLI group and 0% (0/18) in the initial 3G‐NBI group. The PPV of the initial WLI group was 42.5% (17/40), whereas that of the secondary 3G‐NBI was 25% (1/4). The PPV of the initial 3G‐NBI group was 30.2% (16/53). No biopsies were performed during secondary WLI. The examination times were 274 ± 78.2 and 280 ± 82.9 s for WLI and 3G‐NBI, respectively.

3G‐NBI was not superior to WLI in detecting EGC. This finding is likely due to improved WLI image quality.