Investigating endoscopic features of sessile serrated adenomas/polyps by using narrow-band imaging with optical magnification

Masayoshi Yamada; Taku Sakamoto; Yosuke Otake; Takeshi Nakajima; Aya Kuchiba; Hirokazu Taniguchi; Shigeki Sekine; Ryoji Kushima; Hemchand Ramberan; Adolfo Parra-Blanco; Takahiro Fujii; Takahisa Matsuda; Yutaka Saito

doi:10.1016/j.gie.2014.12.037

Investigating endoscopic features of sessile serrated adenomas/polyps by using narrow-band imaging with optical magnification

Gastrointest Endosc. 2015 Jul;82(1):108-17. doi: 10.1016/j.gie.2014.12.037. Epub 2015 Apr 1.

Affiliations

¹ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
² Department of Biostatistics, National Cancer Center, Tokyo, Japan.
³ Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan.
⁴ Molecular Pathology Division, National Cancer Center Research Institute, Tokyo, Japan.
⁵ Department of Gastroenterology, University of Tennessee College of Medicine, Erlanger Hospital, Chattanooga, TN, USA.
⁶ Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁷ TF Clinic, Tokyo, Japan.

PMID: 25840928
DOI: 10.1016/j.gie.2014.12.037

Abstract

Background: A sessile serrated adenoma/polyp (SSA/P) is a common type of colorectal polyp that possesses malignant potential. Although narrow-band imaging (NBI) can easily differentiate neoplastic lesions from hyperplastic polyps (HPs), SSA/Ps can be a challenge to distinguish from HPs.

Objective: To investigate specific endoscopic features of SSA/Ps by using NBI with optical magnification.

Design: Retrospective study.

Setting: Single high-volume referral center.

Patients: A total of 289 patients with histopathologically proven SSA/Ps or HPs obtained from colonoscopic polypectomy.

Intervention: Endoscopic images obtained by using NBI with optical magnification of 242 lesions (124 HPs, 118 SSA/Ps) removed between January 2010 and December 2012 were independently evaluated by 2 experienced endoscopists. Three external experienced endoscopists systematically validated the diagnostic accuracies by using 40 lesions (21 HPs and 19 SSA/Ps) removed between January and March 2013.

Main outcome measurements: Specific endoscopic features of SSA/Ps by using 5 potential characteristics: dilated and branching vessels (DBVs), irregular dark spots, a regular network pattern, a disorganized network pattern, and a dense pattern.

Results: Multivariate analysis demonstrated that DBV had a 2.3-fold odds ratio (95% confidence interval, 0.96-5.69) among SSA/Ps compared with HPs (sensitivity, 56%; specificity, 75%; accuracy, 65%). Interobserver and intraobserver agreement indicated almost perfect agreement for DBVs in both the evaluation and validation studies. When DBVs, proximal location, and tumor size (≥10 mm) were combined, the positive predictive value was 92% and the area under the curve was 0.783 in the receiver-operating characteristics by using the validation group.

Limitations: Retrospective study.

Conclusions: The current study suggests that a DBV is a potentially unique endoscopic feature of a colorectal SSA/P.

Publication types

Evaluation Study

MeSH terms

Adenoma / diagnosis*
Adult
Aged
Aged, 80 and over
Colonic Polyps / diagnosis*
Colonoscopy / methods*
Colorectal Neoplasms / diagnosis*
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Multivariate Analysis
Narrow Band Imaging*
Observer Variation
Retrospective Studies
Sensitivity and Specificity