Original Article
Copyright ©2009 Baishideng. All rights reserved.
World J Gastrointest Endosc. Oct 15, 2009; 1(1): 45-50
Published online Oct 15, 2009. doi: 10.4253/wjge.v1.i1.45
White light endoscopy, narrow band imaging and chromoendoscopy with magnification in diagnosing colorectal neoplasia
Rajvinder Singh, Victoria Owen, Anthony Shonde, Philip Kaye, Christopher Hawkey, Krish Ragunath
Rajvinder Singh, Anthony Shonde, Philip Kaye, Christopher Hawkey, Krish Ragunath, Wolfson Digestive Diseases Centre, Queens Medical Centre campus, Nottingham University Hospitals NHS Trust, NG7 2UH, Nottingham, United Kingdom
Victoria Owen, Trent Research Development Unit, University of Nottingham, NG7 2RD, Nottingham, United Kingdom
Author contributions: Singh R designed, performed, analysed and wrote the paper; Owen V analysed the data; Shonde A, Kaye P, Hawkey C performed the research, Ragunath K performed the research and edited the manuscript.
Correspondence to: Dr. Rajvinder Singh, MBBS, MRCP, FRACP, Endoscopy Unit, Division of Medicine, The Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, 5112 SA, Australia. rajvinder.singh@health.sa.gov.au
Telephone: +61-8-81820657 Fax: +61-8-81829837
Received: January 13, 2009
Revised: March 20, 2009
Accepted: March 30, 2009
Published online: October 15, 2009

AIM: To evaluate the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 3 different techniques: high resolution white light endoscopy (WLE), Narrow Band Imaging (NBI) and Chromoendoscopy (CHR), all with magnification in differentiating adenocarcinomas, adenomatous and hyperplastic colorectal polyps.

METHODS: Each polyp was sequentially assessed first by WLE, followed by NBI and finally by CHR. Digital images of each polyp with each modality were taken and stored. Biopsies or polypectomies were then performed followed by blinded histopathological analysis. Each image was blindly graded based on the Kudo’s pit pattern (KPP). In the assessment with NBI, the mesh brown capillary network pattern (MBCN) of each polyp was also described. The Sn, Sp, PPV and NPV of differentiating hyperplastic (Type I & II-KPP, Type I-MBCN) adenomatous (Types III, IV-KPP, Type II-MBCN) and carcinomatous polyps (Type V-KPP, Type III-MCBN) was then compared with reference to the final histopathological diagnosis.

RESULTS: A total of 50 colorectal polyps (5 adenocarcinomas, 38 adenomas, 7 hyperplastic) were assessed. CHR and NBI [KPP, MBCN or the combined classification (KPP & MBCN)] were superior to WLE in the prediction of polyp histology (P < 0.001, P = 0.002, P = 0.001 and P < 0.001, respectively). NBI, using the MBCN pattern or the combined classification showed higher numerical accuracies compared to CHR, but this was not statistically significant (P = 0.625, 0.250).

CONCLUSION: This feasibility study demonstrated that this combined classification with NBI could potentially be useful in routine clinical practice, allowing the endoscopist to predict histology with higher accuracies using a less cumbersome and technically less challenging method.

Keywords: High-resolution magnification endoscopy, Narrow band imaging with magnification, Chromoendoscopy with magnification, Colorectal polyp, Colorectal neoplasia