A prospective randomized study of colonoscopy using blue laser imaging and white light imaging in detection and differentiation of colonic polyps

Tiing Leong Ang, James Weiquan Li, Yu Jen Wong, Yi-Lyn Jessica Tan, Kwong Ming Fock, Malcolm Teck Kiang Tan, Andrew Boon Eu Kwek, Eng Kiong Teo, Daphne Shih-Wen Ang, Lai Mun Wang, Tiing Leong Ang, James Weiquan Li, Yu Jen Wong, Yi-Lyn Jessica Tan, Kwong Ming Fock, Malcolm Teck Kiang Tan, Andrew Boon Eu Kwek, Eng Kiong Teo, Daphne Shih-Wen Ang, Lai Mun Wang

Abstract

Background and study aims Published data on blue laser imaging (BLI) for detection and differentiation of colonic polyps are limited compared to narrow band imaging (NBI). This study investigated whether BLI can increase the detection rate of colonic polyps and adenomas when compared to white light imaging (WLI), and examined use of NICE (NBI International Colorectal Endoscopic) and JNET (Japan NBI Expert Team) classifications with BLI. Patients and methods Patients aged 50 years and above referred for colonoscopy were randomized to BLI or WLI on withdrawal. Detected polyps were characterized using NICE and JNET classifications under BLI mode and correlated with histology. Primary outcome was adenoma detection rate. Secondary outcomes were utility of NICE and JNET classifications to predict histology using BLI. Results A total of 182 patients were randomized to BLI (92) or WLI (90). Comparing BLI with WLI, the polyp detection rate was 59.8 % vs 40.0 %, P = 0.008, and the adenoma detection rate was 46.2 % vs 27.8 %, P = 0.010. NICE 1 and JNET 1 diagnosed hyperplastic polyps with sensitivity of 87.18 % and specificity of 84.35 %. NICE 2 diagnosed low- (LGD) or high-grade dysplasia (HGD) with sensitivity of 92.31 % and specificity of 77.45 %. JNET 2A diagnosed LGD with sensitivity of 91.95 %, and specificity of 74.53 %. Four cases of focal HGD all had JNET 2A morphology. Conclusion BLI increased adenoma detection rate compared to WLI. NICE and JNET classifications can be applied when using BLI for endoscopic diagnosis of HP and LGD but histological confirmation remains crucial.

Conflict of interest statement

Competing interests None

Figures

Fig. 1
Fig. 1
Trial profile.
Fig. 2 a
Fig. 2 a
Rectal polyp with NICE 1 andbJNET 1 endoscopic appearance.cHematoxylin & eosin-stained section showed features of a hyperplastic polyp with no dysplasia (40 × magnification).
Fig. 3 a
Fig. 3 a
Ascending colon polyp with NICE 1 andbJNET 1 endoscopic appearance.cHematoxylin & eosin-stained section showed colonic mucosa with dilation and horizontalization of the basal crypt glands and focal serration, consistent with a sessile serrated adenoma, without conventional cytological dysplasia. (100 × magnification).
Fig. 4 a
Fig. 4 a
Rectal polyp with NICE 2 andbJNET 2A endoscopic appearance.cHematoxylin & eosin-stained section showed features of a tubulovillous adenoma with low-grade dysplasia (40 × magnification).
Fig. 5 a
Fig. 5 a
Sigmoid polyp with NICE 1 andbJNET 1 endoscopic appearance.cHematoxylin & eosin-stained section showed features of a tubular adenoma with low-grade dysplasia (100 × magnification).
Fig. 6 a
Fig. 6 a
Cecal polyp with NICE 2 endoscopic appearance.bHematoxylin & eosin-stained section showed focal high-grade dysplasia within a tubulovillous adenoma with predominantly low-grade dysplasia (100 × magnification).
Fig. 7 a
Fig. 7 a
Transverse colon polyp with NICE 2 andbJNET 2A endoscopic appearance.cHematoxylin & eosin-stained section showed features of a sessile serrated adenoma with low-grade dysplasia (40 × magnification).
Fig. 8 a
Fig. 8 a
Sigmoid polyp with JNET 2A endoscopic appearance.bHematoxylin & eosin-stained section showed focal high-grade dysplasia within a tubular adenoma exhibiting predominantly low-grade dysplasia (200 × magnification).

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