Magnifying Narrow-band Imaging Research Articles

Efficacy of Narrow Band Imaging Magnification for Microvessel Pattern of Colorectal Lesions

Aim: To evaluate the clinical efficacy of the Narrow Band Imaging(NBI) magnification in assessment of microvessel pattern. Methods: The subjects are 143 consecutive patients who underwent complete colonic examination which was performed by a single experienced colonoscopist (K.S.) from May 2007 to November 2007. After detection with a conventional colonoscopy, the lesion was each observed by magnifying colonoscopy with a light source with the NBI system. Microvessel network with NBI magnification was classified into 3 patterns. TypeO (obscure): Microvessels were obscure and hardly recognized. This appearance corresponds to normal mucosa or hyperplastic polyps. TypeR (regular)1: Microvessels were arranged regularly and observed like meshy. Microvessel network surrounded either tubular or branched like pits. This appearance corresponds to tubular adenoma. TypeR2: Microvessels were arranged regularly, and not joined with next. Microvessels were arranged intra-papillary respectively, a little meandering and densed thickly. This appearance corresponds to papillary adenoma. TypeIR (irregular) 1. Microvessels were arranged slightly irregularly. This appearance corresponds to intramucosal carcinoma-slightly invasive submucosal carcinoma. TypeIR2: Microvessels were arranged marked irregularly. There was caliber change, thickness and layer. TypeIR3: Microvessels were arranged marked irregularly. There was caliber change and narrowness of microvessels. The dense was low, and avascular area was often observed because of exposure of desmoplastic reaction of the mucosal surface. Both TypeIR2 and IR3 appearances correspond to massively invasive submucosal carcinoma. Final histological diagnoses on the biopsy or resected specimens were determined according to World Health Organization (WHO) criteria. According to final histological diagnoses, the 219 lesions included 19 hyperplastic polyps, 154 tubular adenomas, 31 with intramucosal carcinomas-slightly submucosal invasion, 15 carcinomas with massively submucosal invasion. Results: TypeO lesions were significantly more often in hyperplastic polyps than other catgories. TypeR1 and R2 were significantly more often in adenomas than other catgories. TypeR2 and R3 were significantly more often in massively submucosal invasive carcinoma than other categories. Conclusion: With the NBI magnification, it was possible to distinguish between neoplastic and non-neoplastic lesions. Microvessel pattern with NBI magnification would be useful to diagnose the depth of early colorectal carcinoma.

Narrow Band Imaging for Esophageal Surveillance in Patients with Head and Neck Cancers

Backgrounds: Squamous dysplasia and carcinoma in situ in the esophagus can be visualized by Lugol chromoendoscopy. However, the Lugol staining method often leads to pain and discomfort because iodine causes severe mucosal irritation. The narrow band imaging (NBI) system is a novel technology based on visualization of microvasculature and mucosal patterns. The aim of this study is to assess the feasibility of the NBI system for screening for esophageal cancer in patients with head and neck cancers. Patients and Methods: Patients with head and neck squamous cell carcinoma were examined by NBI esophageal endoscopy followed by chromoendoscopy using iodine dye from April 2006 to November 2007. All procedures were performed using a magnifying endoscope (GIF-Q240Z or GIF-FQ260Z, Olympus Co.). If abnormal mucosal areas (well demarcated brownish area) were identified under the non-magnifying NBI and if scattered brownish dots were observed within the lesion under the magnifying NBI, we defined the lesion as being abnormal. After NBI endoscopy, Lugol idodine solution was sprayed over the entire esophageal mucosa. A well demarcated, unstained lesion was defined as a Lugol-voiding lesion (LVL). Biopsy specimens were taken when the LVL was > 5 mm in size, and divided into 4 categories: squamous cell carcinoma (SCC); high grade intraepithelial neoplasia (HGN); low grade intraepithelial neoplasia (LGN); and lesion without atypia (no atypia). The detection of esophageal SCC and HGN were evaluated. Results: A total of 109 patients were enrolled. The median age of the patients was 64 years (range, 29-86 years), and approximately three fourths of all patients were male. Fourteen superficial lesions were detected by NBI endoscopy. Of these, 6 lesions were diagnosed as SCC and 1 lesion as HGN. Among the patients without positive findings by NBI endoscopy, LVL > 5 mm was shown in 12 lesions. Five lesions were diagnosed as LGN and 7 leisons as no atypia. There was no esophageal SCC or HGN in patients with normal findings by NBI endoscopy. Conclusions: NBI is useful for screening for esophageal squamous cell carcinoma in patients with head and neck cancer. By introducing the NBI system, chromoendoscopy using iodine dye may be necessary less often for the diagnosis of superficial esophageal squamous cell carcinoma.

