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Narrow-band Imaging International Colorectal Endoscopic Classification to predict polyp histology: REDEFINE study (with videos).
Gastrointest Endosc 2016; 84(3):479-486.e3GE

Abstract

BACKGROUND AND AIMS

The Narrow-band Imaging International Colorectal Endoscopic (NICE) Classification has been validated for differentiating hyperplastic from adenomatous polyps. This classification system was based on narrow-band imaging (NBI) technology, leaving uncertainty regarding its applicability to other systems. The aim of this study was to assess accuracy and reliability of histologic predictions for polyps <1 cm by applying the NICE classification to the Fujinon Spectral Imaging Color Enhancement (FICE) System.

METHODS

A video library of 55 polyps <1 cm histologically verified with FICE was prospectively created, including polyps that fulfilled inclusion criteria (morphology, size, histology) in consecutive colonoscopies. Six endoscopists with experience in electronic chromoendoscopy independently reviewed the polyp images, scored the polyps as adenomatous or hyperplastic, and assigned a level of confidence to the predictions. Twenty videos were reassessed at 6 months. The diagnostic performances of the endoscopists was calculated both combined and individually according to the histopathology of the polyps. A mixed-effect logistic regression model, in which polyps were considered as random effects, and polyp histology, confidence level, and readers were considered as fixed effects, was used. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Of the 55 polyps (mean size 4.6 mm), 29 (53%) were adenomas, and 26 (47%) were hyperplastic. Across all the readers and observations, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) were 77%, 75%, 88%, 75%, 77%, and 0.82, respectively. Individual rater accuracy ranged from 66% to 96%, being <90% in 5 of 6 cases. Overall, 68.5% of predictions (226/330) were made with high confidence, although there was high variability (Fleiss kappa, 0.15; 95% CI, 0.08-0.22). Sensitivity, specificity, PPV, NPV, accuracy, and AUC for predictions made with high confidence were 81%, 80.5%, 80%, 77%, 82%, and 0.88 being significantly more accurate as compared with a low confidence of diagnosis (OR 2.4; 95% CI, 1.2-4.7). Regarding the performance of the individual NICE criteria, the odds of adenoma detection were 3.4 (95% CI, 1.8-6.3) and 4.0 (95% CI, 2.1-7.5) by using surface and vessels patterns alone, as compared with the color criterion. Interrater and intrarater agreement with the NICE was only moderate (interrater: Fleiss kappa, 0.51; 95% CI, 0.44-0.56; intrarater: kappa, 0.40; 95% CI, 0.20-0.60).

CONCLUSIONS

The application of the NICE classification to FICE resulted in suboptimal accuracy and only moderate interobserver agreement.

Authors+Show Affiliations

Digestive Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan, Italy; Digestive Endoscopy Unit, Istituto Clinico Humanitas University, Milan, Italy.Digestive Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan, Italy.Digestive Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan, Italy.Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.Departments of Gastroenterology and Endoscopy, Portsmouth Hospitals NHS trust, Portsmouth, United Kingdom.Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, University of Amsterdam, The Netherlands.Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder (St. John of God Hospital), Teaching Hospital of the University of Regensburg, Regensburg, Germany.Gastroenterology Unit, Valduce Hospital, Como, Italy.Digestive Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan, Italy.

Pub Type(s)

