Endoscopy 2008; 40(10): 811-817
DOI: 10.1055/s-2008-1077586
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity

J.  E.  East1 , N.  Suzuki1 , P.  Bassett1 , M.  Stavrinidis1 , H.  J.  W.  Thomas2 , T.  Guenther3 , P.  P.  Tekkis4 , B.  P.  Saunders1
  • 1Wolfson Unit for Endoscopy, St Mark’s Hospital, Imperial College London, London, UK
  • 2Family Cancer Group, Cancer Research Colorectal Cancer Unit, St Mark’s Hospital, Imperial College London, London, UK
  • 3Academic Department of Cellular Pathology, St Mark’s Hospital, Imperial College London, London, UK
  • 4Department of Biosurgery and Surgical Technology, Imperial College London, London, UK
Further Information

Publication History

submitted 20 January 2008

accepted after revision 9 July 2008

Publication Date:
30 September 2008 (online)

Background and study aims: Narrow band imaging (NBI) can accurately characterize colonic polyps using microvascular appearances. We aimed to assess whether the Kudo pit pattern classification is accurate when used with NBI (without dye-spray), and if microvascular appearances or NBI pit patterns maintain accuracy for polyp characterization at sizes < 10 mm.

Patients and methods: 116 polyps < 10 mm in size were detected in 62 patients undergoing surveillance colonoscopy. The polyps were prospectively assessed using NBI and magnification for Kudo pit pattern (III-V neoplastic, I-II non-neoplastic) and vascular pattern intensity (VPI), a measure of microvascular density (strong VPI, neoplastic; normal or weak VPI, non-neoplastic). Sensitivity, specificity, and accuracy were calculated and compared with results from histopathology.

Results: The mean polyp size was 3.4 mm (range 1 – 9 mm). Overall, NBI pit pattern sensitivity, specificity, and accuracy were 0.88, 0.91, and 89.6 %, respectively. Equivalent values for VPI were 0.94, 0.89, and 91.4 %. Results were similar when polyps were subdivided into diminutive polyps (size ≤ 5 mm) and flat polyps. Combining both pit pattern and VPI improved the sensitivity (0.98, P = 0.06 versus NBI pit pattern alone). There was very good agreement between NBI pit pattern and VPI for prediction of dysplasia (kappa = 0.83). No evidence of a learning curve for VPI was found. The NBI pit pattern was better than the VPI at subclassifying hyperplastic from other non-neoplastic polyps (sensitivity 0.79 versus 0.56, respectively, P = 0.02), but accuracy was poor.

Conclusion: The NBI pit pattern and VPI are both highly accurate in characterizing neoplastic colonic polyps of < 10 mm, with VPI appearing to be simple to learn. NBI has the potential to replace conventional histology for small polyps.

