A comparison of conventional endoscopy, chromoendoscopy, and the optimal-band imaging system for the differentiation of neoplastic and non-neoplastic colonic polyps.

BACKGROUND The diagnostic accuracy of conventional endoscopy for small colonic polyps is not satisfactory. Optimal band imaging (OBI) enhances the contrast of the mucosal surface without the use of dye. OBJECTIVE To evaluate the diagnostic accuracy for the differentiation of neoplastic and non-neoplastic colorectal polyps by using magnified OBI colonoscopy. DESIGN An open prospective study. SETTING Jichi Medical University, Japan. PATIENTS A total of 133 colonoscopy cases. MAIN OUTCOME MEASUREMENT A comparative study of the overall accuracy, sensitivity, and specificity for the differentiation of neoplastic and non-neoplastic colorectal polyps < or =5 mm in size by capillary-pattern diagnosis by using conventional colonoscopy, capillary-pattern diagnosis in OBI, and pit-pattern diagnosis in chromoendoscopy with low magnification. RESULTS A total of 107 polyps, composed of 80 neoplastic and 27 non-neoplastic polyps, were evaluated. OBI clearly showed the capillary network of the surface mucosa of neoplastic polyps at low magnification, whereas the surface mucosa of non-neoplastic polyps showed up as a pale lesion. The capillary pattern in conventional colonoscopy had 74% accuracy, 71% sensitivity, and 81% specificity for neoplastic polyps. The accuracy and sensitivity were significantly lower than those that used the capillary pattern in OBI (accuracy 87% and sensitivity 93%) and the pit pattern in chromoendoscopy (accuracy 86% and sensitivity 90%). There were no significant differences in specificity (OBI 70% and chromoendoscopy 74%). The kappa analysis indicated good agreement in both OBI and chromoendoscopy. CONCLUSIONS Capillary-pattern diagnosis in OBI is superior to that in conventional endoscopy and is not significantly different from pit-pattern diagnosis for predicting the histology of small colorectal polyps.

[1]  A. Zauber,et al.  The advanced adenoma as the primary target of screening. , 2002, Gastrointestinal endoscopy clinics of North America.

[2]  N. Suzuki,et al.  Narrow band imaging for colonoscopic surveillance in hereditary non-polyposis colorectal cancer , 2007, Gut.

[3]  Noriko Suzuki,et al.  Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study. , 2007, Gastrointestinal endoscopy.

[4]  O. Dent,et al.  Clinical accuracy in the diagnosis of small polyps using the flexible fiberoptic sigmoidoscope , 1982, Diseases of the colon and rectum.

[5]  Thomas Rabenstein,et al.  Computed Virtual Chromoendoscopy for Classification of Small Colorectal Lesions: A Prospective Comparative Study , 2008, The American Journal of Gastroenterology.

[6]  Chen-Ming Hsu,et al.  Comparative Study of Conventional Colonoscopy, Chromoendoscopy, and Narrow-Band Imaging Systems in Differential Diagnosis of Neoplastic and Nonneoplastic Colonic Polyps , 2006, The American Journal of Gastroenterology.

[7]  Norimichi Tsumura,et al.  Optimal design of mosaic color filters for the improvement of image quality in electronic endoscopes , 1998 .

[8]  E. E. Gresch.  Genetic Alterations During Colorectal-Tumor Development , 1989 .

[9]  S S Cross,et al.  Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy , 2004, Gut.

[10]  Hideaki Haneishi,et al.  Improved Color Reproduction of Electronic Endoscopes , 1995, International Conference on Communications in Computing.

[11]  T. Fujii,et al.  Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK , 2000, The Lancet.

[12]  C. Trautwein,et al.  Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. , 2007, Endoscopy.

[13]  Hideaki Haneishi,et al.  Color correction for colorimetric color reproduction in an electronic endoscope , 1995 .

[14]  Chen-Ming Hsu,et al.  Magnifying Endoscopy with Indigo Carmine Contrast for Differential Diagnosis of Neoplastic and Nonneoplastic Colonic Polyps , 2004, Digestive Diseases and Sciences.

[15]  Chi-Yang Chang,et al.  A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia , 2007, Gut.

[16]  Yoichi Miyake,et al.  A New Spectrophotometer for Measuring the Spectral Reflectance of Gastric Mucous Membrane , 1989 .

[17]  A. Zauber,et al.  Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. , 1993 .

[18]  S S Cross,et al.  Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis , 2004, Gut.

[19]  Kazutomo Togashi,et al.  Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel , 1999, Diseases of the colon and rectum.

[20]  Shinji Tanaka,et al.  Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. , 2007, Gastrointestinal endoscopy.

[21]  S. Kudo,et al.  Colorectal tumours and pit pattern. , 1994, Journal of clinical pathology.

[22]  H. Tajiri,et al.  Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. , 2004, Endoscopy.

[23]  R. Capocaccia,et al.  Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence , 2001, Gut.

[24]  Hiroyuki Osawa,et al.  Optimal band imaging system can facilitate detection of changes in depressed-type early gastric cancer. , 2008, Gastrointestinal endoscopy.

[25]  J Cuzick,et al.  Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. , 1992, The New England journal of medicine.

[26]  A. Neale,et al.  Physician accuracy in diagnosing colorectal polyps , 1987, Diseases of the colon and rectum.