Clin Endosc.  2013 Mar;46(2):120-129. 10.5946/ce.2013.46.2.120.

Optical Diagnosis of Small Colorectal Polyp Histology with High-Definition Colonoscopy Using Narrow Band Imaging

• Rastogi A

• KMID: 1805293
• DOI: http://doi.org/10.5946/ce.2013.46.2.120

Abstract

Optical diagnosis of polyp histology can potentially result in enormous cost savings by way of the "resect and discard" strategy for diminutive polyps and the "do not resect" strategy for diminutive hyperplastic polyps in the distal colon. Narrow Band Imaging (NBI) highlights the surface mucosal and vascular pattern on polyps and has been shown to accurately characterize adenomatous and hyperplastic polyps by experts. However, the results have been a little discouraging amongst lesser experienced endoscopists. Studies have also shown that using the NBI diagnosis of diminutive polyp histology, experts can accurately define the future surveillance colonoscopy intervals. However nonexperts in academic or community setting have as yet failed to achieve the recommended thresholds. The subjectivity in assessment by endoscopists leads to the variable accuracy rates and can be circumvented by computer based automated tools. Although initial experience with a few computer based algorithms have shown accuracies comparable to experts, further refinement and validation will be required before these can be implemented in clinical practice. Incorporation of optical diagnosis of diminutive polyps into clinical practice is bound to face several hurdles. But the potential for enormous cost saving makes it an attractive strategy that can make colonoscopy more cost effective.

Keyword

Narrow band imaging; Optical diagnosis; Diminutive polyps

MeSH Terms

Colon
Colonoscopy
Cost Savings
Narrow Band Imaging
Polyps

Figure

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  Fig. 1 A) A 3-mm polyp with strong vascular pattern intensity. Histopathology showed it was an adenoma (courtesy Dr. James East, MD). (B) A 3-mm hyperplastic polyp showing weak pattern intensity (courtesy Dr. James East, MD).

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  Fig. 2 (A) A 2-mm hyperplastic polyp showing fine capillary network but absent mucosal pattern (bland pattern). (B) A 4-mm hyperplastic polyp showing the circular pattern with dots. (C) A 4-mm adenoma showing the round or oval pattern. (D) A 6-mm adenoma showing the tubulogyrus pattern.

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  Fig. 3 Lesion with clearly visible meshed capillary vessels, histologically diagnosed as an adenoma (courtesy Dr. Yasushi Sano, MD).

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  Fig. 4 (A) Capillary pattern I; hyperplastic polyp (courtesy Dr. KI Fu, MD). (B) Capillary pattern II, adenoma with low-grade dysplasia (courtesy Dr. KI Fu, MD). (C) Capillary pattern III, adenoma with high-grade dysplasia (courtesy Dr. KI Fu, MD).

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  Fig. 5 (A) Hyperplastic polyp. Only very few vessels are visualized on the surface and do not show increased branching (courtesy Dr. J Tischendorf, MD). (B) Polyp showing increased density of irregular, curved and dilated blood vessels. Histologic examination showed adenoma (courtesy Dr. J Tischendorf, MD).

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  Fig. 6 Features of the narrow band imaging International Colorectal Endoscopic (NICE) criteria: (A) color, (B) vessels, and (C) surface pattern (courtesy Dr. D.K. Rex, MD).

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