The Pink Zone Pattern (PP) sign: A novel simple marker for early gastric cancer.

Background: We previously found a pink-colored change in early gastric cancer (EGC) lesions under magnifying endoscopy with narrow-band imaging (ME-NBI) and named it the "Pink Zoon Pattern" (PP) sign, which appeared independent of microvascular and microstructural changes. The aim of this study was to further investigate the characteristics of the PP sign in EGC.

Methods: The consecutive patients with suspicious gastric lesions detected by ME-NBI and confirmed by pathology at Zhejiang Cancer Hospital between November 2020 and December 2021 were enrolled in the study. The suspicious lesions were observed and assessed by the "VS" system and the PP sign respectively.

Results: We found that in the PP-positive group, 238 lesions (96.0%) were diagnosed as malignant. The overall accuracy, sensitivity, and specificity were 84.7%, 85.3%, and 81.8%. Among 164 EGC lesions diagnosed with low confidence (Grades 2, 3, and 4) using the VS system, the overall accuracy of PP to discriminate tumor from normal was 82.3%. The sensitivity and specificity were 82.7% and 81.5% respectively.

Conclusions: The PP sign could be a new simple sign for the diagnosis of EGC and as an effective supplement to VS system when using ME-NBI.