Gastroenterology and Endoscopy Units, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy.
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Int J Colorectal Dis. 2021 Jul;36(7):1561-1568. doi: 10.1007/s00384-021-03897-8. Epub 2021 Mar 1.
For superficial colonic lesions, the NICE and Kudo classifications are used in the in vivo prediction of histology and as guide to therapy. The NICE system derives information from unmagnified NBI endoscopic images. The Kudo one necessitates a magnification, but, as this tool is not commonly available, it is applied also to characterize unmagnified pictures to compare their diagnostic performances.
We conducted a prospective comparison of the NICE versus the Kudo classification for the differential diagnosis of colonic polyps taking histology as the gold standard. The inter-observer agreement for both classifications among 11 colonoscopists was also evaluated. Short unmagnified NBI videoclips of 64 colonic polyps were sent twice to the participants. In the first round, they classified the lesions according to the NICE classification; 4 months later, the same videos were assessed with the Kudo system. The diagnosis provided by the participants was grouped in non-neoplastic, non-invasive neoplasia, invasive neoplasia.
Overall, the diagnostic accuracy was 82% (95%CI: 79-85) with the NICE system and 81% (95%CI: 78-84) with the Kudo one (ρ = 0.78). The accuracy of the NICE classification for non-neoplastic lesions was greater compared with the Kudo's (ρ = 0.03). Sensitivity sub-analyses revealed a higher ability of the NICE in distinguishing between neoplastic vs. non-neoplastic lesions (ρ = 0.01). The overall inter-rater agreement did not differ when the classifications were compared.
The NICE and the Kudo classifications might be considered comparable. Our data could allow the use of the NBI Kudo classification even in those centers where magnification is not available.
对于结肠表面病变，NICE 和 Kudo 分类系统用于体内预测组织学，并作为治疗指南。NICE 系统从未经放大的 NBI 内镜图像中获取信息。Kudo 分类系统需要放大，但由于该工具并不常用，因此也用于对未经放大的图像进行特征描述，以比较其诊断性能。
我们前瞻性地比较了 NICE 与 Kudo 分类系统在以组织学为金标准的结肠息肉鉴别诊断中的应用。还评估了 11 名结肠镜医师对这两种分类系统的观察者间一致性。将 64 个结肠息肉的未经放大的短 NBI 视频片段两次发送给参与者。在第一轮中，他们根据 NICE 分类对病变进行分类；4 个月后，使用 Kudo 系统评估相同的视频。参与者提供的诊断分为非肿瘤性、非侵袭性肿瘤、侵袭性肿瘤。
总体而言，NICE 系统的诊断准确性为 82%（95%CI：79-85），Kudo 系统为 81%（95%CI：78-84）（ρ=0.78）。NICE 分类对非肿瘤性病变的准确性高于 Kudo 分类（ρ=0.03）。敏感性亚分析显示，NICE 系统在区分肿瘤性与非肿瘤性病变方面具有更高的能力（ρ=0.01）。当比较分类系统时，整体观察者间一致性没有差异。
NICE 和 Kudo 分类系统可以被认为是相当的。我们的数据可以允许在那些没有放大设备的中心使用 NBI Kudo 分类系统。
