title: Accuracy of narrow-band imaging in predicting colonoscopy surveillance intervals and histology of distal diminutive polyps: results from a multicenter, prospective trial.
abstract: BACKGROUND
  In vivo prediction of colorectal polyp histology by narrow-band imaging (NBI) could potentially avoid post-polypectomy histologic examination or resection of diminutive lesions, thereby reducing costs and risk.
  
  
  OBJECTIVE
  To assess whether NBI is able to predict colonoscopy surveillance intervals and histology of distal diminutive polyps according to American Society for Gastrointestinal Endoscopy (ASGE) criteria.
  
  
  METHODS
  Prospective, multicenter study.
  
  
  METHODS
  Five endoscopic centers.
  
  
  METHODS
  Consecutive patients undergoing colonoscopy in 5 centers were included.
  
  
  METHODS
  Participating endoscopists were required to pass a before-study qualifying examination. Histology of polyps that were <10 mm was predicted at NBI and assigned a designation of high or low confidence.
  
  
  METHODS
  Accuracy of high-confidence NBI prediction for polyps ≤5 mm in predicting surveillance intervals and negative predictive value (NPV) for adenomatous histology in the rectosigmoid colon were compared with the ASGE thresholds (90% agreement, 90% NPV).
  
  
  RESULTS
  A total of 278 patients (mean age, 63 years; 58% male) were enrolled. At colonoscopy, 574 (97.3%) polyps <10 mm (429 ≤5 mm, 60% adenomatous) were retrieved for histologic analysis. Sensitivity, specificity, positive and negative predictive values, and accuracy of high confidence-NBI predictions for adenomatous histology in lesions ≤5 mm were 90%, 88%, 89%, 89%, and 89%, respectively. High-confidence characterization of polyps ≤5 mm predicted the correct surveillance interval in 92% to 99% of cases, according to the American and European guidelines. NPV of high-confidence NBI for adenomatous histology for the rectosigmoid colon lesions ≤5 mm was 92%.
  
  
  CONCLUSIONS
  Only experienced endoscopists were included.
  
  
  CONCLUSIONS
  High-confidence prediction of histology for polyps ≤5 mm appears to be sufficiently accurate to avoid post-polypectomy histologic examination of the resected lesions as well as to allow rectosigmoid hyperplastic polyps to be left in place without resection. (
  
  
  BACKGROUND
  NCT01675752.).
authors.affiliation: Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Franco
authors.initials: F
authors.lastname: Radaelli
authors.forename: Pietro
authors.initials: P
authors.lastname: Occhipinti
authors.forename: Claudio
authors.initials: C
authors.lastname: De Angelis
authors.forename: Fabio
authors.initials: F
authors.lastname: Romeo
authors.forename: Silvia
authors.initials: S
authors.lastname: Paggi
authors.forename: Silvia
authors.initials: S
authors.lastname: Saettone
authors.forename: Fabio
authors.initials: F
authors.lastname: Cisarò
authors.forename: Manon
authors.initials: M
authors.lastname: Spaander
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003111:Colonic Polyps / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy / Q000379:methods*; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D007089:Image Enhancement / Q000379:methods; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062048:Narrow Band Imaging / Q000379:methods*; D009367:Neoplasm Staging; D009426:Netherlands; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity