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The addition of high magnifying endoscopy improves rates of high confidence optical diagnosis of colorectal polyps.

Iwatate M, Sano Y, Hattori S, Sano W, Hasuike N, Ikumoto T, Kotaka M, Murakami Y, Hewett DG, Soetikno R, Kaltenbach T, Fujimori T - Endosc Int Open (2015)

Bottom Line: Consecutive adult patients undergoing colonoscopy with a high magnifying (maximum, × 80) colonoscope between April and August 2012 were recruited.A level of confidence was assigned to each prediction.UMIN 000007608.

View Article: PubMed Central - PubMed

Affiliation: Sano Hospital, Gastrointestinal Center, Kobe, Japan.

ABSTRACT

Background and study aims: The real-time optical diagnosis of colorectal polyps with high confidence predictions can achieve high levels of accuracy. Increasing the rates of high confidence optical diagnosis can improve the clinical application of real-time optical diagnosis in routine practice. The primary aim of this prospective study was to evaluate whether high magnifying endoscopy improves the rates of high confidence narrow-band imaging (NBI) - based optical diagnosis for differentiating between neoplastic and non-neoplastic colorectal lesions according to the NBI international colorectal endoscopic (NICE) classification.

Patients and methods: Consecutive adult patients undergoing colonoscopy with a high magnifying (maximum, × 80) colonoscope between April and August 2012 were recruited. The optical diagnosis for each polyp was evaluated during colonoscopy in two consecutive stages by the same endoscopist, who first used NBI with non-magnifying endoscopy (NBI-NME), then NBI with magnifying endoscopy (NBI-ME). A level of confidence was assigned to each prediction.

Results: The analysis included 124 patients (mean age, 56.4 years; male-to-female ratio, 72:52) with 248 polyps smaller than 10 mm. Of the 248 polyps, 210 were 1 to 5 mm in size and 38 were 6 to 9 mm in size; 77 polyps were hyperplastic, 4 were sessile serrated adenomas/polyps, 160 were low grade adenomas, 5 were high grade adenomas, and 2 were deep submucosal invasive carcinomas. The rate of high confidence optical diagnosis when NBI-ME was used was significantly higher than the rate when NBI-NME was used for diminutive (1 - 5 mm) polyps (92.9 % vs 79.5 %, P < 0.001) and for small (6 - 9 mm) polyps (94.7 % vs 84.2 %, P = 0.048).

Conclusion: High magnifying endoscopy significantly improved the rates of high confidence NBI-based optical diagnosis of diminutive and small colorectal polyps.

Study registration: UMIN 000007608.

No MeSH data available.


Related in: MedlinePlus

 Depressed-type lesion (0 – IIa + IIc), 8 mm in size. The lesion had a deeply depressed area with a non-traumatic tube whose diameter was 2.5 mm, which was classified as NICE 3 (narrow-band imaging international colorectal endoscopic [classification]) with high confidence by NBI-NME (narrow-band imaging with non-magnifying endoscopy) (a) and NBI-ME (narrow-band imaging with magnifying endoscopy) (b). High magnifying endoscopy revealed the interruption of thick vessels. The endoscopists chose to treat with surgery without endoscopic resection. Histology revealed a moderately differentiated tubular adenocarcinoma invading the deep submucosa (c).
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FI131-2:  Depressed-type lesion (0 – IIa + IIc), 8 mm in size. The lesion had a deeply depressed area with a non-traumatic tube whose diameter was 2.5 mm, which was classified as NICE 3 (narrow-band imaging international colorectal endoscopic [classification]) with high confidence by NBI-NME (narrow-band imaging with non-magnifying endoscopy) (a) and NBI-ME (narrow-band imaging with magnifying endoscopy) (b). High magnifying endoscopy revealed the interruption of thick vessels. The endoscopists chose to treat with surgery without endoscopic resection. Histology revealed a moderately differentiated tubular adenocarcinoma invading the deep submucosa (c).

Mentions: The procedures were done by five endoscopists: two (Y.S. and M.I.) specialists in colonoscopy (SCs) who have extensive experience in magnifying colonoscopy with NBI (> 1000 cases) and three (W.S., S.H., and N.H.) general endoscopists (GEs) who have limited experience in magnifying colonoscopy with NBI (≤ 1000 cases) 1. All five endoscopists were familiar with the NBI international colorectal endoscopic (NICE) classification 78. Magnifying colonoscopes (H260AZI; maximum, × 80 optical zoom; Olympus, Tokyo, Japan) with LUCERA video processors (Olympus) and high definition monitors were used for all procedures. All polyps detected by white light imaging during colonoscopy were washed intensively and examined in two stages, first by NBI with non-magnifying endoscopy (NBI-NME) and subsequently by NBI with high magnifying endoscopy (NBI-ME). The location, size, and shape (Paris classification) of all polyps were recorded 9. The size was estimated with biopsy forceps (2.2 mm closed; EndoJaw, Olympus) or polypectomy snare (10 mm open; Dragonare S, Xemex, Tokyo, Japan). The endoscopists were asked to indicate polyp type with the NICE classification (NICE 1, non-neoplastic lesion; NICE 2, adenoma; NICE 3, deep submucosal invasive carcinoma) and assign their level of confidence (high or low) to the prediction (Fig. 1 and Fig. 2) 27. The endoscopists made a prediction with high confidence when they were 90 % certain of the diagnosis 7. The diagnosis at each stage was recorded by an independent observer, who did not allow the prediction to be changed at subsequent steps.


