Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics

McGill, Sarah; Εvangelou, Εvangelos; Ioannidis, John P. A.; Soetikno, Roy; Kaltenbach, Tonya

doi:10.1136/gutjnl-2012-303965

Cited by 155 publications

(114 citation statements)

References 82 publications

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“…However, the requirement for a post-polypectomy histological assessment leads to a substantial exploitation of medical and economic resources (32). In recent years, a 'resect and discard' strategy based on the findings of image-enhanced endoscopy (e.g., high-definition endoscopy, magnifying endoscopy and chromoendoscopy) for diminutive colorectal polyps has been proposed to save both the time and cost of histopathology (33)(34)(35)(36). However, there are several barriers to applying this strategy in the clinical practice of the present authors.…”

Section: Patient Age ------------------------------------------------mentioning

confidence: 99%

Clinical, endoscopic and pathological characteristics of colorectal polyps in elderly patients: Single-center experience

Zhou

Zhang

Sun

et al. 2017

Molecular and Clinical Oncology

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Abstract. Increasing age is a risk factor for the development of colorectal adenomas and advanced adenomas. However, few studies have been published on the features of colorectal polyps in the elderly. The present study aimed to investigate the clinical, enteroscopic and pathological characteristics of colorectal polyps in Chinese elderly patients in a single center (The Central Hospital of Wuhan, Hubei, China). The endoscopic and pathological reports of colonoscopies performed in our center were retrospectively analyzed. A total of 7,795 consecutive patients referred for colonoscopy were evaluated between January 2013 and December 2014. Of the 297 who met the inclusion criteria, 279 polyps were observed in men and 230 in women. Of all the polyps, 263 were non-adenomatous polyps, 104 were non-advanced adenomas and 142 were advanced adenomas. 336 polyps were left-sided and 173 were right-sided. Polyps ≥10 mm were more likely to exhibit an adenomatous component and advanced features, and these findings continued to hold true when the size cut-off was set at 5 mm. The data shown in the present study have revealed that a significant number of polyps lie proximal to the splenic flexure. Thus, evaluation of the whole bowel is particularly important in elderly patients who are undergoing colonoscopy. In addition, the polyp size was associated with the presence of adenoma, and advanced component, diminutive and small polyps should not be ignored in elderly patients.

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Section: Patient Age ------------------------------------------------mentioning

confidence: 99%

Clinical, endoscopic and pathological characteristics of colorectal polyps in elderly patients: Single-center experience

Zhou

Zhang

Sun

et al. 2017

Molecular and Clinical Oncology

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“…A meta-analysis of 28 studies including 6280 polyps, conducted in 2013, revealed an overall sensitivity of 91% and a specificity of 82%. The concordance of the endoscopic surveillance interval based on real-time prediction, correlated with the pathological assessment, is 92,6% [6].…”

Section: Discussionmentioning

confidence: 94%

The Assessment of the Colo-rectal Polyps in Order to the New Diagnostic and Therapeutic Strategies

Raluca

Brusnic

Gabos

et al. 2015

Acta Medica Marisiensis

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Objective. Assessment of the histological and endoscopic features of the colo-rectal polyps is requered for the application of the new diagnostic and therapeutical strategies in the managment of the diminutive polyps. Methods. This paper is a descriptive retrospective study on 52 pacients reffered for colonoscopy in Gastroenterology Clinic -Clinical County Hospital Targu Mures from January until September 2014. 80 polyps were assessed. Narrow band imaging examination targeted on the protrusive lezions allowed NICE (Narrow Band Imaging International Colorectal Endoscopic) classification and corroboration of the histology prediction and pathological assessment. Results. Polyp detection rate was 48,58%, given the quality of bowel preparation in hospital fair in 84,5%.The predominant histological type was the tubular adenoma (46,25%), and 40% of the polyps were located in the sigmoid. Among the diminutive polyps, 58,33% were hyperplastic(p<0,0001), mainly in the recto-sigmoid (66,67%); the incidence of high grade displasia or cancer was 0. Real -time prediction of the histology of the colorectal polyps using NBI established: NICE 1: 19 polpyps, histology-16 hyperplastic, (p<0,0001, sensitivity: 100%, specificity: 95%), NICE 2: 59 polyps, histology-53 adenomatous, (p<0,0001, sensitivity: 96%, specificity: 76% ), NICE 3: 2 polyps-histologycancer. Conclusions. We did not observe any distribution pattern in the topography of the diminutive polyps. Histologicaly the predominant type was the hyperplastic type. NBI was accurate in real-time prediction of the histology of the colo-rectal polyps. The results are relevant for application of the new strategies in the managment of the diminutive polyps. Introduction Colo-rectal cancer remains the second leading cause of cancer death in developed countries. Detection of preneoplastic lesions in endoscopic surveillance and screening programs and their removal has reduced the number of cancers (by disrupting the sequence adenoma-carcinoma) and improved the prognosis of these patients [1]. Most of the colorectal tumors develop from preexisting adenomas. Polyps are detected in 40% of the screening colonoscopies and 80% of the polyps less than 1 cm are diminutive lesions <5 mm [1].The pathological assessment of all colorectal lesions was considered in the last decades the essential examination leading to the therapeutic attitude [2], setting postpolipectomy colonoscopy surveillance period.The possibility of real-time prediction of the histology of the colorectal polyps by advanced endoscopic techniquesnarrow band imaging(NBI) led to the recommendation of a differentiated management of the diminutive polyps <5 mm detected during colonoscopy. "Predict-do not resect" strategy has been proposed for recto-sigmoid hyperplastic diminutive lesions, while "predict-resect-discard" strategy has been proposed for diminutive polyps proximal to the sigmoid [3].

