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Published in: Surgical Endoscopy 4/2015

01-04-2015

Usefulness of narrow-band imaging with dual-focus magnification for differential diagnosis of small colorectal polyps

Authors: Hiroaki Ikematsu, Takahisa Matsuda, Shozo Osera, Maomi Imajoh, Tomohiro Kadota, Hiroyuki Morimoto, Taku Sakamoto, Yasuhiro Oono, Kazuhiro Kaneko, Yutaka Saito

Published in: Surgical Endoscopy | Issue 4/2015

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Abstract

Background

Many authors have already reported the usefulness of narrow-band imaging (NBI) for the differential diagnosis of non-neoplastic and neoplastic colorectal lesions. However, it is not clear whether magnification is required for differential diagnosis. The aim of this prospective study was to clarify the clinical usefulness of a newly developed NBI system with a dual focus function (dual-focus NBI) compared with conventional white-light imaging (WLI) and NBI without magnification for distinguishing between non-neoplastic and neoplastic lesions.

Patients and Methods

Thirty-seven consecutive patients who underwent screening colonoscopy with the novel system between July and December 2013 were analyzed. Patients with polyps >10 mm and those with polyps previously evaluated by histologic examination or colonoscopy were excluded. Lesions were diagnosed in real time with WLI, NBI without magnification, and dual-focus NBI, and then excised endoscopically. Each diagnosis was compared to that in the final histopathology reports. The primary endpoint was the diagnostic accuracy and the confidence level assigned to each modality by the endoscopists. The secondary endpoint was the differentiation ability according to the size of the lesion (≤5 and 6–10 mm).

Results

In all, 100 lesions including 76 adenomatous polyps and 24 hyperplastic polyps were analyzed in 37 patients. The overall diagnostic accuracy, sensitivity, and specificity for differentiating adenomatous from hyperplastic polyps were 87.0, 89.5, and 79.2 % for WLI, 93.0, 94.7, and 87.5 % for NBI without magnification, and 94.0, 96.1, and 87.5 % for dual-focus NBI, respectively. The level of confidence was significantly different between dual-focus NBI and WLI and NBI without magnification for diminutive (≤5 mm) lesions (p < 0.001 and p < 0.01).

Conclusion

Dual-focus NBI is especially useful for differential diagnosis of diminutive colorectal lesions.
Literature
1.
go back to reference Chapui PH, Dent OF, Goulston KJ (1982) Clinical accuracy in diagnosis of small polyps using the flexible sigmoidscope. Dis Colon Rectum 25:669–672CrossRef Chapui PH, Dent OF, Goulston KJ (1982) Clinical accuracy in diagnosis of small polyps using the flexible sigmoidscope. Dis Colon Rectum 25:669–672CrossRef
2.
go back to reference Neale AV, Demers RY, Budev H, Scott RO (1987) Physician accuracy in diagnosing colorectal polyps. Dis Colon Rectum 30:247–250CrossRefPubMed Neale AV, Demers RY, Budev H, Scott RO (1987) Physician accuracy in diagnosing colorectal polyps. Dis Colon Rectum 30:247–250CrossRefPubMed
3.
go back to reference Kiesslich R, von Bergh M, Hahn M, Hermann G, Jung M (2001) Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon. Endoscopy 33:1001–1006CrossRefPubMed Kiesslich R, von Bergh M, Hahn M, Hermann G, Jung M (2001) Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon. Endoscopy 33:1001–1006CrossRefPubMed
4.
5.
go back to reference Axelrad AM, Fleischer DE, Geller AJ, Nguyen CC, Lewis JH, Al-Kawas FH, Avigan MI, Montgomery EA, Benjamin SB (1996) High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: implication for colon cancer screening. Gastroenterology 110:1253–1258CrossRefPubMed Axelrad AM, Fleischer DE, Geller AJ, Nguyen CC, Lewis JH, Al-Kawas FH, Avigan MI, Montgomery EA, Benjamin SB (1996) High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: implication for colon cancer screening. Gastroenterology 110:1253–1258CrossRefPubMed
6.
go back to reference Konishi K, Kaneko K, Kurahashi T, Yamamoto T, Kushima M, Kanda A, Tajiri H, Mitamura K (2003) A comparison of magnifying and nonmagnifying colonoscopy for diagnosis of colorectal polyps: a prospective study. Gastrointest Endosc 57:48–53CrossRefPubMed Konishi K, Kaneko K, Kurahashi T, Yamamoto T, Kushima M, Kanda A, Tajiri H, Mitamura K (2003) A comparison of magnifying and nonmagnifying colonoscopy for diagnosis of colorectal polyps: a prospective study. Gastrointest Endosc 57:48–53CrossRefPubMed
7.
go back to reference Fu KI, Sano Y, Kato S, Fujii T, Nagashima F, Yoshino T, Okuno T, Yoshida S, Fujimori T (2004) 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 36:1089–1093CrossRefPubMed Fu KI, Sano Y, Kato S, Fujii T, Nagashima F, Yoshino T, Okuno T, Yoshida S, Fujimori T (2004) 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 36:1089–1093CrossRefPubMed
8.
go back to reference Kato S, Fu KI, Sano Y, Fujii T, Saito Y, Matsuda T, Koba I, Yoshida S, Fujimori T (2006) Magnifying colonoscopy as a non-biopsy technique for differential diagnosis of non-neoplastic and neoplastic lesions. World J Gastroenterol 12:1416–1420PubMedCentralPubMed Kato S, Fu KI, Sano Y, Fujii T, Saito Y, Matsuda T, Koba I, Yoshida S, Fujimori T (2006) Magnifying colonoscopy as a non-biopsy technique for differential diagnosis of non-neoplastic and neoplastic lesions. World J Gastroenterol 12:1416–1420PubMedCentralPubMed
9.
go back to reference Sano Y, Ikematsu H, Fu KI, Emura F, Katagiri A, Horimatsu T, Kaneko K, Soetikno R, Yoshida S (2009) Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 69:278–283CrossRefPubMed Sano Y, Ikematsu H, Fu KI, Emura F, Katagiri A, Horimatsu T, Kaneko K, Soetikno R, Yoshida S (2009) Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 69:278–283CrossRefPubMed
10.
go back to reference Su MY, Hsu CM, Ho YP, Chen PC, Lin CJ, Chiu CT (2006) Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps. Am J Gastroenterol 101:2711–2716CrossRefPubMed Su MY, Hsu CM, Ho YP, Chen PC, Lin CJ, Chiu CT (2006) Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps. Am J Gastroenterol 101:2711–2716CrossRefPubMed
11.
go back to reference Chiu HM, Chang CY, Chen CC, Lee YC, Wu MS, Lin JT, Shun CT, Wang HP (2007) A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut 56:373–379CrossRefPubMedCentralPubMed Chiu HM, Chang CY, Chen CC, Lee YC, Wu MS, Lin JT, Shun CT, Wang HP (2007) A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut 56:373–379CrossRefPubMedCentralPubMed
12.
go back to reference 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. 10:1171–1178CrossRefPubMed 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. 10:1171–1178CrossRefPubMed
13.
