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Published on: October 17, 2016
Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps
1Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA. drex@iupui.edu
Background & Aims:
The ability to determine colorectal polyp pathology by endoscopy could reduce the risks of polypectomy and the cost of pathologic evaluation. This study evaluated the ability of the Olympus Exera 180 high-definition colonoscope (Olympus America, Inc, Center Valley, PA), with narrow-band imaging, to predict colorectal polyp histology.
Methods:
A library of 320 endoscopic photographs with correlated histologic information was used to identify endoscopic features associated with adenomatous and hyperplastic histology. These features were tested in a prospective study of 451 consecutively identified colorectal polyps. Polyps were observed endoscopically and assigned a designation of high or low confidence. The primary end points were the predictive value of high-confidence endoscopic interpretations of adenoma and hyperplastic histology for polyps 5 mm and smaller in size.
Results:
Endoscopic predictions of adenoma and hyperplastic histology were made with high confidence for 80% and 83% of cases, respectively. High-confidence predictions were more likely than low-confidence predictions to be correct (P<.001). High-confidence predictions of adenoma and hyperplastic histology were correct for 91% and 95%, respectively, of polyps 5 mm and smaller in size.
Conclusions:
Introduction of confidence levels to the endoscopic interpretation of colorectal polyp histology allows sufficient accuracy for the use of the Exera narrow-band imaging system in the identification of distal hyperplastic polyps that do not need resection, as well as to plan postpolypectomy surveillance without pathologic evaluation of polyps 5 mm in size or smaller.
Insights
High-confidence endoscopic interpretation using narrow-band imaging accurately predicts colorectal polyp histology. This allows for targeted resection and surveillance, reducing unnecessary pathology costs and risks for small polyps.
Area of Science:
- Gastroenterology
- Endoscopic Imaging
- Oncology
Background:
- Endoscopic determination of colorectal polyp histology can decrease polypectomy risks and pathology costs.
- Evaluating the accuracy of high-definition colonoscopy with narrow-band imaging (NBI) is crucial for clinical decision-making.
Purpose of the Study:
- To assess the Olympus Exera 180 high-definition colonoscope's ability, using NBI, to predict colorectal polyp histology.
- To determine the predictive value of high-confidence endoscopic interpretations for adenoma and hyperplastic histology in small polyps.
Main Methods:
- A library of 320 endoscopic images with histologic data was used to identify key features.
- A prospective study of 451 polyps involved endoscopic observation and confidence-level assignment.
- Primary endpoints focused on the accuracy of high-confidence predictions for polyps ≤5 mm.
Main Results:
- High-confidence predictions were achieved in 80% (adenoma) and 83% (hyperplastic) of cases.
- High-confidence predictions demonstrated significantly higher accuracy than low-confidence ones (P<.001).
- Accuracy for high-confidence predictions was 91% for adenoma and 95% for hyperplastic histology in polyps ≤5 mm.
Conclusions:
- Confidence levels enhance endoscopic interpretation of colorectal polyp histology.
- The Exera NBI system is accurate enough to identify distal hyperplastic polyps not requiring resection.
- Pathologic evaluation can be avoided for polyps ≤5 mm, streamlining surveillance and management.
