A prospective dual-center proof-of-principle study evaluating the incremental benefit of narrow-band imaging with a fixed zoom function in real-time prediction of polyp histology. Can we resect and discard?

Published:April 01, 2015DOI:


      Advancements in endoscopic technology have increased the ability to distinguish neoplastic polyps during colonoscopy. If a minimum accuracy can be achieved, then a resect-and-discard model can be implemented, although studies to date have demonstrated limited success, especially in the assessment of serrated polyps.


      To perform a proof-of-principle study assessing the accuracy of narrow-band imaging with near focus in predicting polyp histology including serrated polyps and to determine whether the minimum requirements can be achieved for a resect-and-discard policy.


      Dual-center, prospective case series.


      Two tertiary-care referral endoscopic centers in Australia.


      Two hundred consecutive patients undergoing colonoscopy for routine indications were recruited.


      Any polyps identified were assessed by using standard white light followed by narrow-band imaging with near focus for Kudo pit patterns and modified Sano capillary patterns. Based on this assessment and the macroscopic appearance, the polyp histology was predicted and subsequently compared with histopathology results.

      Main Outcome Measurements

      Correlation in postpolypectomy surveillance intervals between endoscopic and pathologic assessments as well as negative predictive value for rectosigmoid hyperplastic polyps.


      There was a 96% agreement for surveillance intervals between endoscopic assessment and histology by using the American Society for Gastrointestinal Endoscopy guidelines. There was a 96% negative predictive value in assessing rectosigmoid hyperplastic polyps.


      Because this was a proof-of-principle study, there was no control arm, and there were small numbers, especially in assessing subgroups. The results have limited generalizability with the training requirements for polyp recognition, with confidence to be determined.


      Narrow-band imaging with near focus can predict polyp histology (including serrated polyps) accurately in the hands of trained endoscopists. Further studies with larger numbers are required to further validate this practice.


