Endocytoscopy with NBI has the potential to correctly diagnose diminutive colorectal polyps that are difficult to diagnose using conventional NBI

Abstract Background and study aims Real-time diagnosis of colorectal polyps is needed to prevent unnecessary resection of benign polyps. The vessels in hyperplastic polyps sometimes mimic the characteristic meshed capillary network of neoplastic lesions on non-magnified narrow-band imaging (NBI). Endocytoscopy in conjunction with NBI (EC-NBI) enables more detailed vessel observation. The current study evaluated whether EC-NBI can accurately diagnose small colorectal lesions with visible vessels on non-magnified NBI. Patients and methods This retrospective study was conducted from January to December 2016. During colonoscopy, lesion images were obtained using NBI and EC-NBI. On EC-NBI, lesions were classified as having “clear,” “unclear,” or “invisible” blood vessel margins. All specimens were resected and pathologically examined, and the association between vessel margin findings and pathological diagnosis was assessed. The lesion surface to vessel depth was measured in clear, unclear, and invisible lesions. Results Among 114 adenomas, 108 were clear, while six were unclear. Among 36 hyperplastic polyps, eight were clear, while 28 were unclear. A micro-network (MN) pattern was seen in 106 of 114 adenomas, and four of 36 hyperplastic polyps. The sensitivity, specificity, correct diagnostic rate, and positive and negative predictive values of clear blood vessel margins or a MN pattern as an adenoma index were 98.2 %, 69.4 %, 91.3 %, 91.1 %, and 92.6 %, respectively. EC-NBI correctly diagnosed 69.4 % (25/36) of hyperplastic polyps. The lesion surface–blood vessel distance was greater in unclear versus clear lesions (P < 0.001), and invisible versus unclear lesions (P < 0.001). Conclusions EC-NBI may effectively differentiate hyperplastic polyps with visible vessels from adenomas. Blood vessel depth affects visibility.

Download Full-text

The Impact of Narrow-band Imaging on the Pre- and Intra- operative Assessments of Neoplastic and Preneoplastic Laryngeal Lesions. A Systematic Review

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1719119 ◽

2020 ◽

Author(s):

Carmelo Saraniti ◽

Enzo Chianetta ◽

Giuseppe Greco ◽

Norhafiza Mat Lazim ◽

Barbara Verro

Keyword(s):

White Light ◽

Diagnostic Tool ◽

Narrow Band ◽

Narrow Band Imaging ◽

Resection Margins ◽

Predictive Values ◽

White Light Endoscopy ◽

Laryngeal Lesions ◽

Sensitivity Specificity ◽

The Impact

Introduction Narrow-band imaging is an endoscopic diagnostic tool that, focusing on superficial vascular changes, is useful to detect suspicious laryngeal lesions, enabling their complete excision with safe and tailored resection margins. Objectives To analyze the applications and benefits of narrow-band imaging in detecting premalignant and malignant laryngeal lesions through a comparison with white-light endoscopy. Data Synthesis A literature search was performed in the PubMed, Scopus and Web of Science databases using strict keywords. Then, two authors independently analyzed the articles, read the titles and abstracts, and read completely only the relevant studies according to certain eligibility criteria. In total, 14 articles have been included in the present review; the sensitivity, specificity, positive and negative predictive values, and accuracy of pre- and/or intraoperative narrow-band imaging were analyzed. The analysis showed that narrow-band imaging is better than white-light endoscopy in terms of sensitivity, specificity, positive and negative predictive values, and accuracy regarding the ability to identify cancer and/or precancerous laryngeal lesions. Moreover, the intraoperative performance of narrow-band imaging resulted more effective than the in-office performance. Conclusion Narrow-band imaging is an effective diagnostic tool to detect premalignant and malignant laryngeal lesions and to define proper resection margins. Moreover, narrow-band imaging is useful in cases of leukoplakia that may cover a possible malignant lesion and that cannot be easily assessed with white-light endoscopy. Finally, a shared, simple and practical classification of laryngeal lesions, such as that of the European Laryngological Society, is required to identify a shared lesion management strategy. Key Points

Download Full-text

Utility of the narrow-band imaging international colorectal endoscopic classification for optical diagnosis of colorectal polyp histology in clinical practice: a retrospective study

BMC Gastroenterology ◽

10.1186/s12876-021-01898-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yasuhiko Hamada ◽

Kyosuke Tanaka ◽

Masaki Katsurahara ◽

Noriyuki Horiki ◽

Reiko Yamada ◽

...