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“…41 Previously published meta-analyses of VCE for optical diagnosis of colorectal polyps have also used a bivariate model to estimate pooled sensitivity and specificity. [42][43][44] We conducted separate meta-analyses for the each of the three VCE technologies relevant to this report compared with histopathology. For each technology we produced individual meta-analyses according to the level of confidence with which the polyp characterisation had been made by the endoscopist in accordance with how the data were reported in the primary studies (high-confidence predictions; all predictions irrespective of confidence level).…”

Section: Methods Of Data Synthesismentioning

confidence: 99%

“…[42][43][44]149 For example, the ASGE Technology Committee conducted a systematic review to examine whether NBI, i-scan or FICE met the PIVI performance thresholds and, therefore, whether or not the evidence supported a 'diagnosis-and-leave' approach (ASGE Technology Committee, 2015, p. 1). 149 Literature searches were done on a number of standard health research databases, up to May 2014 (thus the search is around 2 years older than our literature search).…”

Section: Doi: 103310/hta21790 Health Technology Assessment 2017 Volmentioning

confidence: 99%

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

Picot

Rose

Cooper

et al. 2017

Health Technol Assess

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BackgroundCurrent clinical practice is to remove a colorectal polyp detected during colonoscopy and determine whether it is an adenoma or hyperplastic by histopathology. Identifying adenomas is important because they may eventually become cancerous if untreated, whereas hyperplastic polyps do not usually develop into cancer, and a surveillance interval is set based on the number and size of adenomas found. Virtual chromoendoscopy (VCE) (an electronic endoscopic imaging technique) could be used by the endoscopist under strictly controlled conditions for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of the VCE technologies narrow-band imaging (NBI), flexible spectral imaging colour enhancement (FICE) and i-scan for the characterisation and management of diminutive (≤ 5 mm) colorectal polyps using high-definition (HD) systems without magnification.DesignSystematic review and economic analysis.ParticipantsPeople undergoing colonoscopy for screening or surveillance or to investigate symptoms suggestive of colorectal cancer.InterventionsNBI, FICE and i-scan.Main outcome measuresDiagnostic accuracy, recommended surveillance intervals, health-related quality of life (HRQoL), adverse effects, incidence of colorectal cancer, mortality and cost-effectiveness of VCE compared with histopathology.Data sourcesElectronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and Database of Abstracts of Reviews of Effects were searched for published English-language studies from inception to June 2016. Bibliographies of related papers, systematic reviews and company information were screened and experts were contacted to identify additional evidence.Review methodsSystematic reviews of test accuracy and economic evaluations were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-analyses were conducted, where possible, to inform the independent economic model. A cost–utility decision-analytic model was developed to estimate the cost-effectiveness of VCE compared with histopathology. The model used a decision tree for patients undergoing endoscopy, combined with estimates of long-term outcomes (e.g. incidence of colorectal cancer and subsequent morbidity and mortality) derived from University of Sheffield School of Health and Related Research’s bowel cancer screening model. The model took a NHS perspective, with costs and benefits discounted at 3.5% over a lifetime horizon. There were limitations in the data on the distribution of adenomas across risk categories and recurrence rates post polypectomy.ResultsThirty test accuracy studies were included: 24 for NBI, five for i-scan and three for FICE (two studies assessed two interventions). Polyp assessments made with high confidence were associated with higher sensitivity and endoscopists experienced in VCE achieved better results than those without experience. Two economic evaluations were included. NBI, i-scan and FICE are cost-saving strategies compared with histopathology and the number of quality-adjusted life-years gained was similar for histopathology and VCE. The correct surveillance interval would be given to 95% of patients with NBI, 94% of patients with FICE and 97% of patients with i-scan.LimitationsLimited evidence was available for i-scan and FICE and there was heterogeneity among the NBI studies. There is a lack of data on longer-term health outcomes of patients undergoing VCE for assessment of diminutive colorectal polyps.ConclusionsVCE technologies, using HD systems without magnification, could potentially be used for the real-time assessment of diminutive colorectal polyps, if endoscopists have adequate experience and training.Future workFuture research priorities include head-to-head randomised controlled trials of all three VCE technologies; more research on the diagnostic accuracy of FICE and i-scan (when used without magnification); further studies evaluating the impact of endoscopist experience and training on outcomes; studies measuring adverse effects, HRQoL and anxiety; and longitudinal data on colorectal cancer incidence, HRQoL and mortality.Study registrationThis study is registered as PROSPERO CRD42016037767.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics

Cited by 155 publications

References 82 publications

Clinical, endoscopic and pathological characteristics of colorectal polyps in elderly patients: Single-center experience

Clinical, endoscopic and pathological characteristics of colorectal polyps in elderly patients: Single-center experience

The Assessment of the Colo-rectal Polyps in Order to the New Diagnostic and Therapeutic Strategies

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

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