Narrow-Band Imaging vs. high definition white light endoscopy for optical diagnosis of serrated adenoma in the colorectum: a prospective randomized multicenter trial

Aims The aim of the study was to investigate whether optical predictions of serrated polyp histology using the narrow-band-imaging (NBI) mode is superior to predictions using high-definition-white-light endoscopy (HDWL) in real-time endoscopy.

Methods We conducted a prospective, randomized study at four locations in Germany. Patients eligible for colonoscopy were randomized 1:1 to either the NBI or HDWL arm. In the NBI arm, polyps were optically classified as adenoma, hyperplastic, or serrated adenoma using the NBI image mode. Real-time predictions were made according to the WASP classification system. In the HDWL arm polyps were classified without NBI or WASP. All polyps were resected and sent to pathology. Histopathological diagnoses served as gold standard. The primary outcome was accuracy of optical diagnoses of serrated adenomas in both study arms. Secondary end points included sensitivity and negative predictive value (NPV).

Results A total of 370 patients were included. 251 or 247 polyps were assessed optically in the NBI or HDWL arm respectively. ADR was 46.0% in the NBI and 41.3% in the HDWL arm (p=0.387). The accuracy for serrated adenomas was 90.4% in the NBI arm and 89.5% in the HDWL arm (p=0.720). Sensitivity and NPV in the NBI arm were 71.0% and 95.8%.

Conclusions Accuracy for the optical diagnosis of serrated adenomas did not differ between the NBI and HDWL arm. Both image modalities achieved highly accurate predictive values. In the NBI arm, the negative predictive value for serrated adenomas was >90% and therefore met PIVI requirements. Thus, optical polyp characterization for serrated adenomas can be supported in a real time setting.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023