1. Accuracy of the Narrow-Band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps
- Author
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Faust Riu, Santiago Soto, Maria Pellise, Mar Iglesias, Juan Manuel Pascual, Francesc Porta, Jordina Llaó, Elba Llop, Eva Martínez-Bauer, Alberto M. Alvarez, Luísa Castro, María López-Cerón, Jesús Montesinos, F J Garcia-Alonso, Antonio Z. Gimeno-García, Nadia Ascon, Lucía Cid, Marco Bustamante-Balén, Juan de la Revilla, Álex Casalots, Vicent Hernandez, Liseth Rivero-Sánchez, Miquel Serra-Burriel, Maria Inés Castro, Paola Quintas, Òria Rosiñol, Laura Guerra Pastrián, J. Martínez, MA Alvarez-Gonzalez, Óscar Nogales, Nuria Carames, Liliam Elbouayadl, Aurora Burgos, Pau Sort, María López-Ibáñez, Sofía Del Carmen, David Martínez, Alejandra Caminoa, Alberto Herreros-de-Tejada, Agustín Seoane, Henar Núñez, Gema de la Poza, Pamela Estévez, Miguel Pantaleón, Pilar Diez-Redondo, Anna Arnau, Beatriz Peñas, Sonia García Hernández, Antoni Tardio Baiges, Jose Ramón Foruny, Joaquín Cubiella, Tomas Martinez, Isabel Peligros, Jorge López-Vicente, Marina Solano, Fernando Gomollón, Eva Marín, Marta Hernández-Conde, Juan Angel González, Francesc Vida, Angel Ferrandez, Jesús M. González-Santiago, Alfonso Martínez, Eduardo Martín, Ignasi Puig, Marta Fornells, Miriam Cuatrecasas, Carlos Sostres, Rafael Rey, Montserrat López Carreira, Álvaro Isava, Carmen González-Lois, Rafael Campo, Daniel Rodríguez-Alcalde, Julio Ducons, Pablo Vega, Guillermo Muñoz, Javier García-Lledó, Fulgencio Dominguez, Eloy Sánchez, Miguel Ángel Simón, and Ramiro Macenlle
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,Colorectal cancer ,Clinical Decision-Making ,Nice ,Colonic Polyps ,Endoscopic mucosal resection ,Adenocarcinoma ,Metastasis ,03 medical and health sciences ,Adenomatous Polyps ,Narrow Band Imaging ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Submucosa ,medicine ,Humans ,Neoplasm Invasiveness ,Prospective Studies ,Prospective cohort study ,Lymph node ,computer.programming_language ,Aged ,Neoplasm Staging ,Hepatology ,Receiver operating characteristic ,business.industry ,Gastroenterology ,Reproducibility of Results ,Colonoscopy ,Middle Aged ,medicine.disease ,Tumor Burden ,030104 developmental biology ,medicine.anatomical_structure ,Spain ,030211 gastroenterology & hepatology ,Female ,Radiology ,business ,Colorectal Neoplasms ,computer - Abstract
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).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 lesions10 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.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.In an analysis of 2123 colon lesions10 mm, we found the NICE classification and morphologic features identify those with deep lesions with96% specificity-even in non-expert hands and without magnification. ClinicalTrials.gov number NCT02328066.
- Published
- 2018