Keyword(s):

Narrow Band ◽

Narrow Band Imaging ◽

Colorectal Polyp ◽

Colorectal Polyps ◽

Optical Diagnosis ◽

High Definition ◽

Clinical Tool ◽

Optical Magnification ◽

High Level ◽

Sensitivity Specificity

Abstract Background Narrow-band imaging (NBI) highlights the surface structures and vessels of colorectal polyps and is useful for determining the polyp histology. The narrow-band imaging international colorectal endoscopic (NICE) classification is a diagnostic tool for determining colorectal polyp histology based on NBI without optical magnification. In this study, we aimed to investigate the value of each type of the NICE classification for determining colorectal polyp histology using endoscopy data accumulated in a clinical setting. Methods Endoscopy data for 534 colorectal polyps (316 patients) treated at our facility were retrospectively analyzed. First, we investigated the diagnostic performance of each type of the NICE classification for the optical diagnosis of colorectal polyp histology. The procedures were performed by experienced endoscopists using high-definition colonoscopy without optical magnification. Second, inter-observer and intra-observer agreements were assessed after providing experts and non-experts with a short lecture on the NICE classification. Using 50 fine NBI images of colorectal polyps without optical magnification, the inter-observer and intra-observer agreements between five experts and five non-experts were assessed. Results The sensitivity, specificity, and accuracy values were 86.0%, 99.6%, and 98.5% for NICE type 1 lesions; 99.2%, 85.2%, and 97.8% for NICE type 2 lesions; and 81.8%, 99.6%, and 99.3% for NICE type 3 lesions, respectively. The inter-observer and intra-observer agreements ranged from substantial to excellent for both experts and non-experts. Conclusions The NICE classification had good diagnostic ability in terms of determining the polyp histology and demonstrated a high level of reproducibility among experts and non-experts. Thus, the NICE classification is a useful clinical tool that can be used without optical magnification.

Download Full-text

Correlation between Gastric Mucosal Morphologic Patterns and Histopathological Severity ofHelicobacter pyloriAssociated Gastritis Using Conventional Narrow Band Imaging Gastroscopy

BioMed Research International ◽

10.1155/2015/808505 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Taweesak Tongtawee ◽

Soraya Kaewpitoon ◽

Natthawut Kaewpitoon ◽

Chavaboon Dechsukhum ◽

Ryan A. Loyd ◽

...

Keyword(s):

Helicobacter Pylori ◽

Narrow Band ◽

Narrow Band Imaging ◽

Predictive Values ◽

Regular Arrangement ◽

Irregular Border ◽

Sensitivity Specificity ◽

Type 3

Background and Aim. Identifying specific gastric mucosal morphologic patterns useful for detectingHelicobacter pyloriassociated gastritis and correlation with histopathological severity.Methods. The endoscopists classified the C-NBI gastroscopic findings into 5 gastric mucosal morphologic patterns as follows: type 1: regular arrangement of collecting venules, type 2: cone-shaped gastric pits, type 3: rod-shaped gastric pits with prominent sulci, type 4: ground glass-like morphology, and type 5: dark brown patches with bluish margin and irregular border. Biopsies of all of the cases were then evaluated by 5 pathologists for definitiveHelicobacter pyloridiagnosis.Result. Type 1 and type 2 patterns were statistically significant in predictingHelicobacter pylorinegative status (58/60,P<0.01). Type 3, type 4, and type 5 patterns were statistically significant in predictingHelicobacter pyloripositive status (132/140,P<0.01). Furthermore, the sensitivity, specificity, and positive and negative predictive values of type 3, 4, or 5 morphologies for predictingHelicobacter pyloripositive were 94.28%, 96.66%, 98.50%, and 87.87%, respectively, correlated well with inflammation grading according to the Sydney classification (P<0.01).Conclusion. Our study suggests that gastric mucosal morphologic patterns in theHelicobacter pyloriinfected gastric mucosa can be reliably identified using C-NBI gastroscopy with good correlation with inflammation grading.