Can Magnification Narrow-Band Imaging (NBI) Colonoscopy Determine Invasion Depth of Early Colorectal Cancer? - A Prospective Study -

Can Magnification Narrow-Band Imaging (NBI) Colonoscopy Determine Invasion Depth of Early Colorectal Cancer? - A Prospective Study -

Comparison with Narrow Band Imaging (NBI) Magnification and Histology Finding in Colorectal Neoplasms

Comparison with Narrow Band Imaging (NBI) Magnification and Histology Finding in Colorectal Neoplasms

A New Classification of Narrow Band Imaging Magnification Endoscopy (NBI-ME) for Early Gastric Neoplasms (EGN) Before Endoscopic Submucosal Resection (ESD)

Background: Some studies suggest that NBI-ME enhances endoscopic diagnosis of eGN compared to white light (WL). However, most NBI-ME classifications are too cumbersome for clinical use. Aims: To assess the utility of a simplified NBI-ME classification system for predicting the histology and endoscopic margins of eGN. Methods: 51 pts with eGN without ulceration were examined using a 80X magnifying gastroscope (GIF-Q240Z) and Evis-Lucera 260 processor (Olympus, Tokyo, Japan) using both WL and NBI-ME, before ESD. Gastric pit patterns, capillary networks, and tumor demarcation lines were carefully observed in 58 lesions: 44 well differentiated cancer (WD), 7 poorly differentiated cancers (PD), 7 dysplasia (DY). Gastric pit patterns: tubular, distorted, mixed (tubular dominant or distorted dominant), unclassified, and normal. Vascular patterns: capillary network pattern (CNP), abnormal tumor vessels (ATV), mixed, and normal. Demarcation lines: well demarcated, no demarcation, and equivocal. Endoscopic imaging quality score: 3- NBI-ME better than WL; 2- NBI-ME equal to WL; 1- WL better than NBI-ME. To assess its clinical utility, the pathologic complete resection (CR) rate of pts who had ESD using NBI-ME was compared with those who had ESD using WL. The pathologist was blinded to the imaging modality. Results: Pit patterns: WF: tubular pattern (6.8%), distorted (25%), mixed tubular dominant (36.3%) and mixed distorted dominant (27.3%) and unclassified (4.5%). PD: distorted (57.1%), mixed tubular dominant (14.2%) and mixed distorted dominant (28.5%). DY: tubular pattern (42.8%), distorted (28.5%), mixed tubular dominant (14.3%) and normal (14.3%). Vascular patterns: WD: CNP (2.2%), abnormal tumor vessels (81.8%), and mixed (9%), and normal (6.8%). PD: CNP (14.3%), abnormal tumor vessels (85.7%), and mixed (0%), and normal (0%). DY: CNP (28.6%), ATV (57.1%), and normal (14.2%). Demarcation lines: WD: well demarcated: (77.2%), not demarcated (15.9%), equivocal (6.8%). PD: well demarcated (28.5%), not demarcated (42.8%), equivocal (28.5%). DY: well demarcated (85.7%), not demarcated (14.2%), equivocal (0). The pathologic CR rate was 84.3% (177/210) using WL and 95.9% (55/58) using NBI-ME. The image quality score of NBI-ME was 2.89 ± 0.3. Conclusions: 1. most WD (88%) and PD (86%) cancers have abnormal tumor vessels, 2. Dysplastic lesions (86%) and WD cancers (77%), but not PD cancers, generally have endoscopically visible demarcation lines, 3. a tubular pits pattern suggests dysplasia, whereas a distorted pattern suggests PD. The ESD pathologic complete resection rate is marginally improved (10%) when using this simplified NBI-ME classification system.

