Application of Lee's scale combined with endoscopic grading of gastric intestinal metaplasia in opportunistic screening of early gastric cancer and precancerous lesions

Wen Jing; Yuan Qingwen; Liang Xuyang

Abstract：Objective To evaluate the screening efficacy of the new gastric cancer screening scoring system(hereinafter referred to as Lee's scale)and the endoscopic grading of gastric intestinal metaplasia(EGGIM)for early gastric cancer and precancerous lesions,so as to provide data support for the formulation of relevant prevention and control strategies in this region.Methods A total of 1547 outpatients who underwent serological testing,gastroscopy and biopsy for pathological examination in the Affiliated Lianyungang Hospital of Xuzhou Medical University from March to December 2023 were included.Before gastroscopy,all patients were divided into three groups according to the Lee's scale:low-risk group,medium-risk group and high-risk group.EGGIM score,grouping and biopsy were performed on all patients during gastroscopy.The detection of early gastric cancer and precancerous lesions in different groups of Lee's scale and EGGIM was analyzed,the screening efficacy of the two methods was evaluated,and the correlation between OLGA/OLGIM stage and Lee's scale,EGGIM was compared.Results 14 cases of early gastric cancer,39 cases of precancerous lesions and 1494 cases of benign gastric lesions were detected.According to the Lee's scale,1260 cases(81.45%)were assigned into low-risk group,233 cases(15.06%)into middle-risk group and 54 cases(3.49%)into high-risk group.And a total of 26,19 and 8 cases of early gastric cancer and precancerous lesions were detected in the three groups,respectively.The detection rate gradually increased with the increase of the score(χ2=43.985,P<0.001).According to EGGIM,955 cases(61.73%)were assigned into 0 point group,484 cases(31.29%)into 1 to 4 points group,and 108 cases(6.98%)into 5 to 10 points group.And early gastric cancer and precancerous lesions were detected in 1,8 and 4 cases,respectively.The detection rate gradually increased with the increase of the score(χ2=173.456,P<0.001).The AUC of Lee's scale and EGGIM in the diagnosis of early gastric cancer and precancerous lesions were 0.748(95%CI:0.684～0.811)and 0.899(95%CI:0.859～0.940),respectively.The optimal critical values were 10.5 and 2.5,respectively.The sensitivity was 0.604 and 0.830,respectively,and the specificity was 0.778 and 0.847,respectively.According to Gamma analysis,there was a weak positive correlation between OLGA stage and Lee's scale score(P=0.011),and there was a positive correlation between OLGIM stage and Lee's scale score(P<0.001).There was a strong positive correlation between OLGA/OLGIM stage and EGGIM score(P<0.001).Conclusion The Lee's scale and EGGIM have certain values in the diagnosis of early gastric cancer and precancerous lesions,which can provide reference for the in-depth development of opportunistic screening for early gastric cancer in the region.