title: Magnifying narrow-band imaging with acetic acid to diagnose early colorectal cancer.
abstract: OBJECTIVE
  To evaluate the diagnostic characteristics of magnifying endoscopy with acetic acid spray and narrow-band imaging (MA-NBI) for early colorectal cancer.
  
  
  METHODS
  We conducted a prospective study to evaluate the diagnostic characteristics of MA-NBI in differentiating early colorectal adenocarcinomas from adenomas. To compare the results, we used magnifying endoscopy with NBI (M-NBI) and magnifying endoscopy with crystal violet staining (M-CV). The study was performed in 2 phases. In phase 1, 10 colonoscopists at our institution were shown still photographs of 35 colorectal polyps (24 adenocarcinomas and 11 adenomas) in M-NBI, MA-NBI, and M-CV. They made diagnostic predictions using a five-grade scoring evaluation. We plotted receiver operating characteristic curves and compared the areas under the curves (AUCs). In phase 2, colorectal polyps measuring ≥ 8 mm were prospectively enrolled. During real-time colonoscopy, one of the 7 colonoscopists scored the lesion as an adenocarcinoma or an adenoma and assigned a level of confidence to the prediction (high or low). We calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each method and compared the proportions of high-confidence predictions.
  
  
  RESULTS
  In phase 1, the mean ± SD AUCs were 0.64 ± 0.031 in M-NBI, 0.71 ± 0.066 in MA-NBI, and 0.76 ± 0.059 in M-CV (P < 0.05 for M-NBI vs MA-NBI, P < 0.001 for M-NBI vs M-CV, and not significant for MA-NBI vs M-CV). In phase 2, 84 patients with 91 lesions (46 adenocarcinomas and 45 adenomas) were enrolled. The diagnostic characteristics were as follows: 73% accuracy, 85% sensitivity, 60% specificity, 68% PPV, and 79% NPV in M-NBI; 73% accuracy, 80% sensitivity, 64% specificity, 70% PPV, and 76% NPV in MA-NBI; and 73% accuracy, 83% sensitivity, 62% specificity, 69% PPV, and 78% NPV in M-CV. The proportions of high-confidence predictions were 57% in M-NBI, 75% in MA-NBI, and 76% in M-CV (P < 0.005 for M-NBI vs MA-NBI, P < 0.0005 for M-NBI vs M-CV, and P = 1.0 for MA-NBI vs M-CV).
  
  
  CONCLUSIONS
  MA-NBI is useful for differentiating early colorectal adenocarcinomas from adenomas.
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Goto
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kusaka
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Tomita
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Itokawa
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Yorimitsu
authors.initials: Y
authors.lastname: Koshikawa
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yamaguchi
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Nakai
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Fujii
authors.affiliation: Norihiro Goto, Toshihiro Kusaka, Yumi Tomita, Hideyuki Tanaka, Yoshio Itokawa, Yorimitsu Koshikawa, Daisuke Yamaguchi, Yoshitaka Nakai, Shigehiko Fujii, Hiroyuki Kokuryu, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto 615-8256, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kokuryu
mesh_terms: D019342:Acetic Acid; D000230:Adenocarcinoma / Q000473:pathology*; D000236:Adenoma / Q000473:pathology*; D019540:Area Under Curve; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods*; D005840:Gentian Violet; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D062048:Narrow Band Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D047368:Tumor Burden
chemical_list: D005840:Gentian Violet; D019342:Acetic Acid
keywords: Acetic acid; Colorectal cancer; Endoscopy; Narrow-band imaging; Neoplasia