Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding.
OBJECTIVE
To study the accuracy of using high definition (HD) scope with narrow band imaging (NBI) vs standard white light colonoscope without NBI (ST), to predict the histology of the colon polyps, particularly those < 1 cm.


METHODS
A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care.


RESULTS
Of participants in the study, 55 (37%) were male and median (interquartile range) of age was 56 (19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope (P = 0.7). The ST scope had a positive predictive value (PPV) and positive likelihood ratio (PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope (68%) compare to ST scope (53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp (HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar.


CONCLUSIONS
Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Hassan
H
Ashktorab
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Firoozeh
F
Etaati
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Farahnaz
F
Rezaeean
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Mehdi
M
Nouraie
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Mansour
M
Paydar
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Hassan Hassanzadeh
HH
Namin
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Andrew
A
Sanderson
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Rehana
R
Begum
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Kawtar
K
Alkhalloufi
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Hassan
H
Brim
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States.
Adeyinka O
AO
Laiyemo
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology; D018256:Adenomatous Polyps / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000000981:diagnostic imaging* / Q000473:pathology; D020685:Colonoscopes; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
Colon cancer screening; High definition colonoscopy; Narrow band imaging; Polyp detection