title: The diagnostic accuracy of high-resolution endoscopy, autofluorescence imaging and narrow-band imaging for differentially diagnosing colon adenoma.
abstract: OBJECTIVE
  Conventional colonoscopy can result in unnecessary biopsy or endoscopic resection due to its inability to distinguish adenomas from hyperplastic polyps. This study therefore evaluated the efficacy of high-resolution endoscopy (HRE), autofluorescence imaging (AFI), and narrow-band imaging (NBI) in discriminating colon adenoma from hyperplastic polyps.
  
  
  METHODS
  This was a prospective multicenter study in patients undergoing AFI and NBI examinations. HRE, AFI, and NBI images were classified into two groups based on morphological characteristics, the predominant color intensities, and the visibility of meshed capillary vessels, respectively. Each of the endoscopic photographs were independently evaluated by a single endoscopist. The images were then assessed by three specialists and three residents, the latter having performed < 500 colonoscopies and < 30 NBI and AFI examinations. Diagnostic test statistics were calculated to compare the accuracy in differentiating colon adenoma from hyperplastic polyps for each method.
  
  
  RESULTS
  A total of 183 patients were enrolled in the study and 339 adenomas and 85 hyperplastic polyps were identified. AFI and NBI could distinguish adenoma from hyperplastic polyps with an accuracy of 84.9 % and 88.4 %, respectively, whereas HRE exhibited an accuracy of 75.9 %. In the 358 lesions in which the AFI diagnosis was consistent with that of NBI, the accuracy, sensitivity, and specificity were high, at 91.9 %, 92.7 %, and 92.9 %, respectively. During the study comparing specialists and residents, AFI and NBI dramatically improved the diagnostic accuracy of residents from 69.1 % to 86.1 % and 84.7 %, respectively.
  
  
  CONCLUSIONS
  Both AFI and NBI are considered to be feasible tools that can discriminate colon adenoma from hyperplastic polyps, and their use may be particularly beneficial for less-experienced endoscopists.
authors: Internal Medicine, Engaru-Kosei General Hospital, Asahikawa, Japan.
authors: R
authors: R
authors: Sato
authors: M
authors: M
authors: Fujiya
authors: J
authors: J
authors: Watari
authors: N
authors: N
authors: Ueno
authors: K
authors: K
authors: Moriichi
authors: S
authors: S
authors: Kashima
authors: S
authors: S
authors: Maeda
authors: K
authors: K
authors: Ando
authors: H
authors: H
authors: Kawabata
authors: R
authors: R
authors: Sugiyama
authors: Y
authors: Y
authors: Nomura
authors: T
authors: T
authors: Nata
authors: K
authors: K
authors: Itabashi
authors: Y
authors: Y
authors: Inaba
authors: K
authors: K
authors: Okamoto
authors: Y
authors: Y
authors: Mizukami
authors: Y
authors: Y
authors: Saitoh
authors: Y
authors: Y
authors: Kohgo
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005453:Fluorescence; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008027:Light; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric