Magnification endoscopy in combination with acetic acid enhancement and narrow-band imaging for the accurate diagnosis of colonic neoplasms

Abstract

Background and study aims Magnification endoscopy with narrow-band imaging (NBIME) and NBIME with acetic acid enhancement (A-NBIME) enable visualization of the vascular and microstructural patterns of colorectal polyp. We compared the diagnostic accuracy and reproducibility of white light endoscopy (WLE), NBIME, and A-NBIME for predictive histologic diagnosis.

Patients and methods Consecutive colorectal polyps (N = 628; 38 hyperplasias, 488 adenomas, 72 M-SM1 cancers, and 30 SM2 cancers) were photographed with WLE, NBIME, and A-NBIME. Endoscopic images were independently reviewed by three experts, according to the traditional criteria for WLE, the Japan NBI Expert Team classification for NBIME, and pit pattern classification for A-NBIME to compare diagnostic accuracy and interobserver diagnostic agreement among modalities.

Results The specificity (95 % confidence interval) of hyperplasia and SM2 cancer with WLE were 98.2 % (96.8 %–99.1%) and 99.4 % (98.5 %–99.9 %), respectively, showing high accuracy for endoscopic resection without magnifying observation. Diagnostic accuracy of WLE, NBIME, and A-NBIME was 80.8 % (77.4 %–83.8 %), 79.3 % (75.9 %–82.4 %), and 86.1 % (83.2 %–88.7 %), respectively, showing the highest accuracy for A-NBIME among modalities (P < .05). NBIME showed a lower PPV for M-SM1 cancer (P < .05), as with WLE (P = .08) compared to A-NBIME. Fleiss’s kappa values for WLE, NBIME, and A-NBIME diagnosis were 0.43 (0.39 – 0.46), 0.52 (0.49 – 0.56) and 0.65 (0.62 – 0.69), respectively, showing insufficient reproducibility of WLE and superiority of A-NBIME among modalities.

Conclusion WLE showed high accuracy for endoscopic resection of colorectal polyps in expert diagnosis. NBIME demonstrated a higher diagnostic reproducibility than WLE. A-NBIME showed possible superiority among modalities in both diagnostic accuracy and reproducibility.

