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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2020; 11(02): 138-145
DOI: 10.1055/s-0040-1714169
Original Article

Utility of Japan Narrow Band Imaging Expert Team Classification Using Narrow Band Imaging for Evaluation of Colonic Polyps

Dipak S. Ahire
1   Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
,
Pravin M. Rathi
1   Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
,
Niranjan H. Banka
1   Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
,
Parth K. Shah
1   Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
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Abstract

Background Narrow band imaging (NBI) is an advanced endoscopic imaging technique that enhances visualization of the mucosal surface and is used as a screening tool for colonic polyps. Its usefulness is currently explored to a lesser extent in India. So, we assessed the utility of Japan NBI Expert Team (JNET) classification for characterization of colorectal polyps.

Methods A prospective observational study was performed from January 2018 to June 2019 of patients undergoing colonoscopy at a tertiary care hospital. NBI image of polyps was captured followed by either polypectomy/biopsy. Histopathology results were correlated with the pattern revealed by NBI on polyps using the JNET classification.

Results A total of 80 patients, 61(76.25%) male with a mean (standard deviation [SD]) age of 58.41 ± 14.59 years were included. Out of the 90 lesions, 23 (25.5%) had type-1 pattern, 45 (50%) had 2A, 13 (14.4%) had 2B, and 9 (10%) had type-3 pattern. On histopathology, majority 51 (59.3%) were found to be adenomatous with low-grade intramucosal neoplasia. When correlating our results with JNET category type 1 and hyperplastic polyps, the sensitivity was 90%, specificity was 97%, negative predictive value was 97%, positive predictive value was 90%, and diagnostic accuracy was 96%. Correlating type 2A and low-grade intramucosal neoplasia had results of 78, 87, 76, 90, and 82%, respectively. Correlating type 2B and high-grade intramucosal neoplasia had results of 83, 90, 99, 38, and 90%, respectively. Correlating type 3 and deep submucosal cancer had results of 88, 98, 99, 78, and 97%, respectively.

Conclusion NBI shows excellent probability to exclude carcinoma possibilities based on the changes in colonic mucosal features. Owing to slightly lower sensitivity for type 2B, it needs additional investigation using pit pattern diagnosis. We demonstrated the high-diagnostic performance of NBI in making an accurate diagnosis of early colorectal cancers in colonoscopy. Further refinement in the NBI technology might add to the current evidence for characterization of polyps.

Keywords

narrow-band imaging - colonic polyps - surface pattern - vessel pattern


Publication History

Article published online:
06 July 2020

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  • References

  • 1 Colucci PM, Yale SH, Rall CJ. Colorectal polyps. Clin Med Res 2003; 1 (03) 261-262
    CrossrefPubMedGoogle Scholar
  • 2 Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143 (03) 844-857
    CrossrefPubMedGoogle Scholar
  • 3 Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 2009; 22 (04) 191-197
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366 (08) 687-696
    CrossrefPubMedGoogle Scholar
  • 5 Neugut AI, Jacobson JS, Rella VA. Prevalence and incidence of colorectal adenomas and cancer in asymptomatic persons. Gastrointest Endosc Clin N Am 1997; 7 (03) 387-399
    CrossrefPubMedGoogle Scholar
  • 6 Gono K, Obi T, Yamaguchi M. et al. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt 2004; 9 (03) 568-577
    CrossrefPubMedGoogle Scholar
  • 7 Iwatate M, Ikumoto T, Hattori S, Sano W, Sano Y, Fujimori T. NBI and NBI combined with magnifying colonoscopy. Diagn Ther Endosc 2012; 2012: 173269
    PubMedGoogle Scholar
  • 8 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143 (03) 599-607.e1
    CrossrefPubMedGoogle Scholar
  • 9 Hayashi N, Tanaka S, Hewett DG. et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78 (04) 625-632
    CrossrefPubMedGoogle Scholar
  • 10 Hattori S, Iwatate M, Sano W. et al. Narrow-band imaging observation of colorectal lesions using NICE classification to avoid discarding significant lesions. World J Gastrointest Endosc 2014; 6 (12) 600-605
    CrossrefPubMedGoogle Scholar
  • 11 Rees CJ, Rajasekhar PT, Wilson A. et al. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the detect inspect characterise resect and discard 2 (DISCARD 2) study. Gut 2017; 66 (05) 887-895
    CrossrefPubMedGoogle Scholar
  • 12 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 (05) 526-533
    CrossrefPubMedGoogle Scholar
  • 13 Higashi R, Uraoka T, Kato J. et al. Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program. Gastrointest Endosc 2010; 72 (01) 127-135
    CrossrefPubMedGoogle Scholar
  • 14 Sano Y, Ikematsu H, Fu KI. et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 2009; 69 (02) 278-283
    CrossrefPubMedGoogle Scholar
  • 15 Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000; 343 (03) 169-174
    CrossrefPubMedGoogle Scholar
  • 16 Lash RH, Genta RM, Schuler CM. Sessile serrated adenomas: prevalence of dysplasia and carcinoma in 2139 patients. J Clin Pathol 2010; 63 (08) 681-686
    CrossrefPubMedGoogle Scholar
  • 17 Anderson JC, Rangasamy P, Rustagi T. et al. Risk factors for sessile serrated adenomas. J Clin Gastroenterol 2011; 45 (08) 694-699
    CrossrefPubMedGoogle Scholar
  • 18 Tischendorf JJ, Wasmuth HE, Koch A, Hecker H, Trautwein C, Winograd R. Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. Endoscopy 2007; 39 (12) 1092-1096
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Ikematsu H, Matsuda T, Emura F. et al. Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol 2010; 10: 33
    CrossrefPubMedGoogle Scholar
  • 20 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (06) (Suppl) S3-S43
    CrossrefPubMedGoogle Scholar
  • 21 Rutter MD, Chattree A, Barbour JA. et al. British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps. Gut 2015; 64 (12) 1847-1873
    CrossrefPubMedGoogle Scholar
  • 22 Komeda Y, Kashida H, Sakurai T. et al. Magnifying narrow band imaging (NBI) for the diagnosis of localized colorectal lesions Using the Japan NBI expert team (JNET) classification. Oncology 2017; 93 (Suppl. 01) 49-54
    CrossrefPubMedGoogle Scholar
  • 23 Sumimoto K, Tanaka S, Shigita K. et al. Clinical impact and characteristics of the narrow-band imaging magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Gastrointest Endosc 2017; 85 (04) 816-821
    CrossrefPubMedGoogle Scholar
  • 24 Atkinson NSS, Ket S, Bassett P. et al. Narrow-band imaging for detection of neoplasia at colonoscopy: A meta-analysis of data from individual patients in randomized controlled trials. Gastroenterology 2019; 157 (02) 462-471
    CrossrefPubMedGoogle Scholar