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Narrow Band Imaging, Magnifying Chromoendoscopy, and Gross Morphological Features for the Optical Diagnosis of T1 Colorectal Cancer and Deep Submucosal Invasion: A Systematic Review and Meta-Analysis.
Am J Gastroenterol 2017; 112(1):54-64AJ

Abstract

OBJECTIVES

Optical diagnosis of T1 colorectal cancer (CRC) and T1 CRC with deep submucosal invasion is important in guiding the treatment strategy. The use of advanced imaging is not standard clinical practice in Western countries. A systematic review and meta-analysis were conducted comparing the accuracy of narrow band imaging (NBI), magnifying chromoendoscopy (MCE), and gross morphological features (GMF) seen with conventional view for the optical diagnosis of T1 CRC and deep submucosal invasion.

METHODS

A literature search identified studies on the optical diagnosis of T1 CRC and deep invasion using NBI, MCE, or GMF. Pooled estimates (PE) of sensitivity and specificity across studies reporting on NBI or MCE were compared using a random effects bivariate meta-regression approach, and a paired analysis focusing on studies that performed both techniques within the same patient was performed.

RESULTS

Thirty-three studies with 31,568 polyps were included. For the optical diagnosis of T1 CRC, both NBI (4 studies; PE 0.85, 95% confidence interval (CI) 0.75-0.91) and MCE (5 studies; PE 0.90, 95% CI 0.83-0.94) yielded higher sensitivity as compared with GMF (3 studies; range 0.21-0.46). No significant preference for NBI or MCE was found (sensitivity relative risk (RR) 0.93, 95% CI 0.79-1.09, P=0.37; specificity RR 0.98, 95% CI 0.86-1.11, P=0.74). Similarly, for the optical diagnosis of deep invasion, both NBI (13 studies; PE 0.77, 95% CI 0.68-0.84) and MCE (17 studies; PE 0.81, 95% 0.75-0.87) yielded higher sensitivity as compared with GMF (6 studies; range 0.18-0.88), and no significant preference for either NBI or MCE was found (sensitivity RR 0.92, 95% CI 0.76-1.11, P=0.36; specificity RR 1.00, 95% CI 0.96-1.04, P=0.92).

CONCLUSIONS

This review supports the use of advanced imaging techniques in preference to GMF to reduce the risk of performing piecemeal resection for T1 CRCs or unnecessary surgical referral for lesions amendable to endoscopic resection. A preference for either NBI or MCE could not be observed.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Endoscopic Services, Western Health, Melbourne, Victoria, Australia. Department of Medicine, Melbourne Medical School-Western Precinct, The University of Melbourne, St Albans, Victoria, Australia.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27644737

Citation

Backes, Y, et al. "Narrow Band Imaging, Magnifying Chromoendoscopy, and Gross Morphological Features for the Optical Diagnosis of T1 Colorectal Cancer and Deep Submucosal Invasion: a Systematic Review and Meta-Analysis." The American Journal of Gastroenterology, vol. 112, no. 1, 2017, pp. 54-64.
Backes Y, Moss A, Reitsma JB, et al. Narrow Band Imaging, Magnifying Chromoendoscopy, and Gross Morphological Features for the Optical Diagnosis of T1 Colorectal Cancer and Deep Submucosal Invasion: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2017;112(1):54-64.
Backes, Y., Moss, A., Reitsma, J. B., Siersema, P. D., & Moons, L. M. (2017). Narrow Band Imaging, Magnifying Chromoendoscopy, and Gross Morphological Features for the Optical Diagnosis of T1 Colorectal Cancer and Deep Submucosal Invasion: A Systematic Review and Meta-Analysis. The American Journal of Gastroenterology, 112(1), pp. 54-64. doi:10.1038/ajg.2016.403.
Backes Y, et al. Narrow Band Imaging, Magnifying Chromoendoscopy, and Gross Morphological Features for the Optical Diagnosis of T1 Colorectal Cancer and Deep Submucosal Invasion: a Systematic Review and Meta-Analysis. Am J Gastroenterol. 2017;112(1):54-64. PubMed PMID: 27644737.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Narrow Band Imaging, Magnifying Chromoendoscopy, and Gross Morphological Features for the Optical Diagnosis of T1 Colorectal Cancer and Deep Submucosal Invasion: A Systematic Review and Meta-Analysis. AU - Backes,Y, AU - Moss,A, AU - Reitsma,J B, AU - Siersema,P D, AU - Moons,L M G, Y1 - 2016/09/20/ PY - 2016/03/01/received PY - 2016/07/02/accepted PY - 2016/9/21/pubmed PY - 2017/6/21/medline PY - 2016/9/21/entrez SP - 54 EP - 64 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 112 IS - 1 N2 - OBJECTIVES: Optical diagnosis of T1 colorectal cancer (CRC) and T1 CRC with deep submucosal invasion is important in guiding the treatment strategy. The use of advanced imaging is not standard clinical practice in Western countries. A systematic review and meta-analysis were conducted comparing the accuracy of narrow band imaging (NBI), magnifying chromoendoscopy (MCE), and gross morphological features (GMF) seen with conventional view for the optical diagnosis of T1 CRC and deep submucosal invasion. METHODS: A literature search identified studies on the optical diagnosis of T1 CRC and deep invasion using NBI, MCE, or GMF. Pooled estimates (PE) of sensitivity and specificity across studies reporting on NBI or MCE were compared using a random effects bivariate meta-regression approach, and a paired analysis focusing on studies that performed both techniques within the same patient was performed. RESULTS: Thirty-three studies with 31,568 polyps were included. For the optical diagnosis of T1 CRC, both NBI (4 studies; PE 0.85, 95% confidence interval (CI) 0.75-0.91) and MCE (5 studies; PE 0.90, 95% CI 0.83-0.94) yielded higher sensitivity as compared with GMF (3 studies; range 0.21-0.46). No significant preference for NBI or MCE was found (sensitivity relative risk (RR) 0.93, 95% CI 0.79-1.09, P=0.37; specificity RR 0.98, 95% CI 0.86-1.11, P=0.74). Similarly, for the optical diagnosis of deep invasion, both NBI (13 studies; PE 0.77, 95% CI 0.68-0.84) and MCE (17 studies; PE 0.81, 95% 0.75-0.87) yielded higher sensitivity as compared with GMF (6 studies; range 0.18-0.88), and no significant preference for either NBI or MCE was found (sensitivity RR 0.92, 95% CI 0.76-1.11, P=0.36; specificity RR 1.00, 95% CI 0.96-1.04, P=0.92). CONCLUSIONS: This review supports the use of advanced imaging techniques in preference to GMF to reduce the risk of performing piecemeal resection for T1 CRCs or unnecessary surgical referral for lesions amendable to endoscopic resection. A preference for either NBI or MCE could not be observed. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/27644737/Narrow_Band_Imaging_Magnifying_Chromoendoscopy_and_Gross_Morphological_Features_for_the_Optical_Diagnosis_of_T1_Colorectal_Cancer_and_Deep_Submucosal_Invasion:_A_Systematic_Review_and_Meta_Analysis_ L2 - http://Insights.ovid.com/pubmed?pmid=27644737 DB - PRIME DP - Unbound Medicine ER -