Endoscopy 2018; 50(04): S54-S55
DOI: 10.1055/s-0038-1637189
ESGE Days 2018 oral presentations
20.04.2018 – Best abstract awards
Georg Thieme Verlag KG Stuttgart · New York

IN VIVO DIAGNOSTIC ACCURACY OF THE NICE CLASSIFICATION FOR PREDICTING DEEP INVASION IN COLONIC LESIONS

, EndoCAR group
I Puig
1   Althaia. Xarxa Assistencial Universitària de Manresa, Endoscopy, Manresa, Spain
,
M López-Cerón
2   Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
,
A Arnau
3   Althaia. Xarxa Assistencial Universitària de Manresa, Manresa, Spain
,
O Rosiñol
3   Althaia. Xarxa Assistencial Universitària de Manresa, Manresa, Spain
,
M Cuatrecasas
2   Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
,
A Herreros-de-Tejada
4   Hospital Universitario Puerta de Hierro, Majadahonda, Spain
,
A Fernández
5   Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
,
F Vida
3   Althaia. Xarxa Assistencial Universitària de Manresa, Manresa, Spain
,
O Nogales Rincón
6   Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
L De Castro
7   Complexo Hospitalario Universitario de Vigo, Vigo, Spain
,
J López-Vicente
8   Hospital Universitario de Móstoles, Móstoles, Spain
,
P Vega
9   Complexo Hospitalario Universitario de Ourense, Ourense, Spain
,
M Álvarez-González
10   Hospital del Mar, Barcelona, Spain
,
J González Santiago
11   Complejo Asistencial Universitario de Salamanca. IBSAL, Salamanca, Spain
,
M Hernández-Conde
4   Hospital Universitario Puerta de Hierro, Majadahonda, Spain
,
P Díez-Redondo
12   Hospital Universitario Río Hortega, Valladolid, Spain
,
L Rivero Sánchez
2   Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
,
A Gimeno-García
13   Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
,
A Burgos
14   Hospital Universitario La Paz, Madrid, Spain
,
J García-Alonso
15   Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
,
E Martínez-Bauer
16   Corporació Sanitària Parc Taulí, Sabadell, Spain
,
B Peñas
17   Hospital Universitario Ramón y Cajal, Madrid, Spain
,
G Muñoz
5   Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
,
I Peligros
6   Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
A Tardio Baiges
7   Complexo Hospitalario Universitario de Vigo, Vigo, Spain
,
C González Lois
18   Hospital Universitario Puerta de Hierro, Madrid, Spain
,
L Guerra Pastrian
14   Hospital Universitario La Paz, Madrid, Spain
,
S García Hernández
13   Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
,
A Caminoa
17   Hospital Universitario Ramón y Cajal, Madrid, Spain
,
T Zamora Martínez
12   Hospital Universitario Río Hortega, Valladolid, Spain
,
L Elbouayadl
8   Hospital Universitario de Móstoles, Móstoles, Spain
,
M López Carreira
15   Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
,
A Casalots Casado
16   Corporació Sanitària Parc Taulí, Sabadell, Spain
,
N Carames Díaz
9   Complexo Hospitalario Universitario de Ourense, Ourense, Spain
,
M Iglesias
10   Hospital del Mar, Barcelona, Spain
,
S del Carmen
11   Complejo Asistencial Universitario de Salamanca. IBSAL, Salamanca, Spain
,
M López-Ibáñez
6   Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
M Pantaleón
10   Hospital del Mar, Barcelona, Spain
,
M Solano
5   Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
,
A Álvarez
11   Complejo Asistencial Universitario de Salamanca. IBSAL, Salamanca, Spain
,
S Soto
9   Complexo Hospitalario Universitario de Ourense, Ourense, Spain
,
P Estévez
7   Complexo Hospitalario Universitario de Vigo, Vigo, Spain
,
M Serra-Burriel
19   Center for the Prevention and Diagnosis of CoeliCenter for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
,
M Bustamante
20   Hospital Universitario y Politécnico de La Fe, Valencia, Spain
,
D Rodríguez Alcalde
8   Hospital Universitario de Móstoles, Móstoles, Spain
,
M Pellisé
2   Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

  • The NICE 3 category in the NBI International Colorectal Endoscopic classification was designed to predict deep submucosal invasion in colorectal lesions for which surgery is indicated.

  • The primary aim of this study was to assess the diagnostic accuracy of the NICE classification for predicting deep submucosal invasion in routine clinical practice.

  • The secondary aim was to determine its accuracy combined with the appreciation of other lesion characteristics.

Methods:

  • Multicenter, prospective, observational diagnostic accuracy study conducted by 58 endoscopists at 17 university and community hospitals in their routine clinical practice.

  • All consecutive lesions > 1 cm assessed with NBI were included.

  • The primary outcome was deep invasion according to the index test (NICE classification) and the gold standard (histology).

  • Conditional inference trees were fitted for the analysis of diagnostic accuracy.

Results:

  • Of 2123 lesions analysed, 89 (4.2%) showed deep invasion.

  • Diagnostic accuracy of NICE 3 for predicting deep invasion was: Se = 58.4% (95% CI 47.5 – 68.8), Sp = 96.4% (95% CI 95.5 – 97.2), PPV = 41.6% (95% CI 32.9 – 50.8), and NPV = 98.1% (95% CI 97.5 – 98.7).

  • A conditional inference tree including all the variables showed that the NICE classification was the best predictor of deep invasion (p < 0.001). Further, statistically significant changes in the probability of deep invasion were found in NICE 3 pedunculated polyps (13%, p = 0.007) and NICE 3 non-pedunculated and ulcerated lesions (93%, p = 0.026). By contrast, deep invasion were more frequent in lesions NICE 1/2 if depressed areas (9.7%, p < 0.001) or nodular mixed type morphology (8.6% p < 0.001) was present, but exceptional in the remaining NICE 1/2 lesions (1.1% p < 0.001).

Conclusions:

  • The diagnostic accuracy of optical diagnosis is limited.

  • However, the NICE classification is the best known tool for predicting deep invasion, even without magnification and when used by non-expert endoscopists.

  • This classification could be improved by including certain morphologies and groß morphological malignant features.