Accuracy of in vivo colorectal polyp discrimination by using dual-focus high-definition narrow-band imaging colonoscopy

Wallace, Michael B.; Crook, Julia E.; Coe, Susan G.; Ussui, Vivian; Staggs, Estela G.; Almansa, Cristina; Patel, Mihir; Bouras, Ernest P.; Cangemi, John R.; Keaveny, Andrew P.; Picco, M.F.; Riegert–Johnson, Douglas L.

doi:10.1016/j.gie.2014.05.305

Cited by 47 publications

(43 citation statements)

References 22 publications

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“…This is unlikely to significantly impact results, given that the type of endoscope used was not changed for the duration of the study and endoscope model was not found to be a predictor of performance in the multivariate analysis. In addition, earlier studies 35,36 have shown no difference in NBI diagnoses between 180 and 190 series colonoscopes. All sites had pathology reviewed by a fellowship-trained gastrointestinal pathologist, however, pathology review was not centralized among the 4 institutions.…”

Section: Discussionmentioning

confidence: 77%

Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy

et al. 2016

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BACKGROUND & AIMS Narrow-band imaging (NBI) allows real-time histologic classification of colorectal polyps. We investigated whether endoscopists without prior training in NBI can achieve the following thresholds recommended by the American Society for Gastrointestinal Endoscopy: for diminutive colorectal polyps characterized with high confidence, a ≥90% negative predictive value for adenomas in the rectosigmoid and a ≥90% agreement in surveillance intervals. METHODS Twenty-six endoscopists from 2 tertiary care centers underwent standardized training in NBI interpretation. Endoscopists made real-time predictions of diminutive colorectal polyp histology and surveillance interval predictions based on NBI. Their performance was evaluated by comparing predicted with actual findings from histologic analysis. Multilevel logistic regression was used to assess predictors of performance. Cumulative summation analysis was used to characterize learning curves. RESULTS The endoscopists performed 1451 colonoscopies and made 3012 diminutive polyp predictions (74.3% high confidence) using NBI. They made 898 immediate post-procedure surveillance interval predictions. An additional 505 surveillance intervals were determined with histology input. The overall negative predictive value for high-confidence characterizations in the rectosigmoid was 94.7% (95% confidence interval: 92.6%–96.8%) and the surveillance interval agreement was 91.2% (95% confidence interval: 89.7%–92.7%). Overall, 97.0% of surveillance interval predictions would have brought patients back on time or early. High-confidence characterization was the strongest predictor of accuracy (odds ratio = 3.42; 95% confidence interval: 2.72–4.29; P < .001). Performance improved over time, however, according to cumulative summation analysis, only 7 participants (26.9%) identified adenomas with sufficient sensitivity such that further auditing is not required. CONCLUSIONS With standardized training, gastroenterologists without prior expertise in NBI were able to meet the negative predictive value and surveillance interval thresholds set forth by the American Society for Gastrointestinal Endoscopy. The majority of disagreement in surveillance interval brought patients back early. Performance improves with time, but most endoscopists will require ongoing auditing of performance.

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Section: Discussionmentioning

confidence: 77%

Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy

et al. 2016

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“…Hence, one cannot be certain if the superiority of bNBI in finding adenomas was not a result of a “brighter processor”. In another study by Wallace et al[26], average risk subjects presenting for screening were randomised to receive the examination by a standard colonoscope (H180) or a dual focus colonoscope (HQ-190). ADR were similar between both groups (52% vs 50%).…”

Section: Discussionmentioning

confidence: 99%

Multicenter randomised controlled trial comparing the high definition white light endoscopy and the bright narrow band imaging for colon polyps

Singh¹,

Cheong²,

Pu³

et al. 2017

WJGE

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AIMTo compare high definition white light endoscopy and bright narrow band imaging for colon polyps’ detection rates.METHODSPatients were randomised to high definition white light endoscopy (HD-WLE) or the bright narrow band imaging (bNBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using bNBI with dual focus (bNBI-DF) according to the Sano’s classification. The primary outcome was to compare adenoma detection rates (ADRs) between the two arms. The secondary outcome was to assess the negative predictive value (NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.RESULTSA total of 1006 patients were randomised to HD-WLE (n = 511) or bNBI (n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in bNBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time (OR = 1.19, 95%CI: 1.15-1.24, P < 0.001), the use of bNBI was associated with a reduced ADR (OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps (86%) in both arms were predicted with high confidence. The sensitivity (Sn), specificity (Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using bNBI-DF for diminutive rectal polyps was 91.0%.CONCLUSIONADRs did not differ between bNBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. bNBI surpassed the PIVI threshold for diminutive polyps.

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“…[7][8][9][10][11][12]15,18,20,26 The pooled percentage of agreement using the random-effects model was 89% (95% CI, 85-93) (Fig. 6).…”

Section: Meta-analysis Of Nbi Studies Evaluating Npv For Adenomatous mentioning

confidence: 97%

“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] These studies collectively evaluated 4013 in situ small or diminutive colorectal polyps in real-time by using NBI and compared it with criterion standard histopathology. The median prevalence of adenomas among these polyps was 48.5% (range 18%-88%).…”

Section: Meta-analysis Of Nbi Studies Evaluating Npv For Adenomatous mentioning

confidence: 99%

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

Dayyeh¹,

Thosani²,

Konda³

et al. 2015

Gastrointestinal Endoscopy

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Accuracy of in vivo colorectal polyp discrimination by using dual-focus high-definition narrow-band imaging colonoscopy

Cited by 47 publications

References 22 publications

Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy

Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy

Multicenter randomised controlled trial comparing the high definition white light endoscopy and the bright narrow band imaging for colon polyps

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

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