Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging

Hewett, David G., Kaltenbach, Tonya, Sano, Yasushi, Tanaka, Shinji, Saunders, Brian P., Ponchon, Thierry, Soetikno, Roy M. and Rex, Douglas K. (2012) Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology, 143 3: 599-607.


Author Hewett, David G.
Kaltenbach, Tonya
Sano, Yasushi
Tanaka, Shinji
Saunders, Brian P.
Ponchon, Thierry
Soetikno, Roy M.
Rex, Douglas K.
Title Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging
Journal name Gastroenterology  (ERA 2012 Listed)    (ERA 2010 Rank A*)   Check publisher's open access policy
Publication date 2012-09
Sub-type Article
DOI 10.1053/j.gastro.2012.05.006
Volume number 143
Issue number 3
ISSN 0016-5085; 1528-0012
Start page 599
End page 607
Total pages 9
Place of publication Maryland Heights, MO, United States
Publisher W.B. Saunders
Collection year 2013
Language eng
Formatted abstract Background & Aims: Almost all colorectal polyps ≤5 mm are benign, yet current practice requires costly pathologic analysis. We aimed to develop and evaluate the validity of a simple narrow-band imaging (NBI)-based classification system for differentiating hyperplastic from adenomatous polyps.

Methods: The study was conducted in 4 phases: (1) evaluation of accuracy and reliability of histologic prediction by NBI-experienced colonoscopists; (2) development of a classification based on color, vessels, and surface pattern criteria, using a modified Delphi method; (3) validation of the component criteria by people not experienced in endoscopy or NBI analysis (25 medical students, 19 gastroenterology fellows) using 118 high-definition colorectal polyp images of known histology; and (4) validation of the classification system by NBI-trained gastroenterology fellows, using still images. We performed a pilot evaluation during real-time colonoscopy.

Results: We developed a classification system for the endoscopic diagnosis of colorectal polyp histology and established its predictive validity. When all 3 criteria were used, the specificity ranged from 94.9% to 100% and the combined sensitivity ranged from 8.5% to 61.0%. The specificities of the individual criteria were lower although the sensitivities were higher. During realtime colonoscopy, endoscopists made diagnoses with high confidence for 75% of consecutive small colorectal polyps, with 89% accuracy, 98% sensitivity, and 95% negative predictive values.

Conclusions: We developed and established the validity of an NBI classification system that can be used to diagnose colorectal polyps. In preliminary real-time evaluation, the system allowed endoscopic diagnoses of colorectal polyp histology.
Keyword Colonoscopy
Image-enhanced endoscopy
Real-time histology
Resect and discard
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article
Collections: Official 2013 Collection
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Created: Mon, 19 Nov 2012, 09:16:18 EST by Dr David Hewett on behalf of School of Psychology