Download PDF
Endoscopy 2011; 43(2): 94-99
DOI: 10.1055/s-0030-1256074
Original article

© Georg Thieme Verlag KG Stuttgart · New York

What is the most reliable imaging modality for small colonic polyp characterization? Study of white-light, autofluorescence, and narrow-band imaging

A.  Ignjatovic1 , J.  E.  East1 , 2 , T.  Guenther3 , J.  Hoare4 , J.  Morris5 , K.  Ragunath6 , A.  Shonde6 , J.  Simmons7 , N.  Suzuki1 , S.  Thomas-Gibson1 , B.  P.  Saunders1
  • 1Wolfson Unit for Endoscopy, St. Mark’s Hospital, Harrow, Middlesex, UK
  • 2Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
  • 3Academic Department of Cellular Pathology, St. Mark’s Hospital, Imperial College London, UK
  • 4Department of Gastroenterology, St. Mary’s Hospital, London, UK
  • 5Department of Gastroenterology, Royal Infirmary Hospital, Glasgow, UK
  • 6Nottingham Digestive Diseases Centre and Biomedical Research Unit, Queen’s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
  • 7Department of Gastroenterology, Royal Berkshire Hospital, Reading, UK
Further Information

Publication History

submitted 8 January 2010

accepted after revision 23 August 2010

Publication Date:
26 January 2011 (online)

Also available at
    Permissions and Reprints

See also:

Commentaire de travail de A. Ignjatovic et al., pp. 94Endoscopy 2011; 43(02): 173-173
DOI: 10.1055/s-0031-1291813

Background and study aims: In vivo optical diagnosis of small colorectal polyps has potential clinical and cost advantages, but requires accuracy and high interobserver agreement for clinically acceptability. We aimed to assess interobserver variability and diagnostic performance of endoscopic imaging modalities in characterizing small colonic polyps.

Methods: High quality still images of 80 polyps < 1 cm were recorded using white-light endoscopy (WLE), autofluorescence imaging (AFI) and narrow-band imaging with and without magnification (NBI and NBImag). All images were assessed for quality, prediction of polyp histology, and vascular pattern intensity (with NBI) by nine experienced colonoscopists (four experts in advanced imaging) from five UK centers. Interobserver agreement (kappa statistic), sensitivity, specificity, and accuracy were calculated compared with histopathological findings.

Results: Interobserver agreement for predicting polyp histology using NBImag was significantly better for experts (κ = 0.63, substantial) compared with nonexperts (κ = 0.30, fair; P < 0.001), and was moderate for all colonoscopists with WLE, AFI and NBI. Interobserver agreement for vascular pattern intensity using NBI was 0.69 (substantial) for experts and 0.57 (good) for nonexperts. NBImag had higher sensitivity than WLE (experts, 0.93 vs. 0.68, P < 0.001; nonexperts, 0.90 vs. 0.52, P < 0.001) and higher overall accuracy (experts, 0.76 vs. 0.64, P = 0.003; nonexperts 0.61 vs. 0.40, P < 0.001). AFI had worse accuracy than WLE for both expert colonoscopists (0.53 vs. 0.64, P = 0.02) and nonexperts (0.32 vs. 0.40, P = 0.04).

Conclusions: Of the imaging modalities tested, NBImag appeared to have the best overall accuracy and interobserver agreement, although not adequate for in vivo diagnosis. NBI and AFI did not have better sensitivity, specificity, or accuracy compared with WLE.

