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Gastroenterology. 2012 Sep;143(3):599-607.e1. doi: 10.1053/j.gastro.2012.05.006. Epub 2012 May 15.

Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging.

Author information

1
Indiana University School of Medicine, Indianapolis, Indiana; The University of Queensland School of Medicine, Brisbane, Australia.
2
Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California.
3
Sano Hospital, Kobe, Japan.
4
Hiroshima University, Hiroshima, Japan.
5
Wolfson Unit for Endoscopy and Imperial College London, St. Marks Hospital, London, United Kingdom.
6
Hôpital Edouard-Herriot, Lyon, France.
7
Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: drex@iupui.edu.

Abstract

BACKGROUND & AIMS:

Almost all colorectal polyps ≤ 5 mm are benign, yet current practice requires costly pathologic analysis. We aimed to develop and evaluate the validity of a simple narrow-band imaging (NBI)-based classification system for differentiating hyperplastic from adenomatous polyps.

METHODS:

The study was conducted in 4 phases: (1) evaluation of accuracy and reliability of histologic prediction by NBI-experienced colonoscopists; (2) development of a classification based on color, vessels, and surface pattern criteria, using a modified Delphi method; (3) validation of the component criteria by people not experienced in endoscopy or NBI analysis (25 medical students, 19 gastroenterology fellows) using 118 high-definition colorectal polyp images of known histology; and (4) validation of the classification system by NBI-trained gastroenterology fellows, using still images. We performed a pilot evaluation during real-time colonoscopy.

RESULTS:

We developed a classification system for the endoscopic diagnosis of colorectal polyp histology and established its predictive validity. When all 3 criteria were used, the specificity ranged from 94.9% to 100% and the combined sensitivity ranged from 8.5% to 61.0%. The specificities of the individual criteria were lower although the sensitivities were higher. During real-time colonoscopy, endoscopists made diagnoses with high confidence for 75% of consecutive small colorectal polyps, with 89% accuracy, 98% sensitivity, and 95% negative predictive values.

CONCLUSIONS:

We developed and established the validity of an NBI classification system that can be used to diagnose colorectal polyps. In preliminary real-time evaluation, the system allowed endoscopic diagnoses of colorectal polyp histology.

Comment in

PMID:
22609383
DOI:
10.1053/j.gastro.2012.05.006
[Indexed for MEDLINE]

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