      ASGE (American Society for Gastrointestinal Endoscopy), ESGE (European Society for Gastrointestinal Endoscopy), NBI (narrow-band imaging), NF (near focus), NHMRC (National Health and Medical Research Council), NPV (negative predictive value), PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations), PPV (positive predictive value), SSA (sessile serrated adenoma)
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        • Ferlay J.
        • Shin H.R.
        • Bray F.
        • et al.
        Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.
        Int J Cancer. 2010; 127: 2893-2917
        • Jemal A.
        • Center M.M.
        • DeSantis C.
        • et al.
        Global patterns of cancer incidence and mortality rates and trends.
        Cancer Epidemiol Biomarkers Prev. 2010; 19: 1893-1907
        • Jemal A.
        • Siegel R.
        • Ward E.
        • et al.
        Cancer statistics, 2006.
        CA Cancer J Clin. 2006; 56: 106-130
        • Allen J.I.
        Molecular biology of colon polyps and colon cancer.
        Semin Surg Oncol. 1995; 11: 399-405
        • Carethers J.M.
        The cellular and molecular pathogenesis of colorectal cancer.
        Gastroenterol Clin North Am. 1996; 25: 737-754
        • Winawer S.J.
        • Zauber A.G.
        • Ho M.N.
        • et al.
        Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.
        N England J Med. 1993; 329: 1977-1981
        • Zauber A.G.
        • Winawer S.J.
        • O'Brien M.J.
        • et al.
        Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.
        N England J Med. 2012; 366: 687-696
        • Rex D.K.
        • Kahi C.
        • O'Brien M.
        • et al.
        The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps.
        Gastrointest Endosc. 2011; 73: 419-422
        • Ladabaum U.
        • Fioritto A.
        • Mitani A.
        • et al.
        Real-time optical biopsy of colon polyps with narrow band imaging in community practice does not yet meet key thresholds for clinical decisions.
        Gastroenterology. 2013; 144: 81-91
        • Yoshida N.
        • Naito Y.
        • Kugai M.
        • et al.
        Efficacy of magnifying endoscopy with flexible spectral imaging color enhancement in the diagnosis of colorectal tumors.
        J Gastroenterol. 2011; 46: 65-72
        • Wanders L.K.
        • East J.E.
        • Uitentuis S.E.
        • 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
        • Repici A.
        • Hassan C.
        • Radaelli F.
        • et al.
        Accuracy of narrow-band imaging in predicting colonoscopy surveillance intervals and histology of distal diminutive polyps: results from a multicenter, prospective trial.
        Gastrointest Endosc. 2013; 78: 106-114
        • Pohl J.
        • Nguyen-Tat M.
        • Pech O.
        • et al.
        Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study.
        Am J Gastroenterol. 2008; 103: 562-569
        • Pigo F.
        • Bertani H.
        • Manno M.
        • et al.
        i-Scan high-definition white light endoscopy and colorectal polyps: prediction of histology, interobserver and intraobserver agreement.
        Int J Colorectal Dis. 2013; 28: 399-406
        • McGill S.K.
        • Evangelou E.
        • Ioannidis J.P.
        • et al.
        Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics.
        Gut. 2013; 62: 1704-1713
        • Leggett B.
        • Whitehall V.
        Role of the serrated pathway in colorectal cancer pathogenesis.
        Gastroenterology. 2010; 138: 2088-2100
        • Hazewinkel Y.
        • Lopez-Ceron M.
        • East J.E.
        • 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
        • Rex D.K.
        • Ahnen D.J.
        • Baron J.A.
        • et al.
        Serrated lesions of the colorectum: review and recommendations from an expert panel.
        Am J Gastroenterol. 2012; 107 (quiz 4, 30): 1315-1329
        • Tadepalli U.S.
        • Feihel D.
        • Miller K.M.
        • et al.
        A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video).
        Gastrointest Endosc. 2011; 74: 1360-1368
        • Kudo S.
        • Hirota S.
        • Nakajima T.
        • et al.
        Colorectal tumours and pit pattern.
        J Clin Pathol. 1994; 47: 880-885
        • Sano Y.
        • Ikematsu H.
        • Fu K.I.
        • et al.
        Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps.
        Gastrointest Endosc. 2009; 69: 278-283
        • Lieberman D.A.
        • Rex D.K.
        • Winawer S.J.
        • et al.
        Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.
        Gastroenterology. 2012; 143: 844-857
        • Hassan C.
        • Quintero E.
        • Dumonceau J.M.
        • et al.
        Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.
        Endoscopy. 2013; 45: 842-851
        • Cancer Council Australia Colonoscopy Surveillance Working Party
        Clinical Practice Guidelines for Surveillance Colonoscopy—in adenoma follow-up; following curative resection of colorectal cancer; and for cancer surveillance in inflammatory bowel disease.
        Cancer Council Australia, Sydney2011
        • Kim Y.S.
        • Kim D.
        • Chung S.J.
        • et al.
        Differentiating small polyp histologies using real-time screening colonoscopy with Fuji Intelligent Color Enhancement.
        Clinical Gastroenterology & Hepatology. 2011; 9: 744-749.e1
        • Salazar Muente F.
        • Barreda Costa C.
        • Barriga Briceno J.A.
        Utility of the capilar pattern in the NBI diagnosis of superficial lesions of the colon: prospective validation in a private endoscopic center Lima, Peru.
        Revista de Gastroenterologia del Peru. 2012; 32: 281-289
        • Singh R.
        • Jayanna M.
        • Navadgi S.
        • et al.
        Narrow-band imaging with dual focus magnification in differentiating colorectal neoplasia.
        Dig Endosc. 2013; 25: 16-20
        • Vu H.T.
        • Sayuk G.S.
        • Hollander T.G.
        • et al.
        Resect and discard approach to colon polyps: real-world applicability among academic and community gastroenterologists.
        Dig Dis Sci. 2015; 60: 502-508
        • Basford P.J.
        • Longcroft-Wheaton G.
        • Higgins B.
        • et al.
        High-definition endoscopy with i-Scan for evaluation of small colon polyps: the HiSCOPE study.
        Gastrointest Endosc. 2014; 79: 111-118
        • Patel S.G.
        • Rastogi A.
        • Austin G.
        • et al.
        Gastroenterology trainees can easily learn histologic characterization of diminutive colorectal polyps with narrow band imaging.
        Clin Gastroenterol Hepatol. 2013; 11: 997-1003.e1
        • Neumann H.
        • Vieth M.
        • Fry L.C.
        • et al.
        Learning curve of virtual chromoendoscopy for the prediction of hyperplastic and adenomatous colorectal lesions: a prospective 2-center study.
        Gastrointest Endosc. 2013; 78: 115-120
        • Bouwens M.W.
        • de Ridder R.
        • Masclee A.A.
        • et al.
        Optical diagnosis of colorectal polyps using high-definition i-scan: an educational experience.
        World J Gastroenterol. 2013; 19: 4334-4343