References

  • 1 Morson B. President’s Address. The polyp–cancer sequence in the large bowel.  Proc R Soc Med. 1974;  67 451-457
    PubMedSearch in Google Scholar
  • 2 Winawer S J, Zauber A J, Ho M et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.  N Engl J Med. 1993;  329 1977-1981
    CrossrefPubMedSearch in Google Scholar
  • 3 Butterly L F, Chase M P, Pohl H, Fiarman G S. Prevalence of clinically important histology in small adenomas.  Clin Gastroenterol Hepatol. 2006;  4 343-348
    CrossrefPubMedSearch in Google Scholar
  • 4 Rex D K, Overhiser A J, Chen S C et al. Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings.  Am J Gastroenterol. 2009;  104 149-153
    CrossrefPubMedSearch in Google Scholar
  • 5 Su M Y, Ho Y P, Chen P C et al. Magnifying endoscopy with indigo carmine contrast for differential diagnosis of neoplastic and nonneoplastic colonic polyps.  Dig Dis Sci. 2004;  49 1123-1127
    CrossrefPubMedSearch in Google Scholar
  • 6 Machida H, Sano Y, Hamamoto Y et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study.  Endoscopy. 2004;  36 1094-1098
    Search in Google Scholar
  • 7 Apel D, Jakobs R, Schilling D et al. Accuracy of high resolution of chromoendoscopy in prediction of histologic findings in diminutive lesions of the rectosigmoid.  Gastrointest Endosc. 2006;  63 824-828
    CrossrefPubMedSearch in Google Scholar
  • 8 De Palma G D, Rega M, Masone S et al. Conventional colonoscopy and magnified chromoendoscopy for the endoscopic histological prediction of diminutive colorectal polyps: a single operator study.  World J Gastroenterol. 2006;  12 2402-2405
    PubMedSearch in Google Scholar
  • 9 Fu K I, Sano Y, Kato S et al. Chromoendoscopy using indigo carmine dye spraying with magnifying observation is the most reliable method for differential diagnosis between non-neoplastic and neoplastic colorectal lesions: a prospective study.  Endoscopy. 2004;  36 1089-1093
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Su M Y, Hsu C M, Ho Y P et al. Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps.  Am J Gastroenterol. 2006;  101 2711-2716
    CrossrefPubMedSearch in Google Scholar
  • 11 Tischendorf J J, Wasmuth H E, Koch A et al. Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study.  Endoscopy. 2007;  39 1092-1096
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Togashi K, Konishi F. Magnification chromo-colonoscopy.  ANZ J Surg. 2006;  76 1101-1105
    CrossrefPubMedSearch in Google Scholar
  • 13 Konishi K, Kaneko K, Kurahashi T et al. A comparison of magnifying and nonmagnifying colonoscopy for diagnosis of colorectal polyps: A prospective study.  Gastrointest Endosc. 2003;  57 48-53
    PubMedSearch in Google Scholar
  • 14 Hurlstone D P. High-resolution magnification chromoendoscopy: common problems encountered in “pit pattern” interpretation and correct classification of flat colorectal lesions.  Am J Gastroenterol. 2002;  97 1069-1070
    PubMedSearch in Google Scholar
  • 15 Sonwalkar S, Rotimi O, Rembacken B J. Characterisation of colonic polyps at conventional (nonmagnifying) colonoscopy after spraying with 0.2 % indigo carmine dye.  Endoscopy. 2006;  38 1218-1223
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Huang Q, Fukami N, Kashida H et al. Interobserver and intra-observer consistency in the endoscopic assessment of colonic pit patterns.  Gastrointest Endosc. 2004;  60 520-526
    CrossrefPubMedSearch in Google Scholar
  • 17 Kudo S, Tamura S, Nakajima T et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy.  Gastrointest Endosc. 1996;  44 8-14
    CrossrefPubMedSearch in Google Scholar
  • 18 Togashi K, Konishi F, Ishizuka T et al. Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel.  Dis Colon Rectum. 1999;  42 1602-1608
    CrossrefPubMedSearch in Google Scholar
  • 19 East J E, Suzuki N, Saunders B P. Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study.  Gastrointest Endosc. 2007;  66 310-316