• References

• 1 IARC. Cancer Today. http://gco.iarc.fr/today/fact-sheets-cancers
• 2 Winawer SJ, Zauber AG, Ho MN. et al. Prevention of colorectal cancer by colonoscopic polypectomy: The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981
• 3 Kudo S, Tamura S, Nakajima T. et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14
• 4 Fujii T, Hasegawa RT, Saitoh Y. et al. Chromoscopy during colonoscopy. Endoscopy 2001; 33: 1036-1041
• 5 Tanaka S, Kaltenbach T, Chayama K. et al. High magnification colonoscopy (with videos). Gastrointest Endosc 2006; 64: 604-613
• 6 Machida H, Sano Y, Hamamoto Y. et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions a pilot study. Endoscopy 2004; 36: 1094-1098
• 7 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: 631-636
• 8 Minoda Y, Ogino H, Chinen T. et al. The objective validity of the JNET classification system for the differential diagnosis of colorectal polyps. Dig Endosc 2019; 31: 544-551
• 9 Wada Y, Kashida H, Kudo S. et al. Diagnostic accuracy of pit pattern and vascular pattern analysis in colorectal lesions. Dig Endosc 2010; 22: 192-199
• 10 Shibagaki K, Amano Y, Ishimura N. et al. Magnification endoscopy with acetic acid- enhancement and a narrow-band imaging system for pit pattern diagnosis of colorectal neoplasms. J Clin Gastroenterol 2015; 49: 306-312
• 11 Yagi K, Aruga Y, Nakamura A. et al. The study of dynamic magnifying endoscopy in gastric neoplasia. Gastrointest Endosc 2005; 62: 963-969
• 12 Togashi K, Hewett DG, Whitaker DA. et al. The use of acetic acid in magnification chromocolonoscopy for pit pattern analysis of small polyps. Endoscopy 2006; 38: 613-616
• 13 Goto N, Kusaka T, Tanaka H. et al. Magnifying narrow-band imaging with acetic acid to diagnose early colorectal cancer. World J Gastroenterol 2014; 20: 16306-16310
• 14 Bossuyt PM, Reitsma JB, Bruns DE. et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med 2003; 138: W1-W12
• 15 Sano Y, Tanaka S, Kudo SE. et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc 2016; 28: 526-533
• 16 Eberl T. Polyps and polyposis syndromes. In: Helmut M. (eds) Atlas of Colonoscopy. New York: Georg Thieme Verlag; 2006: 66-80
• 17 Hazewinkel Y, Ceron LM, East EJ. et al. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc 2013; 77: 916-924
• 18 Uraoka T, Higashi R, Horii J. et al. Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenoma/polyp. J Gastroenterol 2015; 50: 555-563
• 19 Uraoka T, Saito Y, Matsuda T. et al. Endoscopic indication for endoscopic mucosal resection of laterally spreading tumor in the colorectum. Gut 2006; 55: 1592-1597
• 20 Ikehara H, Saito Y, Matsuda T. et al. Diagnosis of depth of invasion for early colorectal cancer using magnifying colonoscopy. J Gastroenterol Hepatol 2010; 25: 905-912
• 21 Yamada M, Sakamoto T, Otake Y. et al. Investigating endoscopic features of sessile serrated adenomas/polyps by using narrow-band imaging with optical magnification. Gastrointest Endosc 2015; 82: 108-117
• 22 Kashida H, Kudo S. Magnifying colonoscopy, early colorectal cancer, and flat adenomas. In: Waye JD, Rex DK, Williams CB. (eds) Colonoscopy; Principles and Practice. 2nd ed. Malden, USA, Oxford, UK, Melbourne, Australia: Blackwell; 2009: 412-422
• 23 Kudo S, Miyachi H, Endo S. Magnifying chromocolonoscopy and tattooing. In: Classen M, Tytgat GNJ, Lightdale CJ. (eds) Gastroenterol Endosc. 2nd edn. New York, USA: Thieme; 2010: 197-202
• 24 Kimura T, Yamamoto E, Yamano H. et al. A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma. Am J Gastroenterol 2012; 107: 460-469
• 25 Japanese Society for Cancer of the Colon and Rectum. General rules for clinical and pathological studies on cancer of the colon, rectum and anus [Japanese]. 8th ed. Tokyo: Kanehara; 2013
• 26 Lacy S, Riffe D. Sampling error and selecting intercoder reliability sample for normal content categories. Journal Mass Commun Q 1996; 73: 963-973
• 27 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
• 28 Tung 1 SY, Wu CS, Su MY. Magnifying colonoscopy in differentiating neoplastic from nonneoplastic colorectal lesions. Am J Gastroenterol 2001; 96: 2628-2632
• 29 Konishi K, Kaneko K, Kurahashi T. et al. A comparison of magnifying and nonmagnifying colonoscopy for diagnosis of colorectal polyps: a prospective study. Gastrointest Endosc 2003; 57: 48-53
• 30 Chiu HM, Chang CY, Chen CC. et al. A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut 2007; 56: 373-379
• 31 Smith WF. Foundations of Materials Science and Engineering. 3rd ed. McGraw-Hill; 2004
• 32 Wanders LK, East JE, Uitentuis SE. et al. Diagnostic performance of narrowed spectrum endoscopy, autofluorescence imaging, and confocal laser endomicroscopy for optical diagnosis of colonic polyps: a meta-analysis. Lancet Oncol 2013; 14: 1337-1347
• 33 Kamiński MF, Hassan C, Bisschops R. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2014; 46: 435-449
• 34 Abu Dayyeh BK, Thosani N, Konda V. et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2015; 81: 502.e1-502.e16