Endoscopic prediction of deep submucosal invasive carcinoma: Validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification

Nana Hayashi, Shinji Tanaka, David G. Hewett, Tonya R. Kaltenbach, Yasushi Sano, Thierry Ponchon, Brian P. Saunders, Douglas K. Rex, Roy M. Soetikno

Research output: Contribution to journalArticle

170 Scopus citations


Background: A simple endoscopic classification to accurately predict deep submucosal invasive (SM-d) carcinoma would be clinically useful. Objective: To develop and assess the validity of the NBI international colorectal endoscopic (NICE) classification for the characterization of SM-d carcinoma. Design: The study was conducted in 4 phases: (1) evaluation of endoscopic differentiation by NBI-experienced colonoscopists; (2) extension of the NICE classification to incorporate SM-d (type 3) by using a modified Delphi method; (3) prospective validation of the individual criteria by inexperienced participants, by using high-definition still images without magnification of known histology; and (4) prospective validation of the individual criteria and overall classification by inexperienced participants after training. Setting: Japanese academic unit. Main Outcome Measurements: Performance characteristics of the NICE criteria (phase 3) and overall classification (phase 4) for SM-d carcinoma; sensitivity, specificity, predictive values, and accuracy. Results: We expanded the NICE classification for the endoscopic diagnosis of SM-d carcinoma (type 3) and established the predictive validity of its individual components. The negative predictive values of the individual criteria for diagnosis of SM-d carcinoma were 76.2% (color), 88.5% (vessels), and 79.1% (surface pattern). When any 1 of the 3 SM-d criteria was present, the sensitivity was 94.9%, and the negative predictive value was 95.9%. The overall sensitivity and negative predictive value of a global, high-confidence prediction of SM-d carcinoma was 92%. Interobserver agreement for an overall SM-d carcinoma prediction was substantial (kappa 0.70). Limitations: Single Japanese center, use of still images without prospective clinical evaluation. Conclusion: The NICE classification is a valid tool for predicting SM-d carcinomas in colorectal tumors.

Original languageEnglish (US)
Pages (from-to)625-632
Number of pages8
JournalGastrointestinal endoscopy
Issue number4
StatePublished - Oct 1 2013



  • deep submucosal invasion
  • narrow-band imaging
  • NBI
  • NBI international colorectal endoscopic
  • NICE
  • SM-d

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Hayashi, N., Tanaka, S., Hewett, D. G., Kaltenbach, T. R., Sano, Y., Ponchon, T., Saunders, B. P., Rex, D. K., & Soetikno, R. M. (2013). Endoscopic prediction of deep submucosal invasive carcinoma: Validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification. Gastrointestinal endoscopy, 78(4), 625-632. https://doi.org/10.1016/j.gie.2013.04.185