Comparison of Narrow Band Imaging and Fujinon Intelligent Color Enhancement in Predicting Small Colorectal Polyp Histology.

Kang HY ，Kim YS ，Kang SJ ，Chung GE ，Song JH ，Yang SY ，Lim SH ，Kim D ，Kim JS ... -  《-》

Narrow-band Imaging International Colorectal Endoscopic Classification to predict polyp histology: REDEFINE study (with videos).

The Narrow-band Imaging International Colorectal Endoscopic (NICE) Classification has been validated for differentiating hyperplastic from adenomatous polyps. This classification system was based on narrow-band imaging (NBI) technology, leaving uncertainty regarding its applicability to other systems. The aim of this study was to assess accuracy and reliability of histologic predictions for polyps <1 cm by applying the NICE classification to the Fujinon Spectral Imaging Color Enhancement (FICE) System. A video library of 55 polyps <1 cm histologically verified with FICE was prospectively created, including polyps that fulfilled inclusion criteria (morphology, size, histology) in consecutive colonoscopies. Six endoscopists with experience in electronic chromoendoscopy independently reviewed the polyp images, scored the polyps as adenomatous or hyperplastic, and assigned a level of confidence to the predictions. Twenty videos were reassessed at 6 months. The diagnostic performances of the endoscopists was calculated both combined and individually according to the histopathology of the polyps. A mixed-effect logistic regression model, in which polyps were considered as random effects, and polyp histology, confidence level, and readers were considered as fixed effects, was used. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Of the 55 polyps (mean size 4.6 mm), 29 (53%) were adenomas, and 26 (47%) were hyperplastic. Across all the readers and observations, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) were 77%, 75%, 88%, 75%, 77%, and 0.82, respectively. Individual rater accuracy ranged from 66% to 96%, being <90% in 5 of 6 cases. Overall, 68.5% of predictions (226/330) were made with high confidence, although there was high variability (Fleiss kappa, 0.15; 95% CI, 0.08-0.22). Sensitivity, specificity, PPV, NPV, accuracy, and AUC for predictions made with high confidence were 81%, 80.5%, 80%, 77%, 82%, and 0.88 being significantly more accurate as compared with a low confidence of diagnosis (OR 2.4; 95% CI, 1.2-4.7). Regarding the performance of the individual NICE criteria, the odds of adenoma detection were 3.4 (95% CI, 1.8-6.3) and 4.0 (95% CI, 2.1-7.5) by using surface and vessels patterns alone, as compared with the color criterion. Interrater and intrarater agreement with the NICE was only moderate (interrater: Fleiss kappa, 0.51; 95% CI, 0.44-0.56; intrarater: kappa, 0.40; 95% CI, 0.20-0.60). The application of the NICE classification to FICE resulted in suboptimal accuracy and only moderate interobserver agreement.

Repici A ，Ciscato C ，Correale L ，Bisschops R ，Bhandari P ，Dekker E ，Pech O ，Radaelli F ，Hassan C ... -  《-》

High-definition endoscopy with i-Scan for evaluation of small colon polyps: the HiSCOPE study.

Traditional white-light endoscopy cannot reliably distinguish between small (<10 mm) adenomatous and hyperplastic colon polyps. High-definition white-light (HDWL) endoscopy and i-Scan may improve in vivo characterization of small colon polyps. To compare HDWL endoscopy and HDWL plus i-Scan for the assessment of small colon polyps and to measure performance against the American Society for Gastrointestinal Endoscopy (ASGE) thresholds for assessment of diminutive colon polyps. Prospective cohort study. Single academic hospital. Patients undergoing bowel cancer screening colonoscopy. In vivo assessment of all polyps <10 mm by using HDWL and i-Scan image enhancement. The primary outcome measure was overall diagnostic accuracy of in vivo assessment of colon polyps <10 mm. Secondary outcome measures were sensitivity and specificity for adenomatous histology, negative predictive value for adenomatous histology of diminutive rectosigmoid polyps, and accuracy of prediction of polyp surveillance intervals. A total of 209 polyps in 84 patients were included. There were no significant differences between HDWL endoscopy and i-Scan in characterization of polyps <10 mm (accuracy 93.3% vs 94.7%; P = 1.00; sensitivity 95.5% vs 97.0%; P = .50; specificity 89.3% vs 90.7%; P = 1.00). The negative predictive value for adenomatous histology of diminutive rectosigmoid polyps was 100% with both HDWL endoscopy and i-Scan. U.K. and U.S. polyp surveillance intervals were predicted with 95.2% accuracy with HDWL endoscopy and 97.2% accuracy with i-Scan. Single-center study. HDWL endoscopy may be as accurate as HDWL with i-Scan image enhancement for the in vivo characterization of small colon polyps. Both modalities fulfil the ASGE performance thresholds for the assessment of diminutive colon polyps. ( NCT01761279.).

Basford PJ ，Longcroft-Wheaton G ，Higgins B ，Bhandari P ... -  《-》

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation.

Picot J ，Rose M ，Cooper K ，Pickett K ，Lord J ，Harris P ，Whyte S ，Böhning D ，Shepherd J ... -  《-》

Leaving distal colorectal hyperplastic polyps in place can be achieved with high accuracy by using narrow-band imaging: an observational study.

Accurate colonoscopic assessment of colorectal polyp histology could avoid resection of distal nonadenomatous polyps and reduce costs and risk. To assess the accuracy of predicting histology by using narrow-band imaging (NBI) in real time for distal colorectal polyps. Prospective observational study. University hospital and ambulatory surgery center. This study involved 225 consecutive adults undergoing elective screening or surveillance colonoscopy. We evaluated real-time histology of 235 distal (rectosigmoid) colorectal polyps from 31 patients by using high-definition colonoscopy and NBI without optical magnification. For each polyp, the endoscopist described size, Paris classification, and surface characteristics (vascular and pit pattern, color, pseudodepression). Before resection, histology was predicted, and a level of confidence (high or low) was assigned. Sensitivity and negative predictive value of high-confidence endoscopic predictions of adenomatous versus hyperplastic histology for polyps ≤ 5 mm. The accuracy of a high-confidence endoscopic prediction was 97.7%, sensitivity for adenomatous histology 93.9%, specificity 98.4%, negative predictive value 97.9%, and positive predictive value 75.6%. The performance characteristics for predicting diminutive distal polyps (≤ 5 mm) with high confidence were sensitivity 96.0%, specificity 99.4%, negative predictive value 99.4%, and positive predictive value 96.0%. Single-center study with a single endoscopist. NBI without optical magnification is sufficiently accurate to allow distal hyperplastic polyps to be left in place without resection and small, distal adenomas to be discarded without pathologic assessment. These findings validate NBI criteria based on color, vessels, and pit characteristics for predicting real-time colorectal polyp histology.

Hewett DG ，Huffman ME ，Rex DK 《-》