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

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.

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Narrow-band imaging vs. high definition white light for optical diagnosis of small colorectal polyps: a randomized multicenter trial

Endoscopy ◽

10.1055/s-0042-110650 ◽

2016 ◽

Vol 48 (10) ◽

pp. 909-915 ◽

Cited By ~ 13

Author(s):

Peter Klare ◽

Bernhard Haller ◽

Sandra Wormbt ◽

Ellen Nötzel ◽

Dirk Hartmann ◽

...

Keyword(s):

White Light ◽

Narrow Band ◽

Narrow Band Imaging ◽

Multicenter Trial ◽

Colorectal Polyps ◽

Optical Diagnosis ◽

High Definition

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Optical Diagnosis of Small Colorectal Polyp Histology with High-Definition Colonoscopy Using Narrow Band Imaging

Clinical Endoscopy ◽

10.5946/ce.2013.46.2.120 ◽

2013 ◽

Vol 46 (2) ◽

pp. 120 ◽

Cited By ~ 14

Author(s):

Amit Rastogi

Keyword(s):

Narrow Band ◽

Narrow Band Imaging ◽

Colorectal Polyp ◽

Optical Diagnosis ◽

High Definition

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

Endoscopy International Open ◽

10.1055/a-1068-9228 ◽

2020 ◽

Vol 08 (03) ◽

pp. E360-E367

Author(s):

Shinichi Kataoka ◽

Shin-ei Kudo ◽

Masashi Misawa ◽

Hiroki Nakamura ◽

Kenichi Takeda ◽

...

Keyword(s):

Retrospective Study ◽

Blood Vessel ◽

Narrow Band ◽

Narrow Band Imaging ◽

Colorectal Polyps ◽

Hyperplastic Polyps ◽

Predictive Values ◽

Neoplastic Lesions ◽

Sensitivity Specificity ◽

Time Diagnosis

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.

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Real-time optical diagnosis for diminutive colorectal polyps using narrow-band imaging: the VALID randomised clinical trial

Gut ◽

10.1136/gutjnl-2014-307742 ◽

2014 ◽

Vol 64 (10) ◽

pp. 1569-1577 ◽

Cited By ~ 30

Author(s):

Tonya Kaltenbach ◽

Amit Rastogi ◽

Robert V Rouse ◽

Kenneth R McQuaid ◽

Tohru Sato ◽

...

Keyword(s):

Clinical Trial ◽

Real Time ◽

Narrow Band ◽

Narrow Band Imaging ◽

Randomised Clinical Trial ◽

Colorectal Polyps ◽

Optical Diagnosis

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Tu1157 Gastroenterology Trainees Can Perform Real Time Optical Diagnosis of Diminutive Colorectal Polyps Using Narrow Band Imaging

Gastroenterology ◽

10.1016/s0016-5085(14)62778-5 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-769 ◽

Cited By ~ 1

Author(s):

Tonya Kaltenbach ◽

Robert V. Rouse ◽

Sarah K. McGill ◽

Channa R. Jayasakera ◽

Aparna Motiwala ◽

...

Keyword(s):

Real Time ◽

Narrow Band ◽

Narrow Band Imaging ◽

Colorectal Polyps ◽

Optical Diagnosis

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Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study)

Gut ◽

10.1136/gutjnl-2017-314723 ◽

2018 ◽

Vol 68 (2) ◽

pp. 271-279 ◽

Cited By ~ 18

Author(s):

Yara Backes ◽

Matthijs P Schwartz ◽

Frank ter Borg ◽

Frank H J Wolfhagen ◽

John N Groen ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Score ◽

White Light ◽

Clinical Decision Making ◽

Narrow Band ◽

Narrow Band Imaging ◽

Colorectal Polyps ◽

Optical Diagnosis ◽

Temporal Validation ◽

T1 Colorectal Cancer

ObjectiveThis study evaluated the preresection accuracy of optical diagnosis of T1 colorectal cancer (CRC) in large non-pedunculated colorectal polyps (LNPCPs).DesignIn this multicentre prospective study, endoscopists predicted the histology during colonoscopy in consecutive patients with LNPCPs using a standardised procedure for optical assessment. The presence of morphological features assessed with white light, and vascular and surface pattern with narrow-band imaging (NBI) were recorded, together with the optical diagnosis, the confidence level of prediction and the recommended treatment. A risk score chart was developed and validated using a multivariable mixed effects binary logistic least absolute shrinkage and selection (LASSO) model.ResultsAmong 343 LNPCPs, 47 cancers were found (36 T1 CRCs and 11 ≥T2 CRCs), of which 11 T1 CRCs were superficial invasive T1 CRCs (23.4% of all malignant polyps). Sensitivity and specificity for optical diagnosis of T1 CRC were 78.7% (95% CI 64.3 to 89.3) and 94.2% (95% CI 90.9 to 96.6), and 63.3% (95% CI 43.9 to 80.1) and 99.0% (95% CI 97.1 to 100.0) for optical diagnosis of endoscopically unresectable lesions (ie, ≥T1 CRC with deep invasion), respectively. A LASSO-derived model using white light and NBI features discriminated T1 CRCs from non-invasive polyps with a cross-validation area under the curve (AUC) of 0.85 (95% CI 0.80 to 0.90). This model was validated in a temporal validation set of 100 LNPCPs (AUC of 0.81; 95% CI 0.66 to 0.96).ConclusionOur study provides insights in the preresection accuracy of optical diagnosis of T1 CRC. Sensitivity is still limited, so further studies will show how the risk score chart could be improved and finally used for clinical decision making with regard to the type of endoresection to be used and whether to proceed to surgery instead of endoscopy.Trial registration numberNTR5561.

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