References

  • 1 Winawer S J, Zauber A G, Ho M N. et al . The National Polyp Study Workgroup: Prevention of colorectal cancer by colonoscopic polypectomy.  N Engl J Med. 1993;  329 1977-1981
  • 2 Brenner H, Hoffmeister M, Stegmaier C. et al . Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840 149 screening colonoscopies.  Gut. 2007;  56 1585-1589
  • 3 Regula J, Rupinski M, Kraszewska E. et al . Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia.  N Engl J Med. 2006;  355 1863-1872
  • 4 Butterly L F, Chase M P, Pohl H, Fiarman G S. Prevalence of clinically important histology in small adenomas.  Clin Gastroenterol Hepatol. 2006;  4 343-348
  • 5 Chen S C, Mouchli A, Chadalawada V. et al . Histopathology of small polyps removed in the videoendoscopic era [abstract].  Gastrointest Endosc. 2006;  63 AB199
  • 6 Su M Y, Ho Y P, Chen P C. et al . Magnifying endoscopy with indigo carmine contrast for differential diagnosis of neoplastic and nonneoplastic colonic polyps.  Dig Dis Sci. 2004;  49 1123-1127
  • 7 Hurlstone D P, Cross S S, Lobo A J. A 1 mm depressed Type IIC minute colorectal cancer: first reported case and discussion of clinical relevance, with special reference to endoscopic diagnosis.  J Gastroenterol Hepatol. 2003;  18 880-881
  • 8 Winawer S J, Zauber A G, Fletcher R H. et al . Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society.  Gastroenterology. 2006;  130 1872-1885
  • 9 Atkin W S, Saunders B P. Surveillance guidelines after removal of colorectal adenomatous polyps.  Gut. 2002;  51 Suppl 5 V6-9
  • 10 Kudo S, Tamura S, Nakajima T. et al . Diagnosis of colorectal tumorous lesions by magnifying endoscopy.  Gastrointest Endosc. 1996;  44 8-14
  • 11 Togashi K, Konishi F, Ishizuka T. et al . Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel.  Dis Colon Rectum. 1999;  42 1602-1608
  • 12 Davies J, Burke D, Olliver J R. et al . Methylene blue but not indigo carmine causes DNA damage to colonocytes in vitro and in vivo at concentrations used in clinical chromoendoscopy.  Gut. 2007;  56 155-156
  • 13 East J E, Guenther T, Kennedy R H. et al . Narrow band imaging avoids potential chromoendoscopy risks.  Gut. 2007;  56 1168-1169
  • 14 Chiu H M, Chang C Y, Chen C C. et al . A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia.  Gut. 2006;  56 373-379
  • 15 East J E, Suzuki N, Saunders B P. 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
  • 16 Hirata M, Tanaka S, Oka S. et al . Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors.  Gastrointest Endosc. 2007;  65 988-995
  • 17 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
  • 18 Su M Y, Hsu C M, Ho Y P. et al . Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps.  Am J Gastroenterol. 2006;  101 2711-2716
  • 19 Tischendorf J J, Wasmuth H E, Koch A. et al . Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study.  Endoscopy. 2007;  39 1092-1096
  • 20 East J E, Suzuki N, Stavrinidis M. et al . Narrow band imaging for colonoscopic surveillance in hereditary non-polyposis colorectal cancer.  Gut. 2008;  57 65-70
  • 21 East J E, Suzuki N, Swain D. et al . Vascular pattern intensity: a new classification system to differentiate neoplastic and non-neoplastic lesions in the colon using narrow band imaging (NBI) with magnification [abstract].  Gastrointest Endosc. 2006;  63 AB238
  • 22 Japanese Research Society for Cancer of the Colon and Rectum . General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification.  Jpn J Surg. 1983;  13 557-573
  • 23 Participants in the Paris Workshop . The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002.  Gastrointest Endosc. 2003;  58 S3-S43
  • 24 World Health Organization .World Health Organization classification of tumours: pathology and genetics of tumours of the digestive system. Lyon; IARC press 2000
  • 25 Bossuyt P M, Reitsma J B, Bruns D E. et al . Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.  BMJ. 2003;  326 41-44
  • 26 Whiting P, Rutjes A, Reitsma J. et al . The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.  BMC Med Res Methodol. 2003;  3 25
  • 27 De Palma G D, Rega M, Masone S. et al . Conventional colonoscopy and magnified chromoendoscopy for the endoscopic histological prediction of diminutive colorectal polyps: a single operator study.  World J Gastroenterol. 2006;  12 2402-2405
  • 28 Fu K I, Sano Y, Kato S. et al . Chromoendoscopy using indigo carmine dye spraying with magnifying observation is the most reliable method for differential diagnosis between non-neoplastic and neoplastic colorectal lesions: a prospective study.  Endoscopy. 2004;  36 1089-1093
  • 29 Hurlstone D P, Cross S S, Adam I. et al . Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis.  Gut. 2004;  53 284-290
  • 30 Hurlstone D P, Karajeh M, Cross S S. et al . The role of high-magnification chromoscopic colonoscopy in hereditary nonpolyposis colorectal cancer screening: a prospective “back-to-back” endoscopic study.  Am J Gastroenterol. 2005;  100 2167-2173
  • 31 Torlakovic E, Skovlund E, Snover D C. et al . Morphologic reappraisal of serrated colorectal polyps.  Am J Surg Pathol. 2003;  27 65-81
  • 32 East J E, Saunders B P, Jass J R. Sporadic and syndromic hyperplastic polyps and serrated adenomas of the colon: classification, molecular genetics, natural history and clinical management.  Gastroenterol Clin North Am. 2008;  37 25-46
  • 33 Sprung D J. Prevalence of adenocarcinoma in small adenomas [abstract].  Am J Gastroenterol. 2006;  101 S199
  • 34 Gschwantler M, Kriwanek S, Langner E. et al . High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics.  Eur J Gastroenterol Hepatol. 2002;  14 183-188
  • 35 Tanaka S, Oka S, Hirata M. et al . Pit pattern diagnosis for colorectal neoplasia using narrow band imaging magnification.  Dig Endosc. 2006;  18 S52-S56
  • 36 Hirata M, Tanaka S, Oka S. et al . Evaluation of microvessels in colorectal tumours by narrow band imaging (NBI) magnification.  Gastrointest Endosc. 2007;  66 945-952
  • 37 Fukuzawa M, Saito Y, Matsuda T. et al . The efficiency of narrow band imaging with magnification for the estimation of invasion depth diagnosis in early colorectal cancer – a prospective study [abstract].  Gastrointest Endosc. 2007;  65 AB342
  • 38 Brooker J C, Shah S G, Saunders B P. Current issues in the management of colonic polyps: a retrospective review of 2806 consecutive polypectomies [abstract].  Gut. 2002;  50 Suppl II A52
  • 39 Tamura S, Onishi T, Kuratani Y. et al . Evaluation of the diagnostic accuracy rate of minute colonic adenomas: high-resolution magnifying chromoendoscopy vs. histopathology of a biopsy forceps specimen [abstract].  Gastrointest Endosc. 2007;  65 AB94
  • 40 Rosch T. Endoscopic histology – could we imagine incorporating it into daily routine?.  Gut. 2008;  57 149-150
  • 41 East J E, Tan E, Bergman J J. et al . Meta-analysis: narrow band imaging for lesion characterization in the colon, oesophagus, duodenal ampulla and lung.  Aliment Pharmacol Ther. 2008;  27 854-867
  • 42 East J E, Saunders B P. Look, remove and discard: can narrow band imaging replace histopathology for small colorectal polyps – it’s time to push the button!.  Gastrointest Endosc. 2007;  66 953-956
  • 43 East J E, Saunders B P. Narrow band imaging at colonoscopy: seeing through a glass darkly or the light of a new dawn?.  Expert Rev Gastroenterol Hepatol. 2008;  2 1-4

J. E. EastMRCP 

Wolfson Unit for Endoscopy
St Mark's Hospital

Watford Road
Harrow
Middlesex
HA1 3UJ
UK

Fax: +44 208-4233588

Email: jameseast6@yahoo.com

    >