Diagnostic features of sessile serrated adenoma/polyps on magnifying narrow band imaging: A prospective study of diagnostic accuracy

作者：Yamashina Takeshi; Takeuchi Yoji^*; Uedo Noriya; Aoi Kenji; Matsuura Noriko; Nagai Kengo; Matsui Fumi; Ito Takashi; Fujii Mototsugu; Yamamoto Sachiko; Hanaoka Noboru; Higashino Koji; Ishihara Ryu; Tomita Yasuhiko; Iishi Hiroyasu

来源：Journal of Gastroenterology and Hepatology, 2015, 30(1): 117-123.

DOI：10.1111/jgh.12688

• hyperplastic polyp
• magnifying narrow band imaging
• NICE classification
• sessile serrated adenoma/polyp

Background and AimsThe narrow band imaging classification system (NBI International Colorectal Endoscopic [NICE] classification) classifies colorectal polyps very accurately. However, sessile serrated adenoma/polyps (SSA/Ps) pathologically resembles hyperplastic polyp and has a possibility to be left in situ on NICE classification. The aim of this study was to establish and evaluate new simple diagnostic features for SSA/Ps using magnifying narrow band imaging (M-NBI).
MethodsWe performed a single-arm observational study of diagnostic accuracy in two stages, as follows: seeking stage, development of simple diagnostic features for SSA/P and definition of diagnostic criteria based on retrospective assessments of M-NBI; and validation stage, prospective validation and evaluation of the new diagnostic criteria.
ResultsIn the seeking stage, we identified brownish, oval, expanded crypt openings and thick-branched vessels on the surfaces of SSA/Ps. We named these expanded crypt openings (ECOs) and thick and branched vessels (TBVs), respectively. In the validation stage, we enrolled 796 polyps in 261 patients, and classified 126 polyps as NICE type 1; all these lesions were endoscopically removed and assessed histopathologically. The sensitivity, specificity, and accuracy of ECOs for SSA/Ps were 84.3%, 81.1%, and 82.4%, whereas those of TBVs were 45.1%, 68.9%, and 59.2%, respectively. M-NBI provided a sensitivity of 98% and specificity of 59.5% for discrimination of SSA/Ps from other lesions classified as NICE type 1.
ConclusionsIdentification of ECOs, supplemented with TBVs, has high sensitivity for the diagnosis of SSA/P. These findings may facilitate the use of endoscopic optical diagnosis in clinical practice.

• 出版日期2015-1