Accuracy of Capillary Pattern Classification Using NBI Magnification for Diagnosis of Colorectal Lesions

Accuracy of Capillary Pattern Classification Using NBI Magnification for Diagnosis of Colorectal Lesions

Clinical Usefulness of NBI Magnification in Routine Colonoscopic Examination

Clinical Usefulness of NBI Magnification in Routine Colonoscopic Examination

Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study

Chromoendoscopy in combination with magnifying endoscopy is useful in distinguishing neoplastic from non-neoplastic colorectal polyps. Narrow band imaging (NBI) has been developed as a new technique to differentiate tissue patterns in vivo. The aim of the present study was to directly compare the diagnostic values of chromoendoscopy and NBI for the differentiation of neoplastic from non-neoplastic colorectal polyps. In total, 200 colorectal polyps from 99 patients were distributed in a 1 : 1 ratio in order to analyze the surface according to the pit pattern classification and vascular patterns by either magnifying chromoendoscopy or NBI magnification. Histologic analysis was performed on all lesions. Using the Kudo classification of mucosal patterns, NBI with magnification resulted in a sensitivity of 90.5 % and a specificity of 89.2 % for the differentiation of neoplastic vs. non-neoplastic lesions. This performance was comparable to magnifying chromoendoscopy with a sensitivity of 91.7 % and a specificity of 90 %, respectively. Using vascular patterns for differentiation, NBI with magnification correctly identified 93.7 % of neoplastic polyps and 89.2 % of non-neoplastic colorectal lesions, whereas magnifying chromoendoscopy had a specificity of 95 % but a sensitivity of only 66.7 %. NBI in combination with magnifying endoscopy is a promising tool for the differentiation of neoplastic from non-neoplastic colorectal polyps in vivo without the necessity of using dye. The detection of capillary vessels with NBI allows the evaluation of colorectal lesions based on the vascular patterns with high diagnostic accuracy.

Colonoscopy, tumors, and inflammatory bowel disease

Narrow-band imaging (NBI) is a new technique that allows us to distinguish neoplastic and non-neoplastic lesions without chromoendoscopy, and should be very useful in detecting small or flat lesions missed by standard endoscopy. A study recently examined 148 colorectal lesions, 16 hyperplastic polyps, 84 tubular adenomas, and 48 early carcinomas [1]. Lesions were observed first under NBI magnification and then under standard magnification with chromoendoscopy. Correspondence between the two diagnostic methods was 88 % for type II, 100 % for type IIIs, 98 % for type IIIl, 88 % for type IV, 78 % for type Vi, and 100 % (3/3) for type Vn pit patterns. NBI depicted a brownish change on the basis of surface capillaries in 6 % of hyperplasia and 99 % of tubular adenomas (P < 0.005) [1] . In a second, prospective study, 180 colorectal lesions were observed with conventional colonoscopy, under low- and high-magnification NBI, and chromoendoscopy [2]. The diagnostic accuracy of NBI with low or high magnification was significantly higher than that of conventional colonoscopy (P = 0.0434 and P < 0.001), and was comparable to that of chromoendoscopy. Both low- and high-magnification NBI were capable of distinguishing neoplastic from non-neoplastic colorectal lesions [2].

Combined use of narrow-band imaging magnification endoscopy and miniprobe confocal laser microscopy in neoplastic Barrett's esophagus

The identification of intraepithelial neoplasia in Barrett’s esophagus in cases where there are no visible focal lesions remains a challenge. Novel techniques such as narrow-band imaging-assisted magnification endoscopy or confocal laser microscopy could, however, improve the endoscopic detection of neoplasia in Barrett’s esophagus [1,2]. A miniprobe-based confocal laser microscopy system (Cellvizio-GI; Mauna Kea Technologies, Paris, France) became available recently which allows the application of laser microscopy with any conventional endoscope and mosaic imaging [3,4].

Evaluation of microvessels in colorectal tumors by narrow band imaging magnification

Narrow band imaging (NBI) uses optical filters for sequential green and blue illumination and narrows the bandwidth of spectral transmittance. We determined the clinical usefulness of NBI magnification for evaluation of microvascular architecture and qualitative diagnosis of colorectal tumors. This study was a retrospective study. Department of Endoscopy, Hiroshima University, Hiroshima, Japan. A total of 189 colorectal lesions were analyzed. Each lesion was observed by NBI magnifying endoscopy and classified according to microvascular features (ie, thickness and irregularity). Microvessel thickness was classified as invisible, thin, or thick, and microvessel irregularity was classified as invisible, regular, mildly irregular, or severely irregular. NBI endoscopic images were compared with histologic findings. With respect to microvessel thickness, invisible microvessels were found significantly more often in hyperplasia lesions, and thick microvessels were found significantly more often in carcinoma with submucosal massive invasion (sm-m) (P < .01). With respect to microvessel irregularity, invisible microvessels were found significantly often in hyperplasia lesions, and severely irregular microvessels were found significantly often in sm-m lesions (P < .01). Accuracy of diagnosis of sm-m on the basis of thick and severely irregular lesions was 100%. Microvascular features determined by NBI magnification are associated with histologic grade and depth of submucosal invasion. These results indicate that NBI magnification is useful for the prediction of histologic diagnosis and selection of therapeutic strategies of colorectal tumors.

Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study

Chromoendoscopy can accurately differentiate neoplastic from nonneoplastic polyps in the colon. Narrow band imaging (NBI) has been described as "electronic chromoendoscopy," but it is unclear whether pit patterns seen with chromoendoscopy are identical to those with NBI. Pilot study to compare features of diminutive polyps assessed with magnification NBI and chromoendoscopy. Prospective polyp series. Single tertiary referral center in the United Kingdom. Twenty patients seen for routine colonoscopy. Digital images of each polyp recorded with NBI and chromoendoscopy were subsequently assessed as single images in a random order and as paired polyp images by experienced European- and Japanese-trained endoscopists. Pit pattern (Kudo classification); vascular pattern intensity (weak, normal, strong); predicted histology; pit pattern and vessel network clarity (scale 1-3, 1 poor, 3 excellent). A total of 33 polyps <or=6 mm were assessed. Chromoendoscopic and NBI pit patterns were different for 12 and 20 of 33 polyps (Japanese and European, respectively), combined kappa 0.23, P < .001 compared with published intraobsever variation. Sensitivity, specificity, and accuracy for neoplasia were comparable for chromoendoscopic and NBI pit patterns and vascular pattern intensity for both observers. Vessel network clarity was better with NBI, P < .001 (both), as was pit pattern clarity, P = .04 (European). Small sample size; pilot study. Pit patterns were not always identical with NBI and chromoendoscopy. The Kudo classification may need to be modified and revalidated before it can be used with confidence with NBI. Vascular pattern intensity, a simple color change, appears as accurate as pit pattern.

Whistler Summary: “The Slow Rate of Rapid Progress”

Whistler Summary: “The Slow Rate of Rapid Progress”

Evaluation of Microvessels in Colorectal Tumors By Narrow Band Imaging (NBI) Magnification Colonoscopy

Background: Narrow band imaging (NBI) uses optical filters for sequential red-green-blue illumination and narrows the bandwidth of spectral transmittance. The aim of this study is determine the clinical usefulness of NBI magnification for evaluation of microvascular architecture and qualitative diagnosis of colorectal tumors. Materials and Methods: A total of 189 colorectal lesions were analyzed. Each lesion was observed by NBI magnifying endoscopy and classified according to microvascular features (i.e., thickness and irregularity). Capillary thickness was classified as invisible, thin, or thick, and capillary irregularity was classified as invisible, regular, mildly irregular, or severely irregular. NBI endoscopic images were compared to histologic findings. Results: With respect to capillary thickness, invisible capillaries was found significantly often in hyperplasia (HP) lesions, and thick capillaries was found significantly often in carcinoma with submucosal massive invasion (sm-m) (p < 0.01). With respect to capillary irregularity, invisible capillaries was found significantly often in HP lesions, and severely irregular capillaries was found significantly often in sm-m lesions (p < 0.01). Accuracy of diagnosis of sm-m on the basis of thick and severely irregular lesions was 100%. Conclusion: Microvascular features determined by NBI magnification are associated with histologic grade and depth of submucosal invasion. These results indicate that NBI magnification is useful for prediction of histology and selection of therapeutic strategies of colorectal tumors.

Narrow Band Imaging in the Airway: Where Do We Stand?

Narrow Band Imaging in the Airway: Where Do We Stand?

Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors

Narrow band imaging (NBI) uses optical filters for red-green-blue sequential illumination and narrows the bandwidth of spectral transmittance. This study aimed to clarify the clinical usefulness of NBI magnification in assessment of pit patterns for diagnosis of colorectal tumors. This was a retrospective study. Department of Endoscopy, Hiroshima University Hospital. A total of 148 colorectal lesions, 16 hyperplasias, 84 tubular adenomas, and 48 early carcinomas were examined and diagnosed histologically. Mean size of lesions was 15.6+/-7.28 mm. Lesions were observed first under NBI magnification without chromoendoscopy and then under standard magnification with chromoendoscopy, and pit patterns were recorded. Results of NBI magnification were compared with those of standard magnification with chromoendoscopy to assess the clinical usefulness of NBI magnification for diagnosing colorectal neoplasia. Correspondence between the two diagnostic methods was 88% (14/16) for type II, 100% (2/2) for type IIIs, 98% (73/75) for type IIIl, 88% (7/8) for type IV, 78% (25/32) for type Vi, and 100% (3/3) for type Vn pit patterns. NