title: Proposal of a new 'resect and discard' strategy using magnifying narrow band imaging: pilot study of diagnostic accuracy.
abstract: OBJECTIVE
  A 'resect and discard' strategy using non-magnifying narrow band imaging (N-NBI) has been proposed for reducing screening colonoscopy costs, but it does not take into consideration advanced histology and magnifying NBI (M-NBI) that can potentially further improve the 'resect and discard' strategy. We conducted a pilot study to investigate the feasibility of M-NBI for the new 'resect and discard' strategy with consideration for advanced histology.
  
  
  METHODS
  The present study involved 63 patients. For each polyp, optical diagnosis was independently made using N-NBI and M-NBI, a decision (discard or send for pathology) was made based on the M-NBI findings, and histological and optical diagnosis results were compared.
  
  
  RESULTS
  Sensitivity, specificity and accuracy (95% confidence interval) of M-NBI for lesions with advanced histology were 1.00 (0.36-1.00), 0.92 (0.91-0.92) and 0.92 (0.90-0.92), respectively. Whereas the management of 86% of small polyps could be decided without formal histopathology, lesions with advanced histology were not discarded using M-NBI. The diagnostic accuracy of M-NBI in distinguishing neoplastic from non-neoplastic lesions was higher than that of N-NBI.
  
  
  CONCLUSIONS
  We propose a new resect and discard strategy with advanced histology using M-NBI that is a promising strategy to reduce the costs of histopathology and to minimize the risk of discarding important lesions.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Masao
authors.initials: M
authors.lastname: Hanafusa
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kanzaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohta
authors.forename: Noboru
authors.initials: N
authors.lastname: Hanaoka
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods; D003111:Colonic Polyps / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D062048:Narrow Band Imaging / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D057832:Watchful Waiting
keywords: colon polyp surveillance; colonoscopy; colorectal neoplasm; narrow band imaging; resect and discard