title: Meshed capillary vessels found on narrow-band imaging without optical magnification effectively identifies colorectal neoplasia: a North American validation of the Japanese experience.
abstract: BACKGROUND
  The presence of meshed capillary (MC) vessels is highly sensitive (96%) and specific (92%) for diagnosing colorectal neoplasia on colonoscopy by using narrow-band imaging (NBI) with optical magnification, which is not available in North America. However, the efficacy of NBI to identify an MC pattern without optical magnification has not been determined.
  
  
  OBJECTIVE
  To determine the diagnostic capabilities of NBI colonoscopy without optical magnification in differentiating neoplastic from non-neoplastic colorectal polyps by using the MC pattern.
  
  
  METHODS
  Retrospective comparison of prospectively collected colorectal polyp data.
  
  
  METHODS
  Large, academic medical center.
  
  
  METHODS
  This study involved 126 consecutive colorectal polyps (median size 3 mm) that were found in 52 patients (33 men) with a median age of 59.5 years.
  
  
  METHODS
  All lesions identified by white-light colonoscopy were prospectively diagnosed in real-time by using the MC pattern as determined on high-definition NBI, with 1.5x zoom but without true optical magnification, and then endoscopically excised. Surgical pathology was used as the criterion standard.
  
  
  METHODS
  Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of identifying neoplastic polyps were calculated.
  
  
  RESULTS
  NBI without optical magnification was found to have a sensitivity of 93%, specificity of 88%, positive predictive value of 90%, negative predictive value of 91%, and diagnostic accuracy of 91% when all polyp sizes were considered. For lesions < or =5 mm, sensitivity was 87%, specificity was 93%, positive predictive value was 89%, negative predictive value was 91%, and diagnostic accuracy was 90%.
  
  
  CONCLUSIONS
  Single-center, single-endoscopist experience.
  
  
  CONCLUSIONS
  Use of the MC pattern on NBI colonoscopy without optical magnification effectively distinguishes neoplastic from non-neoplastic colorectal polyps. NBI colonoscopy without optical magnification for neoplastic polyp diagnosis appears to be comparable with NBI with optical magnification when the MC pattern is used. A large, prospective trial is needed for further validation.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Zachary H
authors.initials: ZH
authors.lastname: Henry
authors.forename: Paul
authors.initials: P
authors.lastname: Yeaton
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: James T
authors.initials: JT
authors.lastname: Patrie
authors.forename: Dawn G
authors.initials: DG
authors.lastname: Cox
authors.forename: David A
authors.initials: DA
authors.lastname: Peura
authors.forename: Fabian
authors.initials: F
authors.lastname: Emura
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply* / Q000175:diagnosis / Q000473:pathology; D018253:Adenoma, Villous / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002196:Capillaries / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000098:blood supply* / Q000175:diagnosis / Q000473:pathology; D003106:Colon / Q000098:blood supply / Q000473:pathology; D003111:Colonic Polyps / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000098:blood supply* / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012007:Rectum / Q000098:blood supply / Q000473:pathology; D012680:Sensitivity and Specificity; D014481:United States