Download Full-text

Faculty Opinions recommendation of Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717976303.793473139 ◽

2013 ◽

Author(s):

Yiqian Nancy You ◽

Brian Keith Bednarski

Keyword(s):

Real Time ◽

Narrow Band ◽

Narrow Band Imaging ◽

Meta Analysis ◽

Colorectal Polyps ◽

Operating Characteristics

Download Full-text

A Randomized Controlled Clinical Study Comparing the Diagnostic Accuracy of the Histologic Prediction for Colorectal Polyps Depending on the Use of Either Magnified or Nonmagnified Narrow Band Imaging

Clinical Endoscopy ◽

10.5946/ce.2015.48.6.528 ◽

2015 ◽

Vol 48 (6) ◽

pp. 528-533 ◽

Cited By ~ 6

Author(s):

Jin Joo Kim ◽

Kyoung Sup Hong ◽

Joo Sung Kim ◽

Hyun Chae Jung

Keyword(s):

Clinical Study ◽

Diagnostic Accuracy ◽

Narrow Band ◽

Narrow Band Imaging ◽

Colorectal Polyps ◽

Randomized Controlled ◽

Controlled Clinical Study

Download Full-text

Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model

Gut ◽

10.1136/gutjnl-2017-314547 ◽

2017 ◽

Vol 68 (1) ◽

pp. 94-100 ◽

Cited By ~ 160

Author(s):

Michael F Byrne ◽

Nicolas Chapados ◽

Florian Soudan ◽

Clemens Oertel ◽

Milagros Linares Pérez ◽

...

Keyword(s):

Real Time ◽

Predictive Value ◽

Narrow Band Imaging ◽

Colorectal Polyps ◽

Hyperplastic Polyps ◽

Video Images ◽

Video Frames ◽

Endoscopic Video ◽

Design And Methods ◽

Standard Colonoscopy

BackgroundIn general, academic but not community endoscopists have demonstrated adequate endoscopic differentiation accuracy to make the ‘resect and discard’ paradigm for diminutive colorectal polyps workable. Computer analysis of video could potentially eliminate the obstacle of interobserver variability in endoscopic polyp interpretation and enable widespread acceptance of ‘resect and discard’.Study design and methodsWe developed an artificial intelligence (AI) model for real-time assessment of endoscopic video images of colorectal polyps. A deep convolutional neural network model was used. Only narrow band imaging video frames were used, split equally between relevant multiclasses. Unaltered videos from routine exams not specifically designed or adapted for AI classification were used to train and validate the model. The model was tested on a separate series of 125 videos of consecutively encountered diminutive polyps that were proven to be adenomas or hyperplastic polyps.ResultsThe AI model works with a confidence mechanism and did not generate sufficient confidence to predict the histology of 19 polyps in the test set, representing 15% of the polyps. For the remaining 106 diminutive polyps, the accuracy of the model was 94% (95% CI 86% to 97%), the sensitivity for identification of adenomas was 98% (95% CI 92% to 100%), specificity was 83% (95% CI 67% to 93%), negative predictive value 97% and positive predictive value 90%.ConclusionsAn AI model trained on endoscopic video can differentiate diminutive adenomas from hyperplastic polyps with high accuracy. Additional study of this programme in a live patient clinical trial setting to address resect and discard is planned.

Download Full-text

Magnification endoscopy in combination with acetic acid enhancement and narrow-band imaging for the accurate diagnosis of colonic neoplasms

Endoscopy International Open ◽

10.1055/a-1068-2056 ◽

2020 ◽

Vol 08 (04) ◽

pp. E488-E497

Author(s):

Kotaro Shibagaki ◽

Norihisa Ishimura ◽

Takafumi Yuki ◽

Hideaki Taniguchi ◽

Masahito Aimi ◽

...

Keyword(s):

Acetic Acid ◽

Diagnostic Accuracy ◽

Endoscopic Resection ◽

Narrow Band ◽

Narrow Band Imaging ◽

Colonic Neoplasms ◽

High Accuracy ◽

Colorectal Polyps ◽

Histologic Diagnosis ◽

Magnification Endoscopy

Abstract Background and study aims Magnification endoscopy with narrow-band imaging (NBIME) and NBIME with acetic acid enhancement (A-NBIME) enable visualization of the vascular and microstructural patterns of colorectal polyp. We compared the diagnostic accuracy and reproducibility of white light endoscopy (WLE), NBIME, and A-NBIME for predictive histologic diagnosis. Patients and methods Consecutive colorectal polyps (N = 628; 38 hyperplasias, 488 adenomas, 72 M-SM1 cancers, and 30 SM2 cancers) were photographed with WLE, NBIME, and A-NBIME. Endoscopic images were independently reviewed by three experts, according to the traditional criteria for WLE, the Japan NBI Expert Team classification for NBIME, and pit pattern classification for A-NBIME to compare diagnostic accuracy and interobserver diagnostic agreement among modalities. Results The specificity (95 % confidence interval) of hyperplasia and SM2 cancer with WLE were 98.2 % (96.8 %–99.1%) and 99.4 % (98.5 %–99.9 %), respectively, showing high accuracy for endoscopic resection without magnifying observation. Diagnostic accuracy of WLE, NBIME, and A-NBIME was 80.8 % (77.4 %–83.8 %), 79.3 % (75.9 %–82.4 %), and 86.1 % (83.2 %–88.7 %), respectively, showing the highest accuracy for A-NBIME among modalities (P < .05). NBIME showed a lower PPV for M-SM1 cancer (P < .05), as with WLE (P = .08) compared to A-NBIME. Fleiss’s kappa values for WLE, NBIME, and A-NBIME diagnosis were 0.43 (0.39 – 0.46), 0.52 (0.49 – 0.56) and 0.65 (0.62 – 0.69), respectively, showing insufficient reproducibility of WLE and superiority of A-NBIME among modalities. Conclusion WLE showed high accuracy for endoscopic resection of colorectal polyps in expert diagnosis. NBIME demonstrated a higher diagnostic reproducibility than WLE. A-NBIME showed possible superiority among modalities in both diagnostic accuracy and reproducibility.

Download Full-text

Differential Diagnosis of Colorectal Polyps with Narrow Band Imaging Colonoscopy without Magnification

Korean Journal of Gastroenterology ◽

10.4166/kjg.2014.63.5.276 ◽

2014 ◽

Vol 63 (5) ◽

pp. 276 ◽

Cited By ~ 3

Author(s):

Bong Jin Kim ◽

Moo In Park ◽

Seun Ja Park ◽

Won Moon ◽

Eun Taek Park ◽

...

Keyword(s):

Differential Diagnosis ◽

Narrow Band ◽

Narrow Band Imaging ◽

Colorectal Polyps

Download Full-text

Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

Endoscopy ◽

10.1055/a-0833-8548 ◽

2019 ◽

Vol 51 (03) ◽

pp. 253-260 ◽

Cited By ~ 2

Author(s):

Toshio Kuwai ◽

Takuya Yamada ◽

Tatsuya Toyokawa ◽

Hiroaki Iwase ◽

Tomohiro Kudo ◽

...

Keyword(s):

Local Recurrence ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Narrow Band ◽

Narrow Band Imaging ◽

Therapeutic Option ◽

Colorectal Polyps ◽

Delayed Bleeding ◽

Immediate Bleeding

Background Cold polypectomy has been increasingly used to remove diminutive colorectal polyps. We evaluated the local recurrence rate of diminutive polyps at the 1-year follow-up after cold forceps polypectomy (CFP). Methods In a prospective, multicenter, observational cohort study, patients with diminutive colorectal polyps ( ≤ 5 mm) were treated by CFP using jumbo forceps followed by magnified narrow-band imaging (NBI). Patients were assessed for local recurrence at 1-year follow-up. Risk factors associated with local recurrence were analyzed using logistic regression analysis. Results Overall, 955 lesions were resected in 471 patients who completed the 1-year follow-up. The endoscopic complete resection rate was 99.4 %. Immediate and delayed bleeding occurred in 0.8 % and 0.2 % of cases, respectively, with no perforations observed. Local recurrence occurred in 2.1 % of cases at the 1-year follow-up. Univariable analyses indicated that polyps > 3 mm (P < 0.01) and immediate bleeding (P = 0.04) were significantly associated with local recurrence. A trend was observed for patients ≥ 65 years (P = 0.06) and fractional resection (P = 0.09). Multivariable analyses confirmed that lesions > 3 mm were significantly associated with local recurrence (odds ratio 3.4, P = 0.02). Conclusions CFP with jumbo forceps followed by NBI-magnified observation had a low local recurrence rate and is an acceptable therapeutic option for diminutive colorectal polyps. Although we recommend limiting the use of CFP with jumbo forceps to polyps ≤ 3 mm in size, future comparative studies are needed to make recommendations on cold polypectomy using either forceps or snares as the preferred approach for diminutive polyp resection.

Download Full-text