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Background Magnifying narrow-band imaging has enabled observation of the mucosal and vascular patterns of gastrointestinal lesions.This study investigated the potential value of magnifying endoscopy with narrow-band imaging for the classification of gastric intraepithelial neoplasia.Methods Seventy-six patients with gastric intraepithelial neoplasia (82 lesions) at People's Liberation Army General Hospital from December 2009 to November 2010 were analyzed.All patients underwent magnifying endoscopy with narrow-band imaging,and their lesions were differentiated into probable low-grade intraepithelial neoplasia or possible high-grade intraepithelial neoplasia on the basis of the imaging features.Pathologic proof was subsequently obtained by endoscopic submucosal dissection in every case.The validity of magnifying endoscopy with narrow-band imaging was calculated,considering histopathology to be the gold standard.Results Magnifying endoscopy with narrow-band imaging showed 22 low-grade intraepithelial neoplastic lesions and 60 high-grade intraepithelial neoplastic lesions.Of the 22 low-grade intraepithelial neoplastic lesions,16 showed the same results on both imaging and pathology.Of the 60 high-grade intraepithelial neoplastic lesions,53 showed the same results on both imaging and pathology.Thus,the sensitivity of magnifying endoscopy with narrow-band imaging for high-grade intraepithelial neoplasia was 89.83％,which was higher than that for low-grade intraepithelial neoplasia (69.57％).However,the specificity for high-grade intraepithelial neoplasia (69.57％) was lower than that for low-grade intraepithelial neoplasia (89.83％).The overall accuracy of magnifying endoscopy with narrow-band imaging was 84.15％.Conclusions Magnifying endoscopy with narrow-band imaging can distinguish between gastric low- and high-grade intraepithelial neoplasia.It may be a convenient and effective method for the classification of gastric intraepithelial neoplasia.