Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification

Gastrointest Endosc. 2013 Oct;78(4):625-32. doi: 10.1016/j.gie.2013.04.185. Epub 2013 Jul 30.


Background: A simple endoscopic classification to accurately predict deep submucosal invasive (SM-d) carcinoma would be clinically useful.

Objective: To develop and assess the validity of the NBI international colorectal endoscopic (NICE) classification for the characterization of SM-d carcinoma.

Design: The study was conducted in 4 phases: (1) evaluation of endoscopic differentiation by NBI-experienced colonoscopists; (2) extension of the NICE classification to incorporate SM-d (type 3) by using a modified Delphi method; (3) prospective validation of the individual criteria by inexperienced participants, by using high-definition still images without magnification of known histology; and (4) prospective validation of the individual criteria and overall classification by inexperienced participants after training.

Setting: Japanese academic unit.

Main outcome measurements: Performance characteristics of the NICE criteria (phase 3) and overall classification (phase 4) for SM-d carcinoma; sensitivity, specificity, predictive values, and accuracy.

Results: We expanded the NICE classification for the endoscopic diagnosis of SM-d carcinoma (type 3) and established the predictive validity of its individual components. The negative predictive values of the individual criteria for diagnosis of SM-d carcinoma were 76.2% (color), 88.5% (vessels), and 79.1% (surface pattern). When any 1 of the 3 SM-d criteria was present, the sensitivity was 94.9%, and the negative predictive value was 95.9%. The overall sensitivity and negative predictive value of a global, high-confidence prediction of SM-d carcinoma was 92%. Interobserver agreement for an overall SM-d carcinoma prediction was substantial (kappa 0.70).

Limitations: Single Japanese center, use of still images without prospective clinical evaluation.

Conclusion: The NICE classification is a valid tool for predicting SM-d carcinomas in colorectal tumors.

Keywords: NBI; NBI international colorectal endoscopic; NICE; SM-d; deep submucosal invasion; narrow-band imaging.

Publication types

  • Validation Study

MeSH terms

  • Adenoma / diagnosis*
  • Adenoma / pathology
  • Carcinoma / diagnosis*
  • Carcinoma / pathology
  • Colonoscopy / methods*
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / pathology
  • Delphi Technique
  • Humans
  • Intestinal Mucosa / pathology*
  • Narrow Band Imaging / methods*
  • Neoplasm Invasiveness
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity