Two-stage optical system for colorectal polyp assessments

Mirosław Szura, Artur Pasternak, Krzysztof Bucki, Katarzyna Urbańczyk, Andrzej Matyja, Mirosław Szura, Artur Pasternak, Krzysztof Bucki, Katarzyna Urbańczyk, Andrzej Matyja

Abstract

Background and aims: Macroscopic real-time evaluations of the histopathology and degree of invasion of colorectal polyps help to select the most suitable endoscopic treatment method. Dual-focus (DF) narrow-band imaging (NBI) is a new imaging enhancement system that uses digital and optical methods to enhance the view of blood vessels on mucosal surfaces. However, the superiority of this technique over standard imaging techniques has not been previously reported. The aim of this study was to determine whether the two-stage optical systems in a new generation of endoscopes will increase the diagnostic accuracy of colorectal polyp recognition.

Methods: The study included 270 patients, and 386 colorectal polyps were diagnosed and removed. The polyps were assessed with white light and NBI using one- and two-stage optical systems, respectively. After being classified according to the Kudo pit pattern schemes, the polyps were removed and histopathologically verified.

Results: Regarding non-neoplastic lesions (Kudo I and II), no difference was observed in the recognition of polyps when using the NBI-DF function. We observed improved accuracy in the preliminary diagnoses of Kudo IIIL lesions (from 87.16 to 90.09%, p < 0.05) and Kudo IIIS lesions (from 87.29 to 92.79%, p < 0.01). NBI-DF also increased the accuracy of preliminary diagnoses of Kudo IV lesions (from 88.24 to 94.12%, p < 0.01). The Kudo V pit patterns were also more distinct with NBI-DF imaging, increasing the diagnostic accuracy from 91.67 to 100%.

Conclusions: Using a two-stage optical system with electronic colorization of the mucosa increased diagnostic accuracy for differentiating colorectal polyps with neoplastic potential.

Trial registration: ClinicalTrials.gov NCT01688557.

Keywords: Colonoscopy; Colorectal cancer; Dual-focus magnification; Narrow-band imaging.

Figures

Fig. 1
Fig. 1
CONSORT diagram of patient enrollment
Fig. 2
Fig. 2
Pit pattern classification of colorectal neoplasia (Kudo et al.). I Round pit (normal pit), II asteroid pit, IIIS tubular of round pit (smaller than the normal pit, i.e., type I), IIIL tubular of round pit (larger than the normal pit, i.e., type I), IV dendritic or gyrus-like pit, V amorphous, nonstructured pit
Fig. 3
Fig. 3
Inflammatory polyp. A Standard colonoscopic view in WL. B NBI-NF/Kudo I/. C Cross section (HE staining)
Fig. 4
Fig. 4
Hyperplastic polyp. A Standard colonoscopic view in WL. B NBI-NF/Kudo II/. C Cross section (HE staining)
Fig. 5
Fig. 5
Tubular adenoma with low-grade dysplasia. A Standard colonoscopic view in WL. B NBI-NF/Kudo IIIS/. C Cross section (HE staining)
Fig. 6
Fig. 6
Tubular adenoma with low-grade dysplasia. A Standard colonoscopic view in WL. B NBI-NF/Kudo IIIL/. C Cross section (HE staining)
Fig. 7
Fig. 7
Tubular adenoma with high-grade dysplasia. A Standard colonoscopic view in WL. B NBI-NF/Kudo IV/. C Cross section (HE staining)
Fig. 8
Fig. 8
Cribriform comedo-type adenocarcinoma G3. A Standard colonoscopic view in WL. B NBI-NF/Kudo V/. C Cross section (HE staining)

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