The addition of high magnifying endoscopy improves rates of high confidence optical diagnosis of colorectal polyps.

Iwatate M, Sano Y, Hattori S, Sano W, Hasuike N, Ikumoto T, Kotaka M, Murakami Y, Hewett DG, Soetikno R, Kaltenbach T, Fujimori T - Endosc Int Open (2015)

 Depressed-type lesion (0 – IIa + IIc), 8 mm in size. The lesion had a deeply depressed area with a non-traumatic tube whose diameter was 2.5 mm, which was classified as NICE 3 (narrow-band imaging international colorectal endoscopic [classification]) with high confidence by NBI-NME (narrow-band imaging with non-magnifying endoscopy) (a) and NBI-ME (narrow-band imaging with magnifying endoscopy) (b). High magnifying endoscopy revealed the interruption of thick vessels. The endoscopists chose to treat with surgery without endoscopic resection. Histology revealed a moderately differentiated tubular adenocarcinoma invading the deep submucosa (c).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4477263&req=5

FI131-2:  Depressed-type lesion (0 – IIa + IIc), 8 mm in size. The lesion had a deeply depressed area with a non-traumatic tube whose diameter was 2.5 mm, which was classified as NICE 3 (narrow-band imaging international colorectal endoscopic [classification]) with high confidence by NBI-NME (narrow-band imaging with non-magnifying endoscopy) (a) and NBI-ME (narrow-band imaging with magnifying endoscopy) (b). High magnifying endoscopy revealed the interruption of thick vessels. The endoscopists chose to treat with surgery without endoscopic resection. Histology revealed a moderately differentiated tubular adenocarcinoma invading the deep submucosa (c).
Mentions: The procedures were done by five endoscopists: two (Y.S. and M.I.) specialists in colonoscopy (SCs) who have extensive experience in magnifying colonoscopy with NBI (> 1000 cases) and three (W.S., S.H., and N.H.) general endoscopists (GEs) who have limited experience in magnifying colonoscopy with NBI (≤ 1000 cases) 1. All five endoscopists were familiar with the NBI international colorectal endoscopic (NICE) classification 78. Magnifying colonoscopes (H260AZI; maximum, × 80 optical zoom; Olympus, Tokyo, Japan) with LUCERA video processors (Olympus) and high definition monitors were used for all procedures. All polyps detected by white light imaging during colonoscopy were washed intensively and examined in two stages, first by NBI with non-magnifying endoscopy (NBI-NME) and subsequently by NBI with high magnifying endoscopy (NBI-ME). The location, size, and shape (Paris classification) of all polyps were recorded 9. The size was estimated with biopsy forceps (2.2 mm closed; EndoJaw, Olympus) or polypectomy snare (10 mm open; Dragonare S, Xemex, Tokyo, Japan). The endoscopists were asked to indicate polyp type with the NICE classification (NICE 1, non-neoplastic lesion; NICE 2, adenoma; NICE 3, deep submucosal invasive carcinoma) and assign their level of confidence (high or low) to the prediction (Fig. 1 and Fig. 2) 27. The endoscopists made a prediction with high confidence when they were 90 % certain of the diagnosis 7. The diagnosis at each stage was recorded by an independent observer, who did not allow the prediction to be changed at subsequent steps.

Bottom Line: Consecutive adult patients undergoing colonoscopy with a high magnifying (maximum, × 80) colonoscope between April and August 2012 were recruited.A level of confidence was assigned to each prediction.UMIN 000007608.

View Article: PubMed Central - PubMed

Affiliation: Sano Hospital, Gastrointestinal Center, Kobe, Japan.

ABSTRACT

Background and study aims: The real-time optical diagnosis of colorectal polyps with high confidence predictions can achieve high levels of accuracy. Increasing the rates of high confidence optical diagnosis can improve the clinical application of real-time optical diagnosis in routine practice. The primary aim of this prospective study was to evaluate whether high magnifying endoscopy improves the rates of high confidence narrow-band imaging (NBI) - based optical diagnosis for differentiating between neoplastic and non-neoplastic colorectal lesions according to the NBI international colorectal endoscopic (NICE) classification.

Patients and methods: Consecutive adult patients undergoing colonoscopy with a high magnifying (maximum, × 80) colonoscope between April and August 2012 were recruited. The optical diagnosis for each polyp was evaluated during colonoscopy in two consecutive stages by the same endoscopist, who first used NBI with non-magnifying endoscopy (NBI-NME), then NBI with magnifying endoscopy (NBI-ME). A level of confidence was assigned to each prediction.

Results: The analysis included 124 patients (mean age, 56.4 years; male-to-female ratio, 72:52) with 248 polyps smaller than 10 mm. Of the 248 polyps, 210 were 1 to 5 mm in size and 38 were 6 to 9 mm in size; 77 polyps were hyperplastic, 4 were sessile serrated adenomas/polyps, 160 were low grade adenomas, 5 were high grade adenomas, and 2 were deep submucosal invasive carcinomas. The rate of high confidence optical diagnosis when NBI-ME was used was significantly higher than the rate when NBI-NME was used for diminutive (1 - 5 mm) polyps (92.9 % vs 79.5 %, P < 0.001) and for small (6 - 9 mm) polyps (94.7 % vs 84.2 %, P = 0.048).

Conclusion: High magnifying endoscopy significantly improved the rates of high confidence NBI-based optical diagnosis of diminutive and small colorectal polyps.

Study registration: UMIN 000007608.

No MeSH data available.


Related in: MedlinePlus