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)

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.

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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