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. 2020 Apr;8(4):E488-E497.
doi: 10.1055/a-1068-2056. Epub 2020 Mar 23.

Magnification endoscopy in combination with acetic acid enhancement and narrow-band imaging for the accurate diagnosis of colonic neoplasms

Affiliations

Magnification endoscopy in combination with acetic acid enhancement and narrow-band imaging for the accurate diagnosis of colonic neoplasms

Kotaro Shibagaki et al. Endosc Int Open. 2020 Apr.

Abstract

Background and study aims Magnification endoscopy with narrow-band imaging (NBIME) and NBIME with acetic acid enhancement (A-NBIME) enable visualization of the vascular and microstructural patterns of colorectal polyp. We compared the diagnostic accuracy and reproducibility of white light endoscopy (WLE), NBIME, and A-NBIME for predictive histologic diagnosis. Patients and methods Consecutive colorectal polyps (N = 628; 38 hyperplasias, 488 adenomas, 72 M-SM1 cancers, and 30 SM2 cancers) were photographed with WLE, NBIME, and A-NBIME. Endoscopic images were independently reviewed by three experts, according to the traditional criteria for WLE, the Japan NBI Expert Team classification for NBIME, and pit pattern classification for A-NBIME to compare diagnostic accuracy and interobserver diagnostic agreement among modalities. Results The specificity (95 % confidence interval) of hyperplasia and SM2 cancer with WLE were 98.2 % (96.8 %-99.1%) and 99.4 % (98.5 %-99.9 %), respectively, showing high accuracy for endoscopic resection without magnifying observation. Diagnostic accuracy of WLE, NBIME, and A-NBIME was 80.8 % (77.4 %-83.8 %), 79.3 % (75.9 %-82.4 %), and 86.1 % (83.2 %-88.7 %), respectively, showing the highest accuracy for A-NBIME among modalities ( P < .05). NBIME showed a lower PPV for M-SM1 cancer ( P < .05), as with WLE ( P = .08) compared to A-NBIME. Fleiss's kappa values for WLE, NBIME, and A-NBIME diagnosis were 0.43 (0.39 - 0.46), 0.52 (0.49 - 0.56) and 0.65 (0.62 - 0.69), respectively, showing insufficient reproducibility of WLE and superiority of A-NBIME among modalities. Conclusion WLE showed high accuracy for endoscopic resection of colorectal polyps in expert diagnosis. NBIME demonstrated a higher diagnostic reproducibility than WLE. A-NBIME showed possible superiority among modalities in both diagnostic accuracy and reproducibility.

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Conflict of interest statement

Competing interests The authors declare that they have no conflict of interest.

Figures

Fig. 1 a
Fig. 1 a
Pit pattern visualized by CV-MCE and A-NBIME. WLE image shows a laterally spreading tumor that was histologically diagnosed as M-SM1 cancer. The opening of glandular crypts is irregularly shaped, but its contour is equivalently clearly visualized between b CV-MCE and c A-NBIME; yellowish and whitish arrows indicate the same part of the tumor. The pit pattern is diagnosed as type VI-L with both modalities.
Fig. 2
Fig. 2
Endoscopic classification of colorectal polyps. WLE images (left part) were diagnosed as a hyperplasia, b sessile serrated adenoma or c adenoma, d M-SM1 cancer, and e SM2 cancer, according to the traditional criteria. NBIME images (center part) were diagnosed according to the JNET classification: f type 1, g type 1 of SSA or h type 2A, i type 2B, and j type 3, associated with hyperplasia, adenoma, M-SM1 cancer, and SM2 cancer, respectively. A-NBIME images (right) were diagnosed according to the pit pattern classification k type II, l type II of SSA/ m type III or IV, n type V I -low grade, o and type V I -high grade or V N , associated with hyperplasia, adenoma, M-SM1 cancer, and SM2 cancer, respectively. For a detailed explanation of each classification, refer to the “Patients and methods” section.
Fig. 3
Fig. 3
Consort diagram showing the number of enrolled lesions in this study.
Fig. 4
Fig. 4
Diagnostic discrepancy among modalities. a Case 1 with adenoma: WLE shows a reddish and roundish polyp, suggesting adenoma. b However, NBIME shows an irregularly shaped and dilated vessel with an obscure surface, type 2B in the JNET classification, suggesting M-SM1 cancer. c A-NBIME shows a regularly formed and distributed tubular crypt opening, a type III pit pattern, suggesting adenoma. d Case 2 with adenoma: WLE shows a laterally spreading tumor with an irregular surface, suggesting M-SM1 cancer. e NBIME shows an obscure vessel with an irregular surface, type 2B in the JNET classification, suggesting M-SM1 cancer. f However, A-NBIME shows a regularly distributed roundish or tubular or crypt opening, a type III pit pattern, suggesting adenoma.

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References

    1. IARC . Cancer Today. http://gco.iarc.fr/today/fact-sheets-cancers http://gco.iarc.fr/today/fact-sheets-cancers
    1. Winawer S J, Zauber A G, Ho M N et al.Prevention of colorectal cancer by colonoscopic polypectomy: The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–1981. - PubMed
    1. Kudo S, Tamura S, Nakajima T et al.Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. 1996;44:8–14. - PubMed
    1. Fujii T, Hasegawa R T, Saitoh Y et al.Chromoscopy during colonoscopy. Endoscopy. 2001;33:1036–1041. - PubMed
    1. Tanaka S, Kaltenbach T, Chayama K et al.High magnification colonoscopy (with videos) Gastrointest Endosc. 2006;64:604–613. - PubMed