Top

International Journal of Colorectal Disease

Published in:

01-03-2012 | Original Article

Computer-generated surface and tone enhancements to distinguish neoplastic from non-neoplastic colon polyps less than 1 cm in diameter

Authors: Ming-Lun Han, Yi-Chia Lee, Chieh-Chang Chen, Yu-Jen Fang, Ji-Yuh Lee, Tzu-Ling Lin, Long-Wei Lin, Ping-Huei Tseng, Ming-Shiang Wu, Hsiu-Po Wang

Published in: International Journal of Colorectal Disease | Issue 3/2012

Abstract

Background and study aims

Computer-generated enhancements, which can highlight the surface and color of a colonic lesion, may be helpful to predict the histology; however, it remains unclear whether this technology can distinguish neoplastic from non-neoplastic colon polyps when the polyps are <1 cm without magnification.

Patients and methods

Images of colorectal polyps less than 1 cm in diameter were obtained from 54 patients who underwent non-magnified colonoscopy with surface enhancement (SE) and tone enhancement (TE). We calculated the sensitivity, specificity, and accuracy in the prediction of histology. Inter- and intra-observer consistency was evaluated by inviting four endoscopists to rate 45 static images.

Results

Overall sensitivity, specificity, and accuracy following the sequence of SE, TE colon, and TE pit pattern modes were 87.7% (95% confidence interval 81.3–94.1%), 84.1% (76.9–91.3%), and 86.1% (79.4–92.8%), respectively. For each modality, the results were 75.0% (68.7–81.3%), 82.7% (77.2–88.2%), and 77.2% (71.1–83.3%) for SE; 71.1% (64.5–77.7%), 78.8 (72.8–84.8), and 73.3% (66.8–79.8%) for TE colon mode; and 75.0% (68.7–81.3%), 80.8% (75.0–86.8%), and 76.7% (70.5–82.9%) for TE pit pattern mode. Their inter- and intra-observer agreements were all fair (κ range 0.522–0.568) and good (0.605–0.694), respectively. When the same rater evaluated the same lesion under different modalities, eight of 45 (18%) polyps yielded discordant interpretations, and the possibility of incorrect diagnoses was the highest with the TE colon mode.

Conclusion

Computer-generated enhancements are satisfactory in predicting the histology of small colon polyps without the need for magnification. This advantage is mostly related to the pit pattern enhancement.

Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M et al (1988) Genetic alterations during colorectal-tumor development. N Engl J Med 319:525–532PubMedCrossRef

Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981PubMedCrossRef

Kudo S, Hirota S, Nakajima T et al (1994) Colorectal tumors and pit pattern. J Clin Pathol 47:880–885PubMedCrossRef

Kudo S, Rubio CA, Teixiera CR et al (2001) Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 33:367–373PubMed

Tung SY, Wu CSSuMY (2001) Magnifying colonoscopy in differentiating neoplastic from nonneoplastic colorectal lesions. Am J Gastroenterol 96:2628–2632PubMedCrossRef

Konishi K, Kaneko K, Kurahashi T, Yamamoto T, Kushima M, Kanda A et al (2003) A comparison of magnifying and nonmagnifying colonoscopy for diagnosis of colorectal polyps: a prospective study. Gastrointest Endosc 57:48–53PubMedCrossRef

Su MY, Ho YP, Chen PC, Chiu CT, Wu CS, Hsu CM et al (2004) Magnifying endoscopy with indigo carmine contrast for differential diagnosis of neoplastic and nonneoplastic colonic polyps. Dig Dis Sci 49:1123–1127PubMedCrossRef

Kiesslich R, Neurath M (2007) Magnifying chromoendoscopy: effective diagnostic tool for screening colonoscopy. J Gastroenterol Hepatol 22:1700–1701PubMedCrossRef

Kaltenbach T, Sano Y, Friedland S, Soetikno R et al (2008) American Gastroenterological Association (AGA) Institute technology assessment on image-enhanced endoscopy. Gastroenterology 134:327–340PubMedCrossRef

10.

Machida H, Sano Y, Hamamoto Y, Muto M, Kozu T, Tajiri H et al (2004) Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy 36:1094–1098PubMedCrossRef

11.

