Korean J Gastroenterol.  2014 May;63(5):276-282. 10.4166/kjg.2014.63.5.276.

Differential Diagnosis of Colorectal Polyps with Narrow Band Imaging Colonoscopy without Magnification

Affiliations
  • 1Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea. mipark@kosinmed.or.kr

Abstract

BACKGROUND/AIMS
Narrow band imaging (NBI) endoscopy can be used for gross differentiation between the types of colonic polyps. This study was conducted as a retrospective study for estimation of the interobserver and intra-observer agreement of the pit pattern of the mucosal surface and the accuracy of histology prediction.
METHODS
A total of 159 patients underwent complete colonoscopy and 219 polyps examined by NBI endoscopy without magnification were assessed. Interobserver and intra-observer agreement were calculated by investigators in each group for determination of the surface pattern and prediction of histology based on the modified Kudo's classification using intraclass correlation coefficient.
RESULTS
Interobserver agreement for the surface pit pattern and prediction of polyp type was 0.84 and 0.73 in experienced endoscopists, and 0.86 and 0.62 in trainees, respectively. Intra-observer agreement for the surface pit patterns and prediction of polyp type was 0.81, 0.83, 0.85, 0.83, 0.56, 0.84, 0.51, 0.83, and 0.71; and 0.71, 0.70, 0.82, 0.54, 0.72, 0.37, 0.51, 0.34, and 0.30, respectively. The diagnostic accuracy for prediction of polyp type was 69.4% for experienced endoscopists and 72.9% for trainees.
CONCLUSIONS
NBI endoscopy without magnification showed fairly good inter and intra-observer agreement for the pit pattern of the mucosal surface and the accuracy of histology prediction; however, it had some limitation for differentiation of colon polyp histologic type. Training and experience with NBI is needed for improvement of accuracy.

Keyword

Colonic polyps; Narrow band imaging; Pit pattern; Intraclass correlation coefficient; Diagnostic accuracy

MeSH Terms

Adenoma/diagnosis
Adult
Aged
Aged, 80 and over
Carcinoma/diagnosis
Colonic Neoplasms/*diagnosis/pathology
Colonic Polyps/*pathology
Colonoscopy
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Narrow Band Imaging
Retrospective Studies

Figure

  • Fig. 1. Polyp pattern on narrow banding imaging (whitish color). (A) Circular pattern with dots. (B) Round-oval pattern. (C) Tubulogyrus pattern.(D) Irregular pattern.


