Diagnostic performance of Japan NBI Expert Team classification for differentiation among noninvasive, superficially invasive, and deeply invasive colorectal neoplasia

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

doi:10.1016/j.gie.2017.02.018

Cited by 60 publications

(67 citation statements)

References 46 publications

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“…However, we can observe detailed microsurface and microvascular structures using magnified endoscopic examination with image‐enhanced endoscopy (IEE‐ME). IEE‐ME enables approximately 100‐fold real‐time magnification, and its effectiveness in the diagnosis of various gastrointestinal tract disorders has been reported …”

Section: Introductionmentioning

confidence: 99%

How I do it: Endoscopic diagnosis for superficial non‐ampullary duodenal epithelial tumors

Nakayama

Kato

Takatori

et al. 2019

Digestive Endoscopy

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There are no reports on detailed endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors (SNADET) except for relatively small case series. Herein, we conducted a prospective observational study to investigate the relationship between endoscopic findings and histopathological diagnosis of SNADET. A total of 163 SNADET diagnosed using magnified endoscopic examination with image‐enhanced endoscopy (IEE‐ME) were prospectively registered in this study. We investigated location, size, macroscopic type, color, and IEE‐ME findings including surface structure (closed‐ or open‐loop) and presence of white opaque substance (WOS) in SNADET. We analyzed association between these findings and histopathological diagnosis of SNADET based on the Vienna classification (VCL) using logistic regression analysis. In univariate analysis, lesion size, superficial structure, and WOS deposition showed statistical significance, and the oral side of the lesion location showed statistical tendency for association with VCL C4/5. In multivariate analysis, lesion size (odds ratio [OR], 2.92; 95% CI, 1.94–4.39; P < 0.05) and negative WOS (OR, 5.59; 95% CI, 1.72–18.1; P < 0.05) were significantly associated with VCL C4/5 lesions. Superficial structures with a closed‐loop pattern on the surface showed statistical tendency for predicting VCL C4/5 lesions (OR, 2.15; 95% CI, 0.86–5.37; P = 0.10). Based on these findings, we concluded that negative WOS by IEE‐ME and lesion size were independent predictors of VCL C4/5 SNADET. These factors may help us to understand of pathophysiology of SNADET and to select appropriate therapeutic strategies.

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Section: Introductionmentioning

confidence: 99%

How I do it: Endoscopic diagnosis for superficial non‐ampullary duodenal epithelial tumors

Nakayama

Kato

Takatori

et al. 2019

Digestive Endoscopy

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“…Although the usefulness of the JNETclassification has been shown in several studies, the validity of the system has been tested by colonoscopy experts only. [10][11][12] As experts may intuitively judge the nature of polyps based on general impressions of the images or on other factors unrelated to the JNET classification components, the validity should be tested by non-gastroenterologists who are not familiar with colorectal polyps. The clarity and simplicity of the JNET classification system and how easily it can be adopted by trainees may also be determined based on evaluations by non-gastroenterologists.…”

Section: Introductionmentioning

confidence: 99%

Objective validity of the Japan Narrow‐Band Imaging Expert Team classification system for the differential diagnosis of colorectal polyps

Minoda

Ogino

Chinen

et al. 2019

Digestive Endoscopy

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Background and Aim The Japan Narrow‐Band Imaging (NBI) Expert Team (JNET) classification is a recently proposed NBI magnifying endoscopy‐based classification system for colorectal tumors. Although the usefulness of this system has been reported by JNET experts, its objective validity remains unclear. We tested its validity and usefulness for the diagnosis of colorectal polyps by including colonoscopy experts and non‐experts as test participants. Methods Forty NBI images of polyps of various JNET types were shown to 22 doctors (11 experts and 11 non‐gastrointestinal [GI] trainees) who had not examined the patients. The doctors diagnosed the polyps based solely on the surface and vessel patterns in the magnified images and the JNET classification system. Concordance rates of their diagnoses with the pathological findings of the polyps were determined, and the results for experts and non‐GI trainees were compared. Results Both for colonoscopy experts and non‐GI trainees, the JNET classification system was particularly useful for classifying polyps as benign or malignant. Although the accuracy rates for classifying polyps into each JNET type varied among colonoscopy experts, those who were familiar with the JNET classification system were able to diagnose polyps with approximately 90% accuracy. Common mistakes were attributable to misunderstandings of the wording in the JNET classification chart and lack of proper training. Conclusion The JNET classification system is a practical approach for the diagnosis of colorectal polyps. Training is required even for experienced colonoscopists to adopt the system properly. Common pitfalls must be shared among colonoscopists to improve the accuracy of the diagnosis.

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“…Recently, the Japan NBI Expert Team classification system based on magnified NBI was established for diagnosis of colorectal lesions including submucosal invasive cancers [16-18]. Our simplified NBI classification system can be utilized in the setting of screening colonoscopy; however, more detailed observation using magnified NBI would be necessary to evaluate SSPs and to predict invasion depth of advanced lesions.…”

Section: Discussionmentioning

confidence: 99%

A Web-Based Education Program for Colorectal Lesion Diagnosis with Narrow Band Imaging Classification

Aihara

Kumar

Thompson³

2018

Digestion

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Background: An education system for narrow band imaging (NBI) interpretation requires sufficient exposure to key features. However, access to didactic lectures by experienced teachers is limited in the United States. Aim: To develop and assess the effectiveness of a colorectal lesion identification tutorial. Methods: In the image analysis pretest, subjects including 9 experts and 8 trainees interpreted 50 white light (WL) and 50 NBI images of colorectal lesions. Results were not reviewed with subjects. Trainees then participated in an online tutorial emphasizing NBI interpretation in colorectal lesion analysis. A post-test was administered and diagnostic yields were compared to pre-education diagnostic yields. Results: Under the NBI mode, experts showed higher diagnostic yields (sensitivity 91.5% [87.3–94.4], specificity 90.6% [85.1–94.2], and accuracy 91.1% [88.5–93.7] with substantial interobserver agreement [κ value 0.71]) compared to trainees (sensitivity 89.6% [84.8–93.0], specificity 80.6% [73.5–86.3], and accuracy 86.0% [82.6–89.2], with substantial interobserver agreement [κ value 0.69]). The online tutorial improved the diagnostic yields of trainees to the equivalent level of experts (sensitivity 94.1% [90.0–96.6], specificity 89.0% [83.0–93.2], and accuracy 92.0% [89.3–94.7], p < 0.001 with substantial interobserver agreement [κ value 0.78]). Conclusions: This short, online tutorial improved diagnostic performance and interobserver agreement.

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Diagnostic performance of Japan NBI Expert Team classification for differentiation among noninvasive, superficially invasive, and deeply invasive colorectal neoplasia

Cited by 60 publications

References 46 publications

How I do it: Endoscopic diagnosis for superficial non‐ampullary duodenal epithelial tumors

How I do it: Endoscopic diagnosis for superficial non‐ampullary duodenal epithelial tumors

Objective validity of the Japan Narrow‐Band Imaging Expert Team classification system for the differential diagnosis of colorectal polyps

A Web-Based Education Program for Colorectal Lesion Diagnosis with Narrow Band Imaging Classification

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