Su MY, Hsu CM, Ho YP, Chen PC, Lin CJ, Chiu CT et al (2006) Comparative study of conventional colonoscopy, chromoendoscopy, and narrow band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps. Am J Gastroenterol 101:2711–2716PubMedCrossRef

12.

Chiu HM, Chang CY, Chen CC, Lee YC, Wu MS, Lin JT et al (2007) A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut 56:373–379PubMedCrossRef

13.

Hirata M, Tanaka S, Oka S, Kaneko I, Yoshida S, Yoshihara M et al (2007) Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc 65:988–995PubMedCrossRef

14.

Tischendorf JJ, Wasmuth HE, Koch A, Hecker H, Trautwein C, Winograd R (2007) Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. Endoscopy 39:1092–1096PubMedCrossRef

15.

Sikka S, Ringold DA, Jonnalagadda S, Banerjee B (2008) Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopies without optical magnification. Endoscopy 40:818–822PubMedCrossRef

16.

East JE, Suzuki N, Bassett P, Stavrinidis M, Thomas HJ, Guenther T (2008) Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular intensity. Endoscopy 40:811–817PubMedCrossRef

17.

Rastogi A, Bansal A, Wani S, Callahan P, McGregor DH, Cherian R (2008) Narrow-band imaging colonoscopy-a pilot feasibility study for the detection of polyps and correlation of surface patterns with polyp histologic diagnosis. Gastrointest Endosc 67:280–286PubMedCrossRef

18.

Rogart JN, Jain D, Siddiqui UD, Oren T, Lim J, Jamidar P, Aslanian H (2008) Narrow band imaging without high magnification to differentiate polyps during real time colonoscopy: improvement with experience. Gastrointest Endosc 68:1136–1145PubMedCrossRef

19.

Rex DX (2009) Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 136:1174–1181PubMedCrossRef

20.

Rastogi A, Keighley J, Singh V, Callahan P, Bansal A, Wani S (2009) High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study. Am J Gastroenterol 104:2422–2430PubMedCrossRef

21.

Sano Y, Ikematsu H, Fu KI, Emura F, Katagiri A, Horimatsu T (2009) Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 69:278–283PubMedCrossRef

22.

Wada Y, Kudo SE, Kashida H, Ikehara N, Inoue H, Yamamura F (2009) Diagnosis of colorectal lesions with magnifying narrow-band imaging system. Gastrointest Endosc 70:522–531PubMedCrossRef

23.

Henry ZH, Yeaton P, Shami VM, Kahaleh M, Patrie JT, Cox DG (2010) Meshed capillary vessels found on narrow-band imaging without optical magnification effectively identifies colorectal neoplasia: a North American validation of the Japanese experience. Gastrointest Endosc 72:118–126PubMedCrossRef

24.

Pohl J, May A, Rabenstein T, Pech O, Ell C (2008) Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study. Am J Gastroenterol 103:562–569PubMedCrossRef

25.

Liu YX, Huang LY, Bian XP, Cui J, Xu N, Wu CR (2008) Fuji Intelligent Chromo Endoscopy and staining technique for the diagnosis of colon tumor. Chin Med J (Engl) 121:977–982

26.

Teixeira CR, Torresini RS, Canali C, Figueiredo LF, Mucenic M, Pereira Lima JC et al (2009) Endoscopic classification of the capillary-vessel pattern of colorectal lesions by spectral estimation technology and magnifying zoom imaging. Gastrointest Endosc 69:750–756PubMedCrossRef

27.

Parra-Blanco A, Jiménez A, Rembacken B, González N, Nicolás-Pérez D, Gimeno-García A et al (2009) Validation of Fujinon intelligent chromoendoscopy with high definition endoscopes in colonoscopy. World J Gastroenterol 15:5266–5273PubMedCrossRef

28.

dos Santos CE, Lima JC, Lopes CV, Malaman D, Salomão AD, Garcia AC (2010) Computerized virtual chromoendoscopy versus indigo carmine chromoendoscopy combined with magnification for diagnosis of small colorectal lesions: a randomized and prospective study. Eur J Gastroenterol Hepatol 22:1364–1371PubMedCrossRef

29.