Reference

References

1. Huang Q, Fukami N, Kashida H, et al. Interobserver and intraobserver consistency in the endoscopic assessment of colonic pit patterns. Gastrointest Endosc. 2004; 60:520–526.
Article
2. Muto M, Horimatsu T, Ezoe Y, et al. Narrow-band imaging of the gastrointestinal tract. J Gastroenterol. 2009; 44:13–25.
Article
3. Larghi A, Lecca PG, Costamagna G. High-resolution narrow band imaging endoscopy. Gut. 2008; 57:976–986.
Article
4. Su MY, Hsu CM, Ho YP, Chen PC, Lin CJ, Chiu CT. Comparative study of conventional colonoscopy, chromoendoscopy, and nar-row-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps. Am J Gastroenterol. 2006; 101:2711–2716.
Article
5. Machida H, Sano Y, Hamamoto Y, et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy. 2004; 36:1094–1098.
Article
6. East JE, Suzuki N, Saunders BP. Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study. Gastrointest Endosc. 2007; 66:310–316.
Article
7. Rastogi A, Pondugula K, Bansal A, et al. Recognition of surface mucosal and vascular patterns of colon polyps by using nar-row-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. Gastrointest Endosc. 2009; 69:716–722.
Article
8. Tischendorf JJ, Wasmuth HE, Koch A, Hecker H, Trautwein C, Winograd R. Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. Endoscopy. 2007; 39:1092–1096.
Article
9. Kudo S, Hirota S, Nakajima T, et al. Colorectal tumours and pit pattern. J Clin Pathol. 1994; 47:880–885.
Article
10. 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.
Article
11. Singh R, Owen V, Shonde A, Kaye P, Hawkey C, Ragunath K. White light endoscopy, narrow band imaging and chromoendoscopy with magnification in diagnosing colorectal neoplasia. World J Gastrointest Endosc. 2009; 1:45–50.
Article
12. Singh R, Nordeen N, Mei SL, Kaffes A, Tam W, Saito Y. West meets East: preliminary results of narrow band imaging with optical magnification in the diagnosis of colorectal lesions: a multicenter Australian study using the modified Sano's classification. Dig Endosc. 2011; 23(Suppl 1):126–130.
Article
13. Wada Y, Kashida H, Kudo SE, Misawa M, Ikehara N, Hamatani S. Diagnostic accuracy of pit pattern and vascular pattern analyses in colorectal lesions. Dig Endosc. 2010; 22:192–199.
Article
14. Wada Y, Kudo SE, Kashida H, et al. Diagnosis of colorectal lesions with the magnifying narrow-band imaging system. Gastrointest Endosc. 2009; 70:522–531.
Article
15. East JE, Suzuki N, Bassett P, et al. Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity. Endoscopy. 2008; 40:811–817.
Article
16. Rastogi A, Bansal A, Wani S, et al. Narrow-band imaging colonoscopy–a pilot feasibility study for the detection of polyps and correlation of surface patterns with polyp histologic diagnosis. Gastrointest Endosc. 2008; 67:280–286.
17. Uraoka T, Saito Y, Matsuda T, et al. Detectability of colorectal neoplastic lesions using a narrow-band imaging system: a pilot study. J Gastroenterol Hepatol. 2008; 23:1810–1815.
Article
18. Mayinger B, Oezturk Y, Stolte M, et al. Evaluation of sensitivity and inter- and intraobserver variability in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus with enhanced magnification endoscopy. Scand J Gastroenterol. 2006; 41:349–356.
Article
19. Endo T, Awakawa T, Takahashi H, et al. Classification of Barrett's epithelium by magnifying endoscopy. Gastrointest Endosc. 2002; 55:641–647.
Article
20. Matsumoto T, Kudo T, Jo Y, Esaki M, Yao T, Iida M. Magnifying colonoscopy with narrow band imaging system for the diagnosis of dysplasia in ulcerative colitis: a pilot study. Gastrointest Endosc. 2007; 66:957–965.
21. Yao K, Anagnostopoulos GK, Jawhari AU, Kaye PV, Hawkey CJ, Ragunath K. Optical microangiography: high-definition magnification colonoscopy with narrow band imaging (NBI) for visualizing mucosal capillaries and red blood cells in the large intestine. Gut Liver. 2008; 2:14–18.
Article
22. Sakamoto T, Saito Y, Nakajima T, Matsuda T. Comparison of magnifying chromoendoscopy and narrow-band imaging in estimation of early colorectal cancer invasion depth: a pilot study. Dig Endosc. 2011; 23:118–123.
Article
23. Zhou QJ, Yang JM, Fei BY, Xu QS, Wu WQ, Ruan HJ. Narrow-band imaging endoscopy with and without magnification in diagnosis of colorectal neoplasia. World J Gastroenterol. 2011; 17:666–670.
Article
24. Higashi R, Uraoka T, Kato J, et al. Diagnostic accuracy of nar-row-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program. Gastrointest Endosc. 2010; 72:127–135.
Article
25. Ignjatovic A, Thomas-Gibson S, East JE, et al. Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps. Gastrointest Endosc. 2011; 73:128–133.
Article
26. Rogart JN, Jain D, Siddiqui UD, et al. Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. Gastrointest Endosc. 2008; 68:1136–1145.
Article
27. Raghavendra M, Hewett DG, Rex DK. Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes. Gastrointest Endosc. 2010; 72:572–576.
Article
28. Ng SC, Lau JY. Narrow-band imaging in the colon: limitations and potentials. J Gastroenterol Hepatol. 2011; 26:1589–1596.
Article
Full Text Links
  • KJG
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr