Comparison of different virtual chromoendoscopy classification systems for the characterization of colorectal lesions

Abstract

Background and Aim: Commonly used classifications for colorectal lesions (CLs) include the Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Japan NBI Expert Team (JNET) classifications. However, both lack a sessile serrated adenoma/polyp (SSA/P) category. This has been addressed by the modified Sano's (MS) and Workgroup serrAted polypS and Polyposis (WASP) classifications. This study aims to compare the accuracy of wNICE and wJNET (WASP added to both) with the stand-alone MS classification. Methods: Patients undergoing colonoscopy at an Australian tertiary hospital who had at least one CL detected were prospectively enrolled. In the exploratory phase, CLs were characterized in real time with NBI and magnification using all classifications. In the validation phase, CLs were assessed with both NBI and Blue Laser Imaging (BLI) by four external endoscopists in Japan. The primary outcome was the comparison of wJNET and MS. Secondary outcomes included comparisons among all classifications and the calculation of interrater reliability. Results: A total of 483 CLs were evaluated in real time in the exploratory phase, and four sets of 30 CL images (80 on NBI and 40 on BLI) were scored in the validation phase. For high-confidence diagnoses, MS accuracy was superior to wJNET in both the exploratory (86% vs 79%, P < 0.05) and validation (85% vs 69%, P < 0.05) phases. The interrater reliability was substantial for all classifications (κ = 0.74, 0.69, and 0.63 for wNICE, wJNET, and MS, respectively). Conclusions: MS classification achieved the highest accuracy in both the exploratory and validation phases. MS can differentiate serrated and adenomatous polyps as a stand-alone classification.

Impact of narrow-band imaging in prediction of histology of colorectal neoplasia: a prospective study

“…Thirdly, although JNET appears to be clinically useful for selectively diagnosing HGD or super cial T1 carcinoma, JNET 2B exhibits low sensitivity (56.6%) and low PPV (57.7%) [26][27][28][29][30]. This is likely due to including various histological features within this group.…”

External validation of blue light imaging (BLI) criteria for the optical characterization of colorectal polyps by endoscopy experts

“…The role of BLI will continue to evolve with more studies [10][11][12] showing that many of validated classifications using NBI can still be used with ease and reliability in real world. This would help endoscopists embrace novel imaging modalities like BLI for accurate polyp diagnosis as well as characterization to distinguish it into those with serrated features, dysplasia, and submucosal invasion.…”

Optical imaging technologies in endoscopic diagnosis of colon tumors

“…В связи с тем, что наиболее ранней и распространенной является система NBI, с ее использованием выполнено большее количество исследований, и первые эндоскопические классификации, использующие виртуальную хромоскопию, основаны именно на оценке изображений, полученных с помощью NBI. Это относится к таким широко известным классификациям, как NICE, JNET и WASP [28]. Поскольку альтернативные NBI методы виртуальной хромоскопии существуют более 10 лет, то многие коллективы авторов уже доказали, что эти классификации могут применяться в комбинации с любым из методов виртуальной хромоскопии любой фирмыпроизводителя эндоскопического оборудования и позволяют максимально достоверно определять тип выявленной неоплазии и определять тактику лечения [29,30].…”