High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study

Am J Gastroenterol. 2009 Oct;104(10):2422-30. doi: 10.1038/ajg.2009.403. Epub 2009 Jul 7.


Objectives: Standard white light colonoscopy has limited ability to differentiate between polyp types (adenomatous vs. hyperplastic). Narrow band imaging (NBI) highlights the superficial mucosal/vascular patterns on polyps and may facilitate real-time characterization of polyp histology. The aim of this study was to prospectively evaluate and compare the diagnostic characteristics of high-definition white light colonoscopy (HDWL) and NBI without magnification in the real-time prediction of polyp histology (adenomatous vs. hyperplastic) by evaluating the surface mucosal and vascular patterns.

Methods: We conducted a prospective comparative study in a tertiary referral center. A total of 100 patients referred for screening or surveillance colonoscopy were prospectively enrolled and underwent colonoscopy using a high-definition colonoscope with NBI capability. Every polyp detected was initially evaluated with HDWL followed by NBI for the presence of surface mucosal/vascular patterns. Based on these patterns, polyp histology was predicted by both modalities. The main outcome measurements were: (i) diagnostic characteristics of HDWL and NBI in predicting polyp histology and (ii) impact of polyp size and learning effect (first half of study vs. second half) on the ability of NBI to predict adenomas.

Results: A total of 236 polyps were detected in 100 patients-143 adenomas, 77 hyperplastic, and 16 others. Surface patterns (type A: hyperplastic; type B: adenomatous) were recognized in all polyps with NBI (100%) compared to 45% with HDWL. For predicting adenomas, NBI had a significantly higher sensitivity and greater accuracy (96 and 93% respectively) compared with HDWL (38 and 61% respectively) (all P<0.0001). Although the accuracy of NBI for predicting adenomas improved with increasing polyp size (< or =5 mm; 6-9 mm; > or =10 mm) and in the second half compared with the first half of the study, these differences were not statistically significant.

Conclusions: Using a simple surface mucosal/vascular pattern classification, NBI without magnification was highly accurate and significantly superior to HDWL for the real-time prediction of adenomas.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / pathology
  • Colonic Polyps / diagnosis*
  • Colonic Polyps / pathology
  • Colonoscopes
  • Colonoscopy / methods*
  • Female
  • Humans
  • Image Enhancement / methods
  • Male
  • Middle Aged
  • Precancerous Conditions / diagnosis
  • Precancerous Conditions / pathology
  • Predictive Value of Tests
  • Prospective Studies