Background
In vivo prediction of colorectal polyp histology by narrow-band imaging (NBI) could
potentially avoid post-polypectomy histologic examination or resection of diminutive
lesions, thereby reducing costs and risk.
Objective
To assess whether NBI is able to predict colonoscopy surveillance intervals and histology
of distal diminutive polyps according to American Society for Gastrointestinal Endoscopy
(ASGE) criteria.
Design
Prospective, multicenter study.
Setting
Five endoscopic centers.
Patients
Consecutive patients undergoing colonoscopy in 5 centers were included.
Intervention
Participating endoscopists were required to pass a before-study qualifying examination.
Histology of polyps that were <10 mm was predicted at NBI and assigned a designation
of high or low confidence.
Main Outcome Measurements
Accuracy of high-confidence NBI prediction for polyps ≤5 mm in predicting surveillance
intervals and negative predictive value (NPV) for adenomatous histology in the rectosigmoid
colon were compared with the ASGE thresholds (90% agreement, 90% NPV).
Results
A total of 278 patients (mean age, 63 years; 58% male) were enrolled. At colonoscopy,
574 (97.3%) polyps <10 mm (429 ≤5 mm, 60% adenomatous) were retrieved for histologic
analysis. Sensitivity, specificity, positive and negative predictive values, and accuracy
of high confidence-NBI predictions for adenomatous histology in lesions ≤5 mm were
90%, 88%, 89%, 89%, and 89%, respectively. High-confidence characterization of polyps
≤5 mm predicted the correct surveillance interval in 92% to 99% of cases, according
to the American and European guidelines. NPV of high-confidence NBI for adenomatous
histology for the rectosigmoid colon lesions ≤5 mm was 92%.
Limitations
Only experienced endoscopists were included.
Conclusion
High-confidence prediction of histology for polyps ≤5 mm appears to be sufficiently
accurate to avoid post-polypectomy histologic examination of the resected lesions
as well as to allow rectosigmoid hyperplastic polyps to be left in place without resection.
(Clinical trial registration number: NCT01675752.)
Abbreviations:
ASGE (American Society for Gastrointestinal Endoscopy), NBI (narrow-band imaging), PIVI (ASGE preservation and incorporation of valuable endoscopic innovations)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 15, 2013
Accepted:
January 24,
2013
Received:
October 15,
2012
Footnotes
DISCLOSURE: Software and Web site support were provided by Olympus. No other financial relationships relevant to this publication were disclosed.
If you would like to chat with an author of this article, you may contact Dr Hassan at [email protected]
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
