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Prospective evaluation of a simplified narrowband imaging scoring system for a differential diagnosis of colorectal lesions

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Abstract

Background

Narrowband imaging (NBI) allows characterization of colorectal polyps during endoscopy; however, this is underutilized by most US physicians. The aim of this study was to assess diagnostic performance of an NBI scoring system, based on the NBI international colorectal endoscopic classification, and determine a threshold score yielding the highest negative predictive value (NPV) in the characterization of colorectal neoplasia.

Methods

During colonoscopy, colorectal lesions were scored using the NBI scoring system on a 0–3 scale for NBI findings. All lesions were biopsied or endoscopically removed for pathological examinations.

Results

Two hundred and three patients were enrolled, and a total of 156 colorectal lesions were detected in 67 patients. Diagnostic yields under white light mode showed limited diagnostic performance [accuracy 75.6 % (68.9–82.3), sensitivity 69.2 % (58.6–78.3), specificity 84.6 % (73.1–92.0), positive predictive value (PPV) 86.3 % (75.8–92.9), NPV 66.3 % (55.0–76.0)]. Of NBI threshold scores from 1 to 3 for the diagnosis of neoplastic lesion, the score of ≥1 resulted in an accuracy of 88.5 % (83.5–93.5), sensitivity of 97.8 % (91.5–96.6), and specificity of 75.4 % (62.9–84.9), with PPV of 84.8 % (76.1–90.8) and NPV of 96.1 % (85.4–99.3).

Conclusions

The threshold value of ≥1 in this simplified NBI scoring system yielded the highest sensitivity and NPV for non-adenomatous colorectal polyps. This scoring system is simple to apply and is superior to white light endoscopy.

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References

  1. Kubo H, Fujiwara T, Jussila L et al (2000) Involvement of vascular endothelial growth factor receptor-3 in maintenance of integrity of endothelial cell lining during tumor angiogenesis. Blood 96:546–553

    CAS  PubMed  Google Scholar 

  2. Konerding MA, Fait E, Dimitropoulou C et al (1998) Impact of fibroblast growth factor-2 on tumor microvascular architecture. A tridimensional morphometric study. Am J Pathol 152:1607–1616

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Konerding MA, Fait E, Gaumann A (2001) 3D microvascular architecture of pre-cancerous lesions and invasive carcinomas of the colon. Br J Cancer 84:1354–1362

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Sano Y, Ikematsu H, Fu KI et al (2009) Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 69:278–283

    Article  PubMed  Google Scholar 

  5. Horimatsu T, Sano Y, Kaneko K et al (2009) Relationship between MVD and meshed-capillaries using magnifying NBI colonoscopy in colorectal precursor lesions. Hepatogastroenterology 56:372–377

    PubMed  Google Scholar 

  6. Kessler WR, Imperiale TF, Klein RW, Wielage RC, Rex DK (2011) A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps. Endoscopy 43:683–691

    Article  CAS  PubMed  Google Scholar 

  7. http://www.gastro.org/advocacy-regulation/regulatory-issues/2013-physician-fee-schedule-b, Last Accessed 30 July 2014

  8. Rex DK, Kahi C, O’Brien M et al (2011) The American Society for Gastrointestinal Endoscopy PIVI (preservation and incorporation of valuable endoscopic innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 73:419–422

    Article  PubMed  Google Scholar 

  9. Hewett DG, Kaltenbach T, Sano Y et al (2012) Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 143:599–607

    Article  PubMed  Google Scholar 

  10. Snover DC, Ahnen DJ, Burt RW, Odze RD (2010) Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman FT, Carneiro F, Hruban RH et al (eds) WHO classification of tumours of the digestive system. IARC, Lyon, pp 160–165

    Google Scholar 

  11. Hirata M, Tanaka S, Oka S et al (2007) Evaluation of microvessels in colorectal tumors by narrow band imaging magnification. Gastrointest Endosc 66:945–952

    Article  PubMed  Google Scholar 

  12. Kanao H, Tanaka S, Oka S et al (2009) Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc 69:631–636

    Article  PubMed  Google Scholar 

  13. Jass JR (2001) Serrated route to colorectal cancer: back street or super highway? J Pathol 193:283–285

    Article  CAS  PubMed  Google Scholar 

  14. Jass JR, Whitehall VL, Young J, Leggett BA (2002) Emerging concepts in colorectal neoplasia. Gastroenterology 123:862–876

    Article  CAS  PubMed  Google Scholar 

  15. Iino H, Jass JR, Simms LA, Young J, Leggett B, Ajioka Y et al (1999) DNA microsatellite instability in hyperplastic polyps, serrated adenomas, and mixed polyps: a mild mutator pathway for colorectal cancer? J Clin Pathol 52:5–9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. O’Brien MJ, Yang S, Mack C, Xu H, Huang CS, Mulcahy E et al (2006) Comparison of microsatellite instability, CpG island methylation phenotype, BRAF and KRAS status in serrated polyps and traditional adenomas indicates separate pathways to distinct colorectal carcinoma end points. Am J Surg Pathol 30:1491–1501

    Article  PubMed  Google Scholar 

  17. Spring KJ, Zhao ZZ, Karamatic R, Walsh MD, Whitehall VL, Pike T et al (2006) High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology 131:1400–1407

    Article  CAS  PubMed  Google Scholar 

  18. Jass JR, Baker K, Zlobec I, Higuchi T, Barker M, Buchanan D et al (2006) Advanced colorectal polyps with the molecular and morphological features of serrated polyps and adenomas: concept of a ‘fusion’ pathway to colorectal cancer. Histopathology 49:121–131

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Higuchi T, Sugihara K, Jass JR (2005) Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology 47:32–40

    Article  CAS  PubMed  Google Scholar 

  20. Torlakovic E, Skovlund E, Snover DC, Torlakovic G, Nesland JM (2003) Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol 27:65–81

    Article  PubMed  Google Scholar 

  21. Rex DK, Ahnen DJ, Baron JA et al (2012) Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 107:1315–1330

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kimura T, Yamamoto E, Yamano HO et al (2012) A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma. Am J Gastroenterol 107:460–469

    Article  CAS  PubMed  Google Scholar 

  23. Nakao Y, Saito S, Ohya T, et al. (2013) Endoscopic features of colorectal serrated lesions using image-enhanced endoscopy with pathological analysis. Eur J Gastroenterol Hepatol 25:981–988

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis St., Thorn 1404, Boston, MA, 02115, USA

    Hiroyuki Aihara, Nitin Kumar, Marvin Ryou, Robert Burakoff, Marwan Abou Gergi, Michele B. Ryan & Christopher C. Thompson

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  1. Hiroyuki Aihara
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  2. Nitin Kumar
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  3. Marvin Ryou
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Correspondence to Hiroyuki Aihara.

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Christopher C. Thompson: Consultant for Olympus. Hiroyuki Aihara, Nitin Kumar, Marvin Ryou, Robert Burakoff, Marwan Abou Gergi, and Michele B. Ryan have no conflicts of interest or financial ties to disclose.

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Aihara, H., Kumar, N., Ryou, M. et al. Prospective evaluation of a simplified narrowband imaging scoring system for a differential diagnosis of colorectal lesions. Surg Endosc 30, 3598–3603 (2016). https://doi.org/10.1007/s00464-015-4660-5

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  • DOI: https://doi.org/10.1007/s00464-015-4660-5

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