    CrossrefPubMedSearch in Google Scholar
  • 20 East J E, Tan E K, Bergman J J et al. Meta-analysis: narrow band imaging for lesion characterization in the colon, oesophagus, duodenal ampulla and lung.  Aliment Pharmacol Ther. 2008;  28 854-867
    CrossrefPubMedSearch in Google Scholar
  • 21 Chiu H M, Chang C Y, Chen C C et al. A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia.  Gut. 2007;  56 373-379
    CrossrefPubMedSearch in Google Scholar
  • 22 East J E, Guenther T, Kennedy R H, Saunders B P. Narrow band imaging avoids potential chromoendoscopy risks.  Gut. 2007;  56 1168-1169
    PubMedSearch in Google Scholar
  • 23 Hirata M, Tanaka S, Oka S et al. Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors.  Gastrointest Endosc. 2007;  65 988-995
    CrossrefPubMedSearch in Google Scholar
  • 24 van den Broek F J, Reitsma J B, Curvers W L et al. Systematic review of narrow-band imaging for the detection and differentiation of neoplastic and nonneoplastic lesions in the colon (with videos).  Gastrointest Endosc. 2009;  69 124-135
    CrossrefPubMedSearch in Google Scholar
  • 25 East J E, Suzuki N, Bassett P et al. Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity.  Endoscopy. 2008;  40 811-817
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Rastogi A, Pondugula K, Bansal A et al. Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology.  Gastrointest Endosc. 2009;  69 716-722
    CrossrefPubMedSearch in Google Scholar
  • 27 Rogart J N, Jain D, Siddiqui U D et al. Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience.  Gastrointest Endosc. 2008;  68 1136-1145
    CrossrefPubMedSearch in Google Scholar
  • 28 van den Broek F J, van Soest E J, Naber A H et al. Combining autofluorescence imaging and narrow-band imaging for the differentiation of adenomas from non-neoplastic colonic polyps among experienced and non-experienced endoscopists.  Am J Gastroenterol. 2009;  104 1498-1507
    CrossrefPubMedSearch in Google Scholar
  • 29 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002.  Gastrointest Endosc. 2003;  58 (Suppl 6) S3-S43
    CrossrefPubMedSearch in Google Scholar
  • 30 World Health Organization .World Health Organization classification of tumours: pathology and genetics of tumours of the digestive system. Lyon: IARC Press; 2000
    Search in Google Scholar
  • 31 Whiting P, Rutjes A W, Reitsma J B et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.  BMC Med Res Methodol. 2003;  3 25
    CrossrefPubMedSearch in Google Scholar
  • 32 Bossuyt P M, Reitsma J B, Bruns D E et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.  BMJ. 2003;  326 41-44
    CrossrefPubMedSearch in Google Scholar
  • 33 Kiesslich R, Goetz M, Lammersdorf K et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis.  Gastroenterology. 2007;  132 874-882
    CrossrefPubMedSearch in Google Scholar
  • 34 Ignjatovic A, East J E, Suzuki N et al. Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study.  Lancet Oncol. 2009;  10 1171-1178
    CrossrefPubMedSearch in Google Scholar
  • 35 East J E, Saunders B P. Look, remove, and discard: can narrow-band imaging replace histopathology for small colorectal polyps? It is time to push the button!.  Gastrointest Endosc. 2007;  66 953-956
    CrossrefPubMedSearch in Google Scholar
  • 36 Curvers W, Baak L, Kiesslich R et al. Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett’s esophagus.  Gastroenterology. 2008;  134 670-679
    CrossrefPubMedSearch in Google Scholar
  • 37 Sikka S, Ringold D A, Jonnalagadda S, Banerjee B. Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopes without optical magnification.  Endoscopy. 2008;  40 818-822
    Thieme ConnectPubMedSearch in Google Scholar

A. IgnjatovicMD 

Wolfson Unit for Endoscopy
St. Mark’s Hospital

Watford Road, Harrow
Middlesex HA1 3UJ
United Kingdom

Fax: +44-208-4233588

Email: anaignjatovic@me.com