go back to reference Goda K, Dobashi A, Tajiri H (2014) Perspectives on narrow-band imaging endoscopy for superficial squamous neoplasms of the orohypopharynx and esophagus. Dig Endosc. 26:1–11CrossRefPubMed Goda K, Dobashi A, Tajiri H (2014) Perspectives on narrow-band imaging endoscopy for superficial squamous neoplasms of the orohypopharynx and esophagus. Dig Endosc. 26:1–11CrossRefPubMed
14.
go back to reference Singh R, Jayanna M, Navadgi S, Ruszkiewicz A, Saito Y, Uedo N (2013) Narrow-band imaging with dual focus magnification in differentiating colorectal neoplasia. Dig Endosc. 25:16–20CrossRefPubMed Singh R, Jayanna M, Navadgi S, Ruszkiewicz A, Saito Y, Uedo N (2013) Narrow-band imaging with dual focus magnification in differentiating colorectal neoplasia. Dig Endosc. 25:16–20CrossRefPubMed
15.
go back to reference Aronchick CA, Lipshutz WH, Wright SH, DuFrayne FJ, Bergman GE (1999) Validation of an instrument to assess colon cleansing [abstract]. Am J Gastroenterol 94:2667 Aronchick CA, Lipshutz WH, Wright SH, DuFrayne FJ, Bergman GE (1999) Validation of an instrument to assess colon cleansing [abstract]. Am J Gastroenterol 94:2667
16.
go back to reference The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc (2003);58:S3–43 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc (2003);58:S3–43
17.
go back to reference Emura F, Saito Y, Taniguchi M, Fujii T, Tagawa K, Yamakado M (2007) Further validation of magnifying chromocolonoscopy for differentiating colorectal neoplastic polyps in a health screening center. J Gastroenterol Hepatol 22:1722–1727CrossRefPubMed Emura F, Saito Y, Taniguchi M, Fujii T, Tagawa K, Yamakado M (2007) Further validation of magnifying chromocolonoscopy for differentiating colorectal neoplastic polyps in a health screening center. J Gastroenterol Hepatol 22:1722–1727CrossRefPubMed
18.
go back to reference Rex DK (2009) Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 134:1174–1181CrossRef Rex DK (2009) Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 134:1174–1181CrossRef
19.
go back to reference Hamilton SR, Bosman FT (eds) (2010) World Health Organization classification of tumours of the digestive system. IARC Press, Lyon, pp 132–142 Hamilton SR, Bosman FT (eds) (2010) World Health Organization classification of tumours of the digestive system. IARC Press, Lyon, pp 132–142
20.
go back to reference Wada Y, Kudo SE, Kashida H, Ikehara N, Inoue H, Yamamura F, Ohtsuka K, Hamatani S (2009) Diagnosis of colorectal lesions with the magnifying narrow-band imaging system. Gastrointest Endosc 70:522–531CrossRefPubMed Wada Y, Kudo SE, Kashida H, Ikehara N, Inoue H, Yamamura F, Ohtsuka K, Hamatani S (2009) Diagnosis of colorectal lesions with the magnifying narrow-band imaging system. Gastrointest Endosc 70:522–531CrossRefPubMed
21.
go back to reference Hirata M, Tanaka S, Oka S, Kaneko I, Yoshida S, Yoshihara M, Chayama K (2007) Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc 65:988–995CrossRefPubMed Hirata M, Tanaka S, Oka S, Kaneko I, Yoshida S, Yoshihara M, Chayama K (2007) Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc 65:988–995CrossRefPubMed
22.
go back to reference Hewett DG, Kaltenbach T, Sano Y, Tanaka S, Saunders BP, Ponchon T, Soetikno R, Rex DK (2012) Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 143:599–607CrossRefPubMed Hewett DG, Kaltenbach T, Sano Y, Tanaka S, Saunders BP, Ponchon T, Soetikno R, Rex DK (2012) Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 143:599–607CrossRefPubMed
23.
go back to reference Higashi R, Uraoka T, Kato J, Kuwaki K, Ishikawa S, Saito Y, Matsuda T, Ikematsu H, Sano Y, Suzuki S, Murakami Y, Yamamoto K (2010) Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program. Gastrointest Endosc 72:127-35CrossRefPubMed Higashi R, Uraoka T, Kato J, Kuwaki K, Ishikawa S, Saito Y, Matsuda T, Ikematsu H, Sano Y, Suzuki S, Murakami Y, Yamamoto K (2010) Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program. Gastrointest Endosc 72:127-35CrossRefPubMed
24.
go back to reference Hassan C, Pickhardt PJ, Rex DK (2010) A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol. 8:865–869CrossRefPubMed Hassan C, Pickhardt PJ, Rex DK (2010) A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol. 8:865–869CrossRefPubMed
25.
go back to reference Sakamoto T, Matsuda T, Nakajima T, Saito Y (2013) Clinicopathological features of colorectal polyps: evaluation of the ‘predict, resect and discard’ strategies. Colorectal Dis 15:295–300CrossRef Sakamoto T, Matsuda T, Nakajima T, Saito Y (2013) Clinicopathological features of colorectal polyps: evaluation of the ‘predict, resect and discard’ strategies. Colorectal Dis 15:295–300CrossRef
26.
go back to reference Kudo S, Kashida H, Tamura T, Kogure E, Imai Y, Yamano H, Hart AR (2000) Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer. World J Surg 27:1081–1090CrossRef Kudo S, Kashida H, Tamura T, Kogure E, Imai Y, Yamano H, Hart AR (2000) Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer. World J Surg 27:1081–1090CrossRef
27.
go back to reference Saitoh Y, Waxman I, West AB, Popnikolov NK, Gatalica Z, Watari J, Obara T, Kohgo Y, Pasricha PJ (2001) Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology 120:1657-65CrossRefPubMed Saitoh Y, Waxman I, West AB, Popnikolov NK, Gatalica Z, Watari J, Obara T, Kohgo Y, Pasricha PJ (2001) Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology 120:1657-65CrossRefPubMed
28.
go back to reference Tsuda S, Veress B, Toth E, Fork FT (2002) Flat and depressed colorectal tumours in a southern Swedish population: a prospective chromoendoscopic and histopathological study. Gut 51:550–555CrossRefPubMedCentralPubMed Tsuda S, Veress B, Toth E, Fork FT (2002) Flat and depressed colorectal tumours in a southern Swedish population: a prospective chromoendoscopic and histopathological study. Gut 51:550–555CrossRefPubMedCentralPubMed
29.
go back to reference Soetikno R, Friedland S, Kaltenbach T, Chayama K, Tanaka S (2006) Nonpolypoid (flat and depressed) colorectal neoplasms. Gastroenterology 130:566–576CrossRefPubMed Soetikno R, Friedland S, Kaltenbach T, Chayama K, Tanaka S (2006) Nonpolypoid (flat and depressed) colorectal neoplasms. Gastroenterology 130:566–576CrossRefPubMed
30.
go back to reference Matsuda T, Saito Y, Fujii T, Uraoka T, Nakajima T, Kobayashi N, Emura F, Ono A, Shimoda T, Ikematsu H, Fu KI, Sano Y, Fujimori T (2009) Size does not determine the grade of malignancy of early invasive colorectal cancer. World J Gastroenterol 15:2708–2713CrossRefPubMedCentralPubMed Matsuda T, Saito Y, Fujii T, Uraoka T, Nakajima T, Kobayashi N, Emura F, Ono A, Shimoda T, Ikematsu H, Fu KI, Sano Y, Fujimori T (2009) Size does not determine the grade of malignancy of early invasive colorectal cancer. World J Gastroenterol 15:2708–2713CrossRefPubMedCentralPubMed
31.
go back to reference Kaltenbach T, Friedland S, Soetikno R (2008) A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates. Gut 57:1406–1412CrossRefPubMed Kaltenbach T, Friedland S, Soetikno R (2008) A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates. Gut 57:1406–1412CrossRefPubMed
32.
go back to reference Adler A, Aschenbeck J, Yenerim T, Mayr M, Aminalai A, Drossel R, Schröder A, Scheel M, Wiedenmann B, Rösch T (2009) Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial. Gastroenterology 136:410–416CrossRefPubMed Adler A, Aschenbeck J, Yenerim T, Mayr M, Aminalai A, Drossel R, Schröder A, Scheel M, Wiedenmann B, Rösch T (2009) Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial. Gastroenterology 136:410–416CrossRefPubMed
33.
go back to reference Ikematsu H, Saito Y, Tanaka S, Uraoka T, Sano Y, Horimatsu T, Matsuda T, Oka S, Higashi R, Ishikawa H, Kaneko K (2012) The impact of narrow band imaging for colon polyp detection: a multicenter randomized controlled trial by tandem colonoscopy. J Gastroenterol 47:1099–1107CrossRefPubMed Ikematsu H, Saito Y, Tanaka S, Uraoka T, Sano Y, Horimatsu T, Matsuda T, Oka S, Higashi R, Ishikawa H, Kaneko K (2012) The impact of narrow band imaging for colon polyp detection: a multicenter randomized controlled trial by tandem colonoscopy. J Gastroenterol 47:1099–1107CrossRefPubMed
34.
go back to reference Ikematsu H, Matsuda T, Emura F, Saito Y, Uraoka T, Fu KI, Kaneko K, Ochiai A, Fujimori T, Sano Y (2010) Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol. 10:33CrossRefPubMedCentralPubMed Ikematsu H, Matsuda T, Emura F, Saito Y, Uraoka T, Fu KI, Kaneko K, Ochiai A, Fujimori T, Sano Y (2010) Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol. 10:33CrossRefPubMedCentralPubMed
Metadata
Title
Usefulness of narrow-band imaging with dual-focus magnification for differential diagnosis of small colorectal polyps
Authors
Hiroaki Ikematsu
Takahisa Matsuda
Shozo Osera
Maomi Imajoh
Tomohiro Kadota
Hiroyuki Morimoto
Taku Sakamoto
Yasuhiro Oono
Kazuhiro Kaneko
Yutaka Saito
Publication date
01-04-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 4/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3736-y

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