Observer agreement for diagnosis of colorectal lesions with analysis of the vascular pattern by image-enhanced endoscopy

Background/Aims: Image-enhanced endoscopy (IEE) can differentiate neoplastic from non-neoplastic colorectal lesions through indirect analysis of pit patterns and microvascular architecture. We evaluated the accuracy of Flexible Spectral Imaging Color Enhancement (FICE) in differentiating neoplastic from non-neoplastic lesions and observer agreement in the analysis of capillary pattern of colorectal lesions.

Methods: A prospective double-blind trial was conducted in two referral endoscopy centers. Vascular pattern was analyzed by IEE with magnification. Lesions were divided into two groups and examined separately by two experts. Examiners, blinded to each other’s interpretations, switched groups and the lesions were reviewed. After 60 days, lesions were reevaluated.

Results: In total, 76 patients were referred to colonoscopy for colon cancer screening. Of 100 colorectal lesions, 88 were neoplastic (73 tubular adenomas, 10 tubulovillous adenomas, 1 villous adenoma, 2 serrated adenomas, 2 adenocarcinomas) and 12 were non-neoplastic (hyperplastic polyps). Mean diameter of the lesions was 6.7 mm. Examiners 1 and 2 had 95 % accuracy. The interobserver kappa coefficient was 0.80 and the intraobserver kappa coefficient was 0.88 for examiner 1 and 0.73 for examiner 2.

Conclusion: IEE with magnification is effective for real-time predictive histological diagnosis of colorectal lesions, with inter- and intraobserver agreement ranging from good to excellent.

• References

• 1 Zauber AG, Winawer SJ, O'Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. NEJM 2012; 366: 687-696
• 2 Morson BC. The polyp-cancer sequence in the large bowel. Proc R Soc Med 1974; 67: 451-457
• 3 Matsuda T, Saito Y, Hotta K et al. Prevalence and clinicopathological features of nonpolypoid colorectal neoplasms: should we pay more attention to identifying flat and depressed lesions?. Dig Endosc 2010; 22: 57-S62
• 4 Rex DK, Ahnen DJ, Baron JA et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329
• 5 Sano Y, Tanaka S, Teixeira CR et al. Endoscopic detection and diagnosis of 0-IIc neoplastic colorectal lesions. Endoscopy 2005; 37: 261-267
• 6 Su MY, Ho YP, Chen PC 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 Zanoni EC, Cutait R, Averbach M et al. Magnifying colonoscopy: interobserver agreement in the assessment of colonic pit patterns and its correlation with histopathological findings. Int J Colorectal Dis 2007; 22: 1383-1388
• 8 Matsuda T, Fujii T, Saito Y et al. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008; 103: 2700-2706
• 9 Hurlstone DP, Cross SS, Brown S et al. A prospective evaluation of high-magnification chromoscopic colonoscopy in predicting completeness of EMR. Gastrointest Endosc 2004; 59: 642-650
• 10 Santos CE, Malaman D, Pereira-Lima JC. Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas. Arq Gastroenterol 2011; 48: 242-247
• 11 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
• 12 Tischendorf JJ, Wasmuth HE, 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
• 13 Kanao H, Tanaka S, Oka S et al. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc 2009; 69: 631-639
• 14 Su MY, Hsu CM, Ho YP et al. Comparative study of conventional colonoscopy, chromoendoscopy, and narrow band imaging systems in differential diagnosis of neoplastic and non-neoplastic colonic polyps. Am J Gastroenterol 2006; 101: 2711-2716
• 15 Hoffman A, Kagel C, Goetz M et al. Recognition and characterization of small colonic neoplasia with high-definition colonoscopy using i-Scan is as precise as chromoendoscopy. Dig Liver Dis 2010; 42: 45-50
• 16 The Paris endoscopic classification of superficial neoplastic lesions. Gastrointest Endosc 2003; 58: 3-S43
• 17 Teixeira CR, Torresini RS, Canali C et al. Endoscopic classification of the capillary-vessel pattern of colorectal lesions by spectral estimation technology and magnifying imaging. Gastrointest Endosc 2009; 69: 750-756
• 18 Hamilton SR, Aaltonen LA editors World Health Organization classification of tumours: Pathology and genetics of tumours of the digestive system. Lyon: IARC Press 2000; 104-119
• 19 Rastogi A, Pondugula K, Bansal A et al. Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. Gastrointest Endosc 2009; 69: 716-722
• 20 Huang Q, Fukami N, Kashida H et al. Interobserver and intra-observer consistency in the endoscopic assessment of colonic pit patterns. Gastrointest Endosc 2004; 60: 520-526
• 21 Kudo S, Hirota S, Nakajima T et al. Colorectal tumours and pit pattern. J Clin Pathol 1994; 47: 880-885
• 22 Kudo S, Tamura S, Nakajima T et al. Diagnosis of colorectal tumours lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14
• 23 East JE, Suzuki N, Saunders BP. 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
• 24 dos Santos CE, Lima JC, Lopes CV et al. 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 2010; 22: 1364-1371
• 25 Yoshida N, Naito Y, Inada Y et al. The detection of surface patterns by flexible spectral imaging color enhancement without magnification for diagnosis of colorectal polyps. Int J Colorectal Dis 2012; 27: 605-611
• 26 Teixeira CR, Oliveira LA, Saito Y et al. Worldwide multicenter interobserver validation of a novel endoscopic classification of the capillary vessel pattern of colorectal lesions. Gut 2010; 59: A72
• 27 Santos CE, Pereira-Lima JC, Lopes CV et al. Comparative study between MBI (FICE^®) and magnification chromoendoscopy with indigo carmine in the differential diagnosis of neoplastic and non-neoplastic colorectal lesions. Arq Gastroenterol 2009; 46: 111-115
• 28 Kimura T, Yamamoto E, Yamano HO et al. A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma. Am J Gastroenterol 2012; 107: 460-469
• 29 Ishigooka S, Nomoto M, Obinata N et al. Evaluation of magnifying colonoscopy in the diagnosis of serrated polyps. World J Gastroenterol 2012; 18: 4308-4316
• 30 dos Santos CE, Malaman D, Lopes CV et al. Digital chromoendoscopy for diagnosis of diminutive colorectal lesions. Diagn Ther Endosc 2012; 2012: 279521