Clinical impact and characteristics of the narrow-band imaging magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team

Sumimoto, Kazuo; Tanaka, Shinji; Shigita, Kenjiro; Hirano, Daiki; Tamaru, Yuzuru; Ninomiya, Yuki; Asayama, Naoki; Hayashi, Nana; Arihiro, Koji; Yoshihara, Masaharu; Chayama, Kazuaki

doi:10.1016/j.gie.2016.07.035

Cited by 131 publications

(120 citation statements)

References 65 publications

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“…Consistent with a previous report by Sumimoto et al [14] , the sensitivity, specificity, PPV, NPV, and accuracy of the JNET Type 1 classification were satisfactory. These parameters were similarly high for JNET Type 2A, suggesting that HP-SSP and LGD lesions can be accurately diagnosed using the JNET classification alone.…”

Section: Discussionsupporting

confidence: 91%

Magnifying Narrow Band Imaging (NBI) for the Diagnosis of Localized Colorectal Lesions Using the Japan NBI Expert Team (JNET) Classification

Komeda¹,

Kashida²,

Sakurai³

et al. 2017

Oncology

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were compared with the final pathological diagnoses to determine the JNET classification's accuracy. The interobserver agreement was calculated, and the intraobserver agreement was assessed after 6 months. Results: The final pathological diagnoses identified 14 HPs/SSPs, 127 LGDs, 22 HGDs, 19 SM-s carcinomas, and 17 SM-d carcinomas. The respective sensitivities, specificities, positive predictive value, negative predictive value, and accuracies were as follows: Type 1, 85.7, 99.5, 92.3, 98.9, and 98.5%; Type 2A, 96.0, 81.9, 90.3, 92.1, and 90.9%; Type 2B, 75.6%, 90.5, 67.3, 93.4, and 87.4%; and Type 3, 29.4%, 100, 100, 93.8, and 94.0%. The interobserver agreement and the intraobserver agreement were moderate (κ value: 0.52) and excellent (κ value: 0.88), respectively. Lesions presenting as Type 2B during NBI comprised a range of colorectal tumors, including HGDs, SM-s, and SM-d. Conclusions: The JNET classification was useful for the diagnosis of HPs/SSPs, LGDs, and SM-d, but not SM-s lesions. For low-confidence cases, magnified chromoendoscopy is recommended to ensure correct diagnoses. In this classification system, types 1, 2A, 2B, and 3 correspond to hyperplastic polyps (HPs) including sessile serrated polyps (SSPs), low-grade dysplasia (LGD), high-grade dysplasia (HGD) to shallow submucosal invasive (SM-s) carcinomas, and deep submucosal invasive (SM-d) carcinomas, respectively. Methods: To validate this system, we performed a retrospective image evaluation study, in which 199 colorectal tumors previously assessed by NBI magnifying endoscopy were classified by 3 blinded experienced colonoscopists using the JNET system. The results

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Section: Discussionsupporting

confidence: 91%

Magnifying Narrow Band Imaging (NBI) for the Diagnosis of Localized Colorectal Lesions Using the Japan NBI Expert Team (JNET) Classification

Komeda¹,

Kashida²,

Sakurai³

et al. 2017

Oncology

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“…Although the incidence of muscularis mucosa residue with CSDP was similar to previous reports and significantly higher than that without CSDP, we believe that a 57% incomplete mucosal layer resection rate is still considerably high. 12,13 In our study, we included JNET type 2A lesions, which are suspected low-grade adenomas, and 6% of the lesions were high-grade adenomas. A previous study reported that the loss of muscularis mucosa was seen in 27.8% in CSP specimens, and it correlated with positive histological margins.…”

Section: Discussionmentioning

confidence: 99%

“…The location, size, macroscopic type, and Japan Narrow-band imaging Expert Team (JNET) classification 12,13 were documented for all polyps. After split-dose bowel preparation 11 , colonoscopy was performed by one of 19 experienced colonoscopists (seven experts and 12 senior residents), using a magnifying colonoscope (EVIS CF-H260AZI, HQ290, or PCF-Q260AZI; Olympus, Co., Ltd., Tokyo, Japan).…”

Section: Methodsmentioning

confidence: 99%

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

Shichijo

Takeuchi

Kitamura

et al. 2019

J of Gastro and Hepatol

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Background and Aim The true incidence of incomplete muscularis mucosa resection with cold snare polypectomy (CSP) is unknown. We examined the incidence of incomplete muscularis mucosa resection both with and without cold snare defect protrusion (CSDP). Methods We prospectively enrolled patients undergoing polypectomy for 4 to 9mm nonpedunculated polyps. We evaluated the presence of CSDP immediately following CSP and biopsied the CSDP or the center of the mucosal defect without CSDP. The presence of the muscularis mucosa and any residual polyp in the biopsies was evaluated histologically. The primary outcome was the incidence of incomplete mucosal layer resection defined as the presence of muscularis mucosa or residual polyp in the biopsies. Results From August 2017 to October 2018, 188 patients were screened, and 357 polyps were included. CSDP was detected in 122/355 (34%) evaluated mucosal defects. Excluding five lesions requiring hemostasis immediately following CSP, 352 mucosal defects were biopsied. After excluding 102 biopsies containing normal mucosa, we evaluated 250 biopsies. The overall incidence of incomplete mucosal layer resection was 63% (159/250), 76% (68/90) with CSDP and 57% (91/159) without CSDP (P < 0.01). Both univariate and multivariate analyses showed that size (≥ 6 mm), resection time (≥ 5 s), and serrated lesions were risk factors for CSDP. Conclusions Cold snare defect protrusion (CSDP), which was present with 36%, was a good indicator for incomplete mucosal layer resection. Even in nonCSDP polypectomies, 57% of the mucosal layer was not removed completely. Thus, CSP should be used for intra‐epithelial lesions only, and careful pretreatment evaluation is recommended.

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“…These results cannot be generalized to blue‐light laser imaging (BLI) and other classifications systems such as BASIC (BLI Adenoma Serrated International Classification) . We have not used the NBI Expert Team (JNET) classification which has been demonstrated to characterize polyps using magnification with high accuracy . However, optical zoom magnifying endoscopes are not widely used in clinical practice in Western countries.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled study of the prediction of diminutive/small colorectal polyp histology using didactic versus computer‐based self‐learning module in gastroenterology trainees

Smith

Saltzman

Shivaji

et al. 2019

Digestive Endoscopy

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Background and Aim The aim of this randomized trial was to evaluate the performance of self‐training versus didactic training in order to increase the diagnostic accuracy of diminutive/small colonic polyp histological prediction by trainees. Methods Sixteen trainees reviewed 78 videos (48 iSCAN‐OE and 30 NBI) of diminutive/small polyps in a pretraining assessment. Trainees were randomized to receive computer‐based self‐learning (n = 8) or didactic training (n = 8) using identical teaching materials and videos. The same 78 videos, in a different randomized order, were assessed. The NICE (NBI International Colorectal Endoscopic) and SIMPLE (Simplified Identification Method for Polyp Labeling during Endoscopy) classification systems were used to classify diminutive/small polyps. Results A higher proportion of high‐confidence predictions of polyps was made by the self‐training group versus the didactic group using both the SIMPLE classification (77.1% [95% CI 73.4–80.3] vs 69.9% [95% CI 66.1–73.5%] [P = 0.005]) and the NICE classification (77% [95% CI 73.2–80.4%] vs 69.8% [95% CI 66–73.4%] [P = 0.006]). When using NICE, sensitivity of the self‐training group compared with the didactic group was 72% versus 83% (P = 0.0005), and the accuracy was 66.1% versus 69.1%. The training improved the confidence of participants and SIMPLE was preferred over NICE. Conclusion Self‐learning for the prediction of diminutive/small polyp histology is a method of training that can achieve results similar to didactic training. Availability of adequate self‐learning teaching modules could enable widespread implementation of optical diagnosis in clinical practice.

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Clinical impact and characteristics of the narrow-band imaging magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team

Cited by 131 publications

References 65 publications

Magnifying Narrow Band Imaging (NBI) for the Diagnosis of Localized Colorectal Lesions Using the Japan NBI Expert Team (JNET) Classification

Magnifying Narrow Band Imaging (NBI) for the Diagnosis of Localized Colorectal Lesions Using the Japan NBI Expert Team (JNET) Classification

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

Randomized controlled study of the prediction of diminutive/small colorectal polyp histology using didactic versus computer‐based self‐learning module in gastroenterology trainees

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