Journal Article
Video-Audio Media

Language

eng

PubMed ID

26928372

Citation

Repici, Alessandro, et al. "Narrow-band Imaging International Colorectal Endoscopic Classification to Predict Polyp Histology: REDEFINE Study (with Videos)." Gastrointestinal Endoscopy, vol. 84, no. 3, 2016, pp. 479-486.e3.
Repici A, Ciscato C, Correale L, et al. Narrow-band Imaging International Colorectal Endoscopic Classification to predict polyp histology: REDEFINE study (with videos). Gastrointest Endosc. 2016;84(3):479-486.e3.
Repici, A., Ciscato, C., Correale, L., Bisschops, R., Bhandari, P., Dekker, E., ... Hassan, C. (2016). Narrow-band Imaging International Colorectal Endoscopic Classification to predict polyp histology: REDEFINE study (with videos). Gastrointestinal Endoscopy, 84(3), pp. 479-486.e3. doi:10.1016/j.gie.2016.02.020.
Repici A, et al. Narrow-band Imaging International Colorectal Endoscopic Classification to Predict Polyp Histology: REDEFINE Study (with Videos). Gastrointest Endosc. 2016;84(3):479-486.e3. PubMed PMID: 26928372.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Narrow-band Imaging International Colorectal Endoscopic Classification to predict polyp histology: REDEFINE study (with videos). AU - Repici,Alessandro, AU - Ciscato,Camilla, AU - Correale,Loredana, AU - Bisschops,Raf, AU - Bhandari,Pradeep, AU - Dekker,Evelien, AU - Pech,Oliver, AU - Radaelli,Franco, AU - Hassan,Cesare, Y1 - 2016/02/27/ PY - 2015/11/21/received PY - 2016/02/03/accepted PY - 2016/3/2/entrez PY - 2016/3/2/pubmed PY - 2017/8/30/medline SP - 479 EP - 486.e3 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 84 IS - 3 N2 - BACKGROUND AND AIMS: The Narrow-band Imaging International Colorectal Endoscopic (NICE) Classification has been validated for differentiating hyperplastic from adenomatous polyps. This classification system was based on narrow-band imaging (NBI) technology, leaving uncertainty regarding its applicability to other systems. The aim of this study was to assess accuracy and reliability of histologic predictions for polyps <1 cm by applying the NICE classification to the Fujinon Spectral Imaging Color Enhancement (FICE) System. METHODS: A video library of 55 polyps <1 cm histologically verified with FICE was prospectively created, including polyps that fulfilled inclusion criteria (morphology, size, histology) in consecutive colonoscopies. Six endoscopists with experience in electronic chromoendoscopy independently reviewed the polyp images, scored the polyps as adenomatous or hyperplastic, and assigned a level of confidence to the predictions. Twenty videos were reassessed at 6 months. The diagnostic performances of the endoscopists was calculated both combined and individually according to the histopathology of the polyps. A mixed-effect logistic regression model, in which polyps were considered as random effects, and polyp histology, confidence level, and readers were considered as fixed effects, was used. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Of the 55 polyps (mean size 4.6 mm), 29 (53%) were adenomas, and 26 (47%) were hyperplastic. Across all the readers and observations, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) were 77%, 75%, 88%, 75%, 77%, and 0.82, respectively. Individual rater accuracy ranged from 66% to 96%, being <90% in 5 of 6 cases. Overall, 68.5% of predictions (226/330) were made with high confidence, although there was high variability (Fleiss kappa, 0.15; 95% CI, 0.08-0.22). Sensitivity, specificity, PPV, NPV, accuracy, and AUC for predictions made with high confidence were 81%, 80.5%, 80%, 77%, 82%, and 0.88 being significantly more accurate as compared with a low confidence of diagnosis (OR 2.4; 95% CI, 1.2-4.7). Regarding the performance of the individual NICE criteria, the odds of adenoma detection were 3.4 (95% CI, 1.8-6.3) and 4.0 (95% CI, 2.1-7.5) by using surface and vessels patterns alone, as compared with the color criterion. Interrater and intrarater agreement with the NICE was only moderate (interrater: Fleiss kappa, 0.51; 95% CI, 0.44-0.56; intrarater: kappa, 0.40; 95% CI, 0.20-0.60). CONCLUSIONS: The application of the NICE classification to FICE resulted in suboptimal accuracy and only moderate interobserver agreement. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/26928372/Narrow_band_Imaging_International_Colorectal_Endoscopic_Classification_to_predict_polyp_histology:_REDEFINE_study__with_videos__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(16)00170-X DB - PRIME DP - Unbound Medicine ER -