Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging

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

Research output: Contribution to journalArticle

276 Scopus citations

Abstract

BACKGROUND & AIMS: Almost all colorectal polyps ≤5 mm are benign, yet current practice requires costly pathologic analysis. We aimed to develop and evaluate the validity of a simple narrow-band imaging (NBI)-based classification system for differentiating hyperplastic from adenomatous polyps. METHODS: The study was conducted in 4 phases: (1) evaluation of accuracy and reliability of histologic prediction by NBI-experienced colonoscopists; (2) development of a classification based on color, vessels, and surface pattern criteria, using a modified Delphi method; (3) validation of the component criteria by people not experienced in endoscopy or NBI analysis (25 medical students, 19 gastroenterology fellows) using 118 high-definition colorectal polyp images of known histology; and (4) validation of the classification system by NBI-trained gastroenterology fellows, using still images. We performed a pilot evaluation during real-time colonoscopy. RESULTS: We developed a classification system for the endoscopic diagnosis of colorectal polyp histology and established its predictive validity. When all 3 criteria were used, the specificity ranged from 94.9% to 100% and the combined sensitivity ranged from 8.5% to 61.0%. The specificities of the individual criteria were lower although the sensitivities were higher. During realtime colonoscopy, endoscopists made diagnoses with high confidence for 75% of consecutive small colorectal polyps, with 89% accuracy, 98% sensitivity, and 95% negative predictive values. CONCLUSIONS: We developed and established the validity of an NBI classification system that can be used to diagnose colorectal polyps. In preliminary real-time evaluation, the system allowed endoscopic diagnoses of colorectal polyp histology.

Original languageEnglish (US)
Pages (from-to)599-607.e1
JournalGastroenterology
Volume143
Issue number3
DOIs
StatePublished - Sep 2012

Keywords

  • Colonoscopy
  • Image-Enhanced Endoscopy
  • Real-Time Histology
  • Resect and Discard

ASJC Scopus subject areas

  • Gastroenterology

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    Hewett, D. G., Kaltenbach, T., Sano, Y., Tanaka, S., Saunders, B. P., Ponchon, T., Soetikno, R., & Rex, D. K. (2012). Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology, 143(3), 599-607.e1. https://doi.org/10.1053/j.gastro.2012.05.006