Hoffman A, Basting N, Goetz M, Tresch A, Mudter J, Biesterfeld S et al (2009) High-definition endoscopy with i-Scan and Lugol’s solution for more precise detection of mucosal breaks in patients with reflux symptoms. Endoscopy 41:107–112PubMedCrossRef

30.

Hoffman A, Kagel C, Goetz M, Tresch A, Mudter J, Biesterfeld S et al (2010) Recognition and characterization of small colonic neoplasia with high-definition colonoscopy using i-Scan is as precise as chromoendoscopy. Dig Liver Dis 42:45–50PubMedCrossRef

31.

Hoffman A, Sar F, Goetz M, Tresch A, Mudter J, Biesterfeld S et al (2010) High-definition endoscopy combined with i-Scan is superior in the detection of colorectal neoplasias compared with standard video colonoscopy: a prospective randomized control trial. Endoscopy 42:827–833PubMedCrossRef

32.

Kodashima S, Fujishiro M (2010) Novel image-enhanced endoscopy with i-Scan technology. World J Gasteroenterol 16:1043–1049CrossRef

33.

Muto T, Bussey HJ, Morson BC (1975) The evolution of cancer of colon and rectum. Cancer 36:2251–2270PubMedCrossRef

34.

Sano Y, Emura F, Ikematsu H (2009) Narrow-band imaging. In: Waye JD, Rex DK, Williams CB (eds) Colonoscopy principle and practice, 2nd edn. Wiley-Blackwell, Hoboken, pp 514–526

35.

Japanese Research Society of Cancer of the Colon and Rectum (1983) General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification. Jpn J Surg 13:557–573CrossRef

36.

Hamilton SR, Aaltonen LA (eds) (2000) World Health Organization classification of tumours. Pathology and genetics of tumours of the digestive system. IARC, Lyon

37.

Stokes ME, Davis CS, Koch GG (2000) Categorical data analysis using the SAS system, 2nd edn. SAS institute, Cary (NC)

38.

Konerding MA, Fait E, Gaumann A (2001) 3D microvascular architecture of pre-cancerous lesions and invasive carcinomas of the colon. Br J Cancer 84:1354–1362PubMedCrossRef

39.

Tseng PH, Chen CC, Chiu HM, Liao WC, Wu MS, Lin JT et al (2011) Performance of narrow band imaging and magnification endoscopy in the prediction of therapeutic response in patients with gastroesophageal reflux disease. J Clin Gastroenterol 45:501–506PubMedCrossRef

40.

Ignjatovic A, East JE, Suzuki N, Vance M, Guenther T, Saunders BP (2009) Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect Inspect Characterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol 10:1171–1178PubMedCrossRef

Title: Computer-generated surface and tone enhancements to distinguish neoplastic from non-neoplastic colon polyps less than 1 cm in diameter
Authors: Ming-Lun Han
Yi-Chia Lee
Chieh-Chang Chen
Yu-Jen Fang
Ji-Yuh Lee
Tzu-Ling Lin
Long-Wei Lin
Ping-Huei Tseng
Ming-Shiang Wu
Hsiu-Po Wang
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 3/2012
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-011-1319-0

At a glance: The STEP trials

Springer Medicine

Computer-generated surface and tone enhancements to distinguish neoplastic from non-neoplastic colon polyps less than 1 cm in diameter

Abstract

Background and study aims

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and study aims

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2012

Pleiotrophin is a potential colorectal cancer prognostic factor that promotes VEGF expression and induces angiogenesis in colorectal cancer

Ultrastaging of colon cancer by sentinel node biopsy using fluorescence navigation with indocyanine green

Long-term risk of adenocarcinoma post-ileal pouch–anal anastomosis for ulcerative colitis: report of two cases and review of the literature

Autofluorescence imaging and the quantitative intensity of fluorescence for evaluating the dysplastic grade of colonic neoplasms

Early recurrence of pseudomyxoma peritonei following treatment failure of cytoreductive surgery and perioperative intraperitoneal chemotherapy is indicative of a poor survival outcome

Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial