Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics

Sarah K McGill, Evangelos Evangelou, John P A Ioannidis, Roy M Soetikno, Tonya Kaltenbach, Sarah K McGill, Evangelos Evangelou, John P A Ioannidis, Roy M Soetikno, Tonya Kaltenbach

Abstract

Purpose: Many studies have reported on the use of narrow band imaging (NBI) colonoscopy to differentiate neoplastic from non-neoplastic colorectal polyps. It has potential to replace pathological diagnosis of diminutive polyps. We aimed to perform a systematic review and meta-analysis on the real-time diagnostic operating characteristics of NBI colonoscopy.

Methods: We searched PubMed, SCOPUS and Cochrane databases and abstracts. We used a two-level bivariate meta-analysis following a random effects model to summarise the data and fit hierarchical summary receiver-operating characteristic (HSROC) curves. The area under the HSROC curve serves as an indicator of the diagnostic test strength. We calculated summary sensitivity, specificity and negative predictive value (NPV). We assessed agreement of surveillance interval recommendations based on endoscopic diagnosis compared to pathology.

Results: For NBI diagnosis of colorectal polyps, the area under the HSROC curve was 0.92 (95% CI 0.90 to 0.94), based on 28 studies involving 6280 polyps in 4053 patients. The overall sensitivity was 91.0% (95% CI 87.6% to 93.5%) and specificity was 82.6% (95% CI 79.0% to 85.7%). In eight studies (n=2146 polyps) that used high-confidence diagnostic predictions, sensitivity was 93.8% and specificity was 83.3%. The NPVs exceeded 90% when 60% or less of all polyps were neoplastic. Surveillance intervals based on endoscopic diagnosis agreed with those based on pathology in 92.6% of patients (95% CI 87.9% to 96.3%).

Conclusions: NBI diagnosis of colorectal polyps is highly accurate--the area under the HSROC curve exceeds 0.90. High-confidence predictions provide >90% sensitivity and NPV. It shows high potential for real-time endoscopic diagnosis.

Keywords: Colonic Polyps; Colonoscopy; Colorectal Cancer Screening; Colorectal Neoplasia; Meta-Analysis.

Figures

Figure 1
Figure 1
Endoscopic image with narrow band imaging of diminutive colorectal polyps. (A) Adenoma and (B) non-neoplastic polyp.
Figure 2
Figure 2
Flow chart of the search strategy and selected studies.
Figure 3
Figure 3
Hierarchical summary receiver-operating characteristic (HSROC) curve for the diagnostic performance of narrow band imaging to diagnose neoplastic and non-neoplastic polyps among all studies (blue line) and among published studies (green line). The size of the circles indicates the weight of the individual studies. The summary sensitivity and specificity is shown with a yellow square and the 95% confidence region is plotted. For all studies, the area under the HSROC curve was 0.92 (95% CI 0.90 to 0.94); for published studies, the area under the HSROC curve was 0.93 (0.90 to 0.95).
Figure 4
Figure 4
Hierarchical summary receiver-operating characteristic (HSROC) curve for the diagnostic performance of narrow band imaging to diagnose diminutive polyps (blue line) and diminutive polyps that were diagnosed with high confidence (green line). For high-confidence predictions of diminutive polyps, area under the HSROC curve was 0.94 (95% CI 0.92 to 0.96).
Figure 5
Figure 5
Disagreement between endoscopically directed and pathology directed surveillance intervals. Each dot represents patients whose endoscopic-directed surveillance interval differed from that dictated by the pathological assessment. Discordant intervals in 22 patients in the study by Pohl et al are not plotted, as this information was not reported.
Figure 6
Figure 6
Sensitivities and specificities of individual studies (see study numbers, table 1) plotted with the hierarchical summary receiver-operating characteristic (SROC) curve.

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