Usefulness of narrow-band imaging with dual-focus magnification for differential diagnosis of small colorectal polyps.

Abstract

Many authors have already reported the usefulness of narrow-band imaging (NBI) for the differential diagnosis of non-neoplastic and neoplastic colorectal lesions. However, it is not clear whether magnification is required for differential diagnosis. The aim of this prospective study was to clarify the clinical usefulness of a newly developed NBI system with a dual focus function (dual-focus NBI) compared with conventional white-light imaging (WLI) and NBI without magnification for distinguishing between non-neoplastic and neoplastic lesions. Thirty-seven consecutive patients who underwent screening colonoscopy with the novel system between July and December 2013 were analyzed. Patients with polyps >10mm and those with polyps previously evaluated by histologic examination or colonoscopy were excluded. Lesions were diagnosed in real time with WLI, NBI without magnification, and dual-focus NBI, and then excised endoscopically. Each diagnosis was compared to that in the final histopathology reports. The primary endpoint was the diagnostic accuracy and the confidence level assigned to each modality by the endoscopists. The secondary endpoint was the differentiation ability according to the size of the lesion (≤5 and 6-10mm). In all, 100 lesions including 76 adenomatous polyps and 24 hyperplastic polyps were analyzed in 37 patients. The overall diagnostic accuracy, sensitivity, and specificity for differentiating adenomatous from hyperplastic polyps were 87.0, 89.5, and 79.2% for WLI, 93.0, 94.7, and 87.5% for NBI without magnification, and 94.0, 96.1, and 87.5% for dual-focus NBI, respectively. The level of confidence was significantly different between dual-focus NBI and WLI and NBI without magnification for diminutive (≤5mm) lesions (p<0.001 and p<0.01). Dual-focus NBI is especially useful for differential diagnosis of diminutive colorectal lesions.