Digestive Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan, Italy; Digestive Endoscopy Unit, Istituto Clinico Humanitas University, Milan, Italy.
Digestive Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan, Italy.
Gastrointest Endosc. 2016 Sep;84(3):479-486.e3. doi: 10.1016/j.gie.2016.02.020. Epub 2016 Feb 27.
The Narrow-band Imaging International Colorectal Endoscopic (NICE) Classification has been validated for differentiating hyperplastic from adenomatous polyps. This classification system was based on narrow-band imaging (NBI) technology, leaving uncertainty regarding its applicability to other systems. The aim of this study was to assess accuracy and reliability of histologic predictions for polyps <1 cm by applying the NICE classification to the Fujinon Spectral Imaging Color Enhancement (FICE) System.
A video library of 55 polyps <1 cm histologically verified with FICE was prospectively created, including polyps that fulfilled inclusion criteria (morphology, size, histology) in consecutive colonoscopies. Six endoscopists with experience in electronic chromoendoscopy independently reviewed the polyp images, scored the polyps as adenomatous or hyperplastic, and assigned a level of confidence to the predictions. Twenty videos were reassessed at 6 months. The diagnostic performances of the endoscopists was calculated both combined and individually according to the histopathology of the polyps. A mixed-effect logistic regression model, in which polyps were considered as random effects, and polyp histology, confidence level, and readers were considered as fixed effects, was used. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).
Of the 55 polyps (mean size 4.6 mm), 29 (53%) were adenomas, and 26 (47%) were hyperplastic. Across all the readers and observations, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) were 77%, 75%, 88%, 75%, 77%, and 0.82, respectively. Individual rater accuracy ranged from 66% to 96%, being <90% in 5 of 6 cases. Overall, 68.5% of predictions (226/330) were made with high confidence, although there was high variability (Fleiss kappa, 0.15; 95% CI, 0.08-0.22). Sensitivity, specificity, PPV, NPV, accuracy, and AUC for predictions made with high confidence were 81%, 80.5%, 80%, 77%, 82%, and 0.88 being significantly more accurate as compared with a low confidence of diagnosis (OR 2.4; 95% CI, 1.2-4.7). Regarding the performance of the individual NICE criteria, the odds of adenoma detection were 3.4 (95% CI, 1.8-6.3) and 4.0 (95% CI, 2.1-7.5) by using surface and vessels patterns alone, as compared with the color criterion. Interrater and intrarater agreement with the NICE was only moderate (interrater: Fleiss kappa, 0.51; 95% CI, 0.44-0.56; intrarater: kappa, 0.40; 95% CI, 0.20-0.60).
The application of the NICE classification to FICE resulted in suboptimal accuracy and only moderate interobserver agreement.
窄带成像国际结直肠内镜（NICE）分类已被验证可用于区分增生性息肉和腺瘤性息肉。该分类系统基于窄带成像（NBI）技术，因此对于其他系统的适用性存在不确定性。本研究旨在通过将 NICE 分类应用于 Fujinon 光谱成像彩色增强（FICE）系统，评估其对<1cm 息肉的组织学预测的准确性和可靠性。
前瞻性地创建了一个包含 55 个经 FICE 验证的<1cm 息肉的视频库，包括连续结肠镜检查中符合纳入标准（形态、大小、组织学）的息肉。6 名具有电子染色内镜经验的内镜医生独立回顾息肉图像，将息肉评为腺瘤性或增生性，并对预测结果的置信度进行评分。其中 20 个视频在 6 个月时重新评估。根据息肉的组织病理学，分别计算和组合所有内镜医生的诊断性能。使用混合效应逻辑回归模型，其中息肉被视为随机效应，息肉组织学、置信度和读者被视为固定效应。结果表示为比值比（OR）及其 95%置信区间（CI）。
在 55 个息肉（平均大小 4.6mm）中，29 个（53%）为腺瘤，26 个（47%）为增生性息肉。在所有读者和观察中，敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、准确性和曲线下面积（AUC）分别为 77%、75%、88%、75%、77%和 0.82。个体评分者的准确性范围为 66%至 96%，在 6 名内镜医生中，有 5 名的准确性<90%。总体而言，68.5%（226/330）的预测结果具有高度置信度，尽管存在高度变异性（Fleiss kappa，0.15；95%CI，0.08-0.22）。具有高度置信度的预测的敏感性、特异性、PPV、NPV、准确性和 AUC 分别为 81%、80.5%、80%、77%、82%和 0.88，与低置信度诊断相比明显更准确（OR 2.4；95%CI，1.2-4.7）。关于个体 NICE 标准的性能，与颜色标准相比，仅使用表面和血管模式的腺瘤检出率分别为 3.4（95%CI，1.8-6.3）和 4.0（95%CI，2.1-7.5）。使用 NICE 分类的观察者间和观察者内一致性仅为中等（观察者间：Fleiss kappa，0.51；95%CI，0.44-0.56；观察者内：kappa，0.40；95%CI，0.20-0.60）。
将 NICE 分类应用于 FICE 导致准确性较低，且仅具有中等的观察者间一致性。
