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Accuracy of the Narrow-Band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps.
Gastroenterology 2019; 156(1):75-87G

Abstract

BACKGROUND & AIMS

T1 colorectal polyps with at least 1 risk factor for metastasis to lymph node should be treated surgically and are considered endoscopically unresectable. Optical analysis, based on the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification system, is used to identify neoplasias with invasion of the submucosa that require endoscopic treatment. We assessed the accuracy of the NICE classification, along with other morphologic characteristics, in identifying invasive polyps that are endoscopically unresectable (have at least 1 risk factor for metastasis to lymph node).

METHODS

We performed a multicenter, prospective study of data collected by 58 endoscopists, from 1634 consecutive patients (examining 2123 lesions) at 17 university and community hospitals in Spain from July 2014 through June 2016. All consecutive lesions >10 mm assessed with narrow-band imaging were included. The primary end point was the accuracy of the NICE classification for identifying lesions with deep invasion, using findings from histology analysis as the reference standard. Conditional inference trees were fitted for the analysis of diagnostic accuracy.

RESULTS

Of the 2123 lesions analyzed, 89 (4.2%) had features of deep invasion and 91 (4.3%) were endoscopically unresectable. The NICE classification system identified lesions with deep invasion with 58.4% sensitivity (95% CI, 47.5-68.8), 96.4% specificity (95% CI, 95.5-97.2), a positive-predictive value of 41.6% (95% CI, 32.9-50.8), and a negative-predictive value of 98.1% (95% CI, 97.5-98.7). A conditional inference tree that included all variables found the NICE classification to most accurately identify lesions with deep invasion (P < .001). However, pedunculated morphology (P < .007), ulceration (P = .026), depressed areas (P < .001), or nodular mixed type (P < .001) affected accuracy of identification. Results were comparable for identifying lesions that were endoscopically unresectable.

CONCLUSIONS

In an analysis of 2123 colon lesions >10 mm, we found the NICE classification and morphologic features identify those with deep lesions with >96% specificity-even in non-expert hands and without magnification. ClinicalTrials.gov number NCT02328066.

Authors+Show Affiliations

Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain. Electronic address: ignasipuig@gmail.com.Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain.Pathology Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain.Pathology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain; Banc de Tumors, Biobanc Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.Gastroenterology Department, Research Institute Segovia Arana, Hospital Universitario Puerta de Hierro, Madrid, Spain.Digestive Diseases Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Biomedical Research Networking Center in Hepatic and Digestive Diseases, Madrid, Spain.Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain.Digestive Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain.Digestive Diseases Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.Digestive Diseases Department, Hospital Universitario de Móstoles, Madrid, Spain.Digestive Diseases Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.Digestive Diseases Department, Hospital del Mar, Barcelona, Spain.Digestive Diseases Department, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain.Gastroenterology Department, Research Institute Segovia Arana, Hospital Universitario Puerta de Hierro, Madrid, Spain.Digestive Diseases Department, Hospital Universitario Río Hortega, Valladolid, Spain.Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.Digestive Diseases Department, Hospital Universitario de Canarias, Tenerife, Spain.Digestive Diseases Department, Hospital Universitario La Paz, Madrid, Spain.Digestive Diseases Department, Hospital Universitario de Fuenlabrada, Madrid, Spain.Digestive Diseases Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain.Digestive Diseases Department, Corporació Sanitària Parc Taulí, Barecelon, Spain.Digestive Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Biomedical Research Networking Center in Hepatic and Digestive Diseases, Madrid, Spain.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30296432

Citation

Puig, Ignasi, et al. "Accuracy of the Narrow-Band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps." Gastroenterology, vol. 156, no. 1, 2019, pp. 75-87.
Puig I, López-Cerón M, Arnau A, et al. Accuracy of the Narrow-Band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps. Gastroenterology. 2019;156(1):75-87.
Puig, I., López-Cerón, M., Arnau, A., Rosiñol, Ò., Cuatrecasas, M., Herreros-de-Tejada, A., ... Pellise, M. (2019). Accuracy of the Narrow-Band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps. Gastroenterology, 156(1), pp. 75-87. doi:10.1053/j.gastro.2018.10.004.
Puig I, et al. Accuracy of the Narrow-Band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps. Gastroenterology. 2019;156(1):75-87. PubMed PMID: 30296432.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of the Narrow-Band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps. AU - Puig,Ignasi, AU - López-Cerón,María, AU - Arnau,Anna, AU - Rosiñol,Òria, AU - Cuatrecasas,Miriam, AU - Herreros-de-Tejada,Alberto, AU - Ferrández,Ángel, AU - Serra-Burriel,Miquel, AU - Nogales,Óscar, AU - Vida,Francesc, AU - de Castro,Luisa, AU - López-Vicente,Jorge, AU - Vega,Pablo, AU - Álvarez-González,Marco A, AU - González-Santiago,Jesús, AU - Hernández-Conde,Marta, AU - Díez-Redondo,Pilar, AU - Rivero-Sánchez,Liseth, AU - Gimeno-García,Antonio Z, AU - Burgos,Aurora, AU - García-Alonso,Francisco Javier, AU - Bustamante-Balén,Marco, AU - Martínez-Bauer,Eva, AU - Peñas,Beatriz, AU - Pellise,Maria, AU - ,, Y1 - 2018/10/06/ PY - 2018/03/11/received PY - 2018/09/19/revised PY - 2018/10/02/accepted PY - 2018/10/9/pubmed PY - 2019/1/29/medline PY - 2018/10/9/entrez KW - CRC KW - Colon Cancer KW - Early Detection KW - Prognostic Factor SP - 75 EP - 87 JF - Gastroenterology JO - Gastroenterology VL - 156 IS - 1 N2 - BACKGROUND & AIMS: T1 colorectal polyps with at least 1 risk factor for metastasis to lymph node should be treated surgically and are considered endoscopically unresectable. Optical analysis, based on the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification system, is used to identify neoplasias with invasion of the submucosa that require endoscopic treatment. We assessed the accuracy of the NICE classification, along with other morphologic characteristics, in identifying invasive polyps that are endoscopically unresectable (have at least 1 risk factor for metastasis to lymph node). METHODS: We performed a multicenter, prospective study of data collected by 58 endoscopists, from 1634 consecutive patients (examining 2123 lesions) at 17 university and community hospitals in Spain from July 2014 through June 2016. All consecutive lesions >10 mm assessed with narrow-band imaging were included. The primary end point was the accuracy of the NICE classification for identifying lesions with deep invasion, using findings from histology analysis as the reference standard. Conditional inference trees were fitted for the analysis of diagnostic accuracy. RESULTS: Of the 2123 lesions analyzed, 89 (4.2%) had features of deep invasion and 91 (4.3%) were endoscopically unresectable. The NICE classification system identified lesions with deep invasion with 58.4% sensitivity (95% CI, 47.5-68.8), 96.4% specificity (95% CI, 95.5-97.2), a positive-predictive value of 41.6% (95% CI, 32.9-50.8), and a negative-predictive value of 98.1% (95% CI, 97.5-98.7). A conditional inference tree that included all variables found the NICE classification to most accurately identify lesions with deep invasion (P < .001). However, pedunculated morphology (P < .007), ulceration (P = .026), depressed areas (P < .001), or nodular mixed type (P < .001) affected accuracy of identification. Results were comparable for identifying lesions that were endoscopically unresectable. CONCLUSIONS: In an analysis of 2123 colon lesions >10 mm, we found the NICE classification and morphologic features identify those with deep lesions with >96% specificity-even in non-expert hands and without magnification. ClinicalTrials.gov number NCT02328066. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/30296432/Accuracy_of_the_Narrow_Band_Imaging_International_Colorectal_Endoscopic_Classification_System_in_Identification_of_Deep_Invasion_in_Colorectal_Polyps_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(18)35094-7 DB - PRIME DP - Unbound Medicine ER -