Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Oct 15;1(1):45-50.
doi: 10.4253/wjge.v1.i1.45.

White light endoscopy, narrow band imaging and chromoendoscopy with magnification in diagnosing colorectal neoplasia

Rajvinder Singh  1 , Victoria Owen, Anthony Shonde, Philip Kaye, Christopher Hawkey, Krish Ragunath
Affiliations

White light endoscopy, narrow band imaging and chromoendoscopy with magnification in diagnosing colorectal neoplasia

Rajvinder Singh et al. World J Gastrointest Endosc. .

Abstract

Aim: To evaluate the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 3 different techniques: high resolution white light endoscopy (WLE), Narrow Band Imaging (NBI) and Chromoendoscopy (CHR), all with magnification in differentiating adenocarcinomas, adenomatous and hyperplastic colorectal polyps.

Methods: Each polyp was sequentially assessed first by WLE, followed by NBI and finally by CHR. Digital images of each polyp with each modality were taken and stored. Biopsies or polypectomies were then performed followed by blinded histopathological analysis. Each image was blindly graded based on the Kudo's pit pattern (KPP). In the assessment with NBI, the mesh brown capillary network pattern (MBCN) of each polyp was also described. The Sn, Sp, PPV and NPV of differentiating hyperplastic (Type I & II-KPP, Type I-MBCN) adenomatous (Types III, IV-KPP, Type II-MBCN) and carcinomatous polyps (Type V-KPP, Type III-MCBN) was then compared with reference to the final histopathological diagnosis.

Results: A total of 50 colorectal polyps (5 adenocarcinomas, 38 adenomas, 7 hyperplastic) were assessed. CHR and NBI [KPP, MBCN or the combined classification (KPP & MBCN)] were superior to WLE in the prediction of polyp histology (P < 0.001, P = 0.002, P = 0.001 and P < 0.001, respectively). NBI, using the MBCN pattern or the combined classification showed higher numerical accuracies compared to CHR, but this was not statistically significant (P = 0.625, 0.250).

Conclusion: This feasibility study demonstrated that this combined classification with NBI could potentially be useful in routine clinical practice, allowing the endoscopist to predict histology with higher accuracies using a less cumbersome and technically less challenging method.

Keywords: Chromoendoscopy with magnification; Colorectal neoplasia; Colorectal polyp; High-resolution magnification endoscopy; Narrow band imaging with magnification.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Hyperplastic polyp. A: High resolution white light magnified image: the pit pattern cannot be clearly discerned; B: Narrow band imaging with magnification where the Mesh Brown Capillary pattern is not visualised (Type I MBCN); C: Chromoendoscopy with magnification depicting a Kudo’s Type II pit pattern.
Figure 2
Figure 2
Adenomatous polyp. A: High resolution white light magnified image: Kudo’s Type IV pit pattern can be visualised; B: Narrow band imaging with magnification demonstrating Kudo’s Type IV pit pattern and regular capillary network surrounding the pits (Type II MBCN); C: Chromoendoscopy with magnification depicting a Kudo’s Type IV pit pattern.
Figure 3
Figure 3
Carcinoma. A: High resolution white light magnified image where the Type IV/V Kudo’s pit pattern can be made out but with difficulty; B: Narrow band imaging with magnification demonstrating where the Kudo’s pit pattern is not visualised but irregular and tortuous Mesh Brown Capillary Network is clearly seen (Type III MBCN); C: Chromoendoscopy with magnification depicting a Kudo’s Type V pit pattern.
See this image and copyright information in PMC

References

    1. Butterly LF, Chase MP, Pohl H, Fiarman GS. Prevalence of clinically important histology in small adenomas. Clin Gastroenterol Hepatol. 2006;4:343–348. - PubMed
    1. Gono K, Obi T, Yamaguchi M, Ohyama N, Machida H, Sano Y, Yoshida S, Hamamoto Y, Endo T. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt. 2004;9:568–577. - PubMed
    1. Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. 1996;44:8–14. - PubMed
    1. Sano Y, Horimatsu T, Fu IK, Katagiri , A , Muto M, Ishikawa H. Magnifying observation of microvascular architecture of colorectal lesions using a narrow band imaging system. Dig Endosc. 2006;18(Suppl 1):S44–S51.
    1. Singh R, Kaye PV, Ragunath K. Distinction between neoplastic and non-neoplastic colorectal polyps utilizing narrow band imaging with magnification: a novel technique to increase the efficacy of colorectal cancer screening? Scand J Gastroenterol. 2008;43:380–381. - PubMed