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 ... -  《-》

Accuracy of narrow-band imaging in predicting colonoscopy surveillance intervals and histology of distal diminutive polyps: results from a multicenter, prospective trial.

In vivo prediction of colorectal polyp histology by narrow-band imaging (NBI) could potentially avoid post-polypectomy histologic examination or resection of diminutive lesions, thereby reducing costs and risk. To assess whether NBI is able to predict colonoscopy surveillance intervals and histology of distal diminutive polyps according to American Society for Gastrointestinal Endoscopy (ASGE) criteria. Prospective, multicenter study. Five endoscopic centers. Consecutive patients undergoing colonoscopy in 5 centers were included. Participating endoscopists were required to pass a before-study qualifying examination. Histology of polyps that were <10 mm was predicted at NBI and assigned a designation of high or low confidence. Accuracy of high-confidence NBI prediction for polyps ≤5 mm in predicting surveillance intervals and negative predictive value (NPV) for adenomatous histology in the rectosigmoid colon were compared with the ASGE thresholds (90% agreement, 90% NPV). A total of 278 patients (mean age, 63 years; 58% male) were enrolled. At colonoscopy, 574 (97.3%) polyps <10 mm (429 ≤5 mm, 60% adenomatous) were retrieved for histologic analysis. Sensitivity, specificity, positive and negative predictive values, and accuracy of high confidence-NBI predictions for adenomatous histology in lesions ≤5 mm were 90%, 88%, 89%, 89%, and 89%, respectively. High-confidence characterization of polyps ≤5 mm predicted the correct surveillance interval in 92% to 99% of cases, according to the American and European guidelines. NPV of high-confidence NBI for adenomatous histology for the rectosigmoid colon lesions ≤5 mm was 92%. Only experienced endoscopists were included. High-confidence prediction of histology for polyps ≤5 mm appears to be sufficiently accurate to avoid post-polypectomy histologic examination of the resected lesions as well as to allow rectosigmoid hyperplastic polyps to be left in place without resection. ( NCT01675752.).

Repici A ，Hassan C ，Radaelli F ，Occhipinti P ，De Angelis C ，Romeo F ，Paggi S ，Saettone S ，Cisarò F ，Spaander M ，Sharma P ，Kuipers EJ ... -  《-》

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 《-》

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 ... -  《-》

Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy.

Narrow-band imaging (NBI) allows real-time histologic classification of colorectal polyps. We investigated whether endoscopists without prior training in NBI can achieve the following thresholds recommended by the American Society for Gastrointestinal Endoscopy: for diminutive colorectal polyps characterized with high confidence, a ≥90% negative predictive value for adenomas in the rectosigmoid and a ≥90% agreement in surveillance intervals. Twenty-six endoscopists from 2 tertiary care centers underwent standardized training in NBI interpretation. Endoscopists made real-time predictions of diminutive colorectal polyp histology and surveillance interval predictions based on NBI. Their performance was evaluated by comparing predicted with actual findings from histologic analysis. Multilevel logistic regression was used to assess predictors of performance. Cumulative summation analysis was used to characterize learning curves. The endoscopists performed 1451 colonoscopies and made 3012 diminutive polyp predictions (74.3% high confidence) using NBI. They made 898 immediate post-procedure surveillance interval predictions. An additional 505 surveillance intervals were determined with histology input. The overall negative predictive value for high-confidence characterizations in the rectosigmoid was 94.7% (95% confidence interval: 92.6%-96.8%) and the surveillance interval agreement was 91.2% (95% confidence interval: 89.7%-92.7%). Overall, 97.0% of surveillance interval predictions would have brought patients back on time or early. High-confidence characterization was the strongest predictor of accuracy (odds ratio = 3.42; 95% confidence interval: 2.72-4.29; P < .001). Performance improved over time, however, according to cumulative summation analysis, only 7 participants (26.9%) identified adenomas with sufficient sensitivity such that further auditing is not required. With standardized training, gastroenterologists without prior expertise in NBI were able to meet the negative predictive value and surveillance interval thresholds set forth by the American Society for Gastrointestinal Endoscopy. The majority of disagreement in surveillance interval brought patients back early. Performance improves with time, but most endoscopists will require ongoing auditing of performance. ClinicalTrials.gov ID NCT02441998.

Patel SG ，Schoenfeld P ，Kim HM ，Ward EK ，Bansal A ，Kim Y ，Hosford L ，Myers A ，Foster S ，Craft J ，Shopinski S ，Wilson RH ，Ahnen DJ ，Rastogi A ，Wani S ... -  《-》