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Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification.
Gastrointest Endosc 2013; 78(4):625-32GE

Abstract

BACKGROUND

A simple endoscopic classification to accurately predict deep submucosal invasive (SM-d) carcinoma would be clinically useful.

OBJECTIVE

To develop and assess the validity of the NBI international colorectal endoscopic (NICE) classification for the characterization of SM-d carcinoma.

DESIGN

The study was conducted in 4 phases: (1) evaluation of endoscopic differentiation by NBI-experienced colonoscopists; (2) extension of the NICE classification to incorporate SM-d (type 3) by using a modified Delphi method; (3) prospective validation of the individual criteria by inexperienced participants, by using high-definition still images without magnification of known histology; and (4) prospective validation of the individual criteria and overall classification by inexperienced participants after training.

SETTING

Japanese academic unit.

MAIN OUTCOME MEASUREMENTS

Performance characteristics of the NICE criteria (phase 3) and overall classification (phase 4) for SM-d carcinoma; sensitivity, specificity, predictive values, and accuracy.

RESULTS

We expanded the NICE classification for the endoscopic diagnosis of SM-d carcinoma (type 3) and established the predictive validity of its individual components. The negative predictive values of the individual criteria for diagnosis of SM-d carcinoma were 76.2% (color), 88.5% (vessels), and 79.1% (surface pattern). When any 1 of the 3 SM-d criteria was present, the sensitivity was 94.9%, and the negative predictive value was 95.9%. The overall sensitivity and negative predictive value of a global, high-confidence prediction of SM-d carcinoma was 92%. Interobserver agreement for an overall SM-d carcinoma prediction was substantial (kappa 0.70).

LIMITATIONS

Single Japanese center, use of still images without prospective clinical evaluation.

CONCLUSION

The NICE classification is a valid tool for predicting SM-d carcinomas in colorectal tumors.

Authors+Show Affiliations

Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

23910062

Citation

Hayashi, Nana, et al. "Endoscopic Prediction of Deep Submucosal Invasive Carcinoma: Validation of the Narrow-band Imaging International Colorectal Endoscopic (NICE) Classification." Gastrointestinal Endoscopy, vol. 78, no. 4, 2013, pp. 625-32.
Hayashi N, Tanaka S, Hewett DG, et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc. 2013;78(4):625-32.
Hayashi, N., Tanaka, S., Hewett, D. G., Kaltenbach, T. R., Sano, Y., Ponchon, T., ... Soetikno, R. M. (2013). Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointestinal Endoscopy, 78(4), pp. 625-32. doi:10.1016/j.gie.2013.04.185.
Hayashi N, et al. Endoscopic Prediction of Deep Submucosal Invasive Carcinoma: Validation of the Narrow-band Imaging International Colorectal Endoscopic (NICE) Classification. Gastrointest Endosc. 2013;78(4):625-32. PubMed PMID: 23910062.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. AU - Hayashi,Nana, AU - Tanaka,Shinji, AU - Hewett,David G, AU - Kaltenbach,Tonya R, AU - Sano,Yasushi, AU - Ponchon,Thierry, AU - Saunders,Brian P, AU - Rex,Douglas K, AU - Soetikno,Roy M, Y1 - 2013/07/30/ PY - 2012/10/09/received PY - 2013/04/20/accepted PY - 2013/8/6/entrez PY - 2013/8/6/pubmed PY - 2014/5/16/medline KW - NBI KW - NBI international colorectal endoscopic KW - NICE KW - SM-d KW - deep submucosal invasion KW - narrow-band imaging SP - 625 EP - 32 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 78 IS - 4 N2 - BACKGROUND: A simple endoscopic classification to accurately predict deep submucosal invasive (SM-d) carcinoma would be clinically useful. OBJECTIVE: To develop and assess the validity of the NBI international colorectal endoscopic (NICE) classification for the characterization of SM-d carcinoma. DESIGN: The study was conducted in 4 phases: (1) evaluation of endoscopic differentiation by NBI-experienced colonoscopists; (2) extension of the NICE classification to incorporate SM-d (type 3) by using a modified Delphi method; (3) prospective validation of the individual criteria by inexperienced participants, by using high-definition still images without magnification of known histology; and (4) prospective validation of the individual criteria and overall classification by inexperienced participants after training. SETTING: Japanese academic unit. MAIN OUTCOME MEASUREMENTS: Performance characteristics of the NICE criteria (phase 3) and overall classification (phase 4) for SM-d carcinoma; sensitivity, specificity, predictive values, and accuracy. RESULTS: We expanded the NICE classification for the endoscopic diagnosis of SM-d carcinoma (type 3) and established the predictive validity of its individual components. The negative predictive values of the individual criteria for diagnosis of SM-d carcinoma were 76.2% (color), 88.5% (vessels), and 79.1% (surface pattern). When any 1 of the 3 SM-d criteria was present, the sensitivity was 94.9%, and the negative predictive value was 95.9%. The overall sensitivity and negative predictive value of a global, high-confidence prediction of SM-d carcinoma was 92%. Interobserver agreement for an overall SM-d carcinoma prediction was substantial (kappa 0.70). LIMITATIONS: Single Japanese center, use of still images without prospective clinical evaluation. CONCLUSION: The NICE classification is a valid tool for predicting SM-d carcinomas in colorectal tumors. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/23910062/Endoscopic_prediction_of_deep_submucosal_invasive_carcinoma:_validation_of_the_narrow_band_imaging_international_colorectal_endoscopic__NICE__classification_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(13)01853-1 DB - PRIME DP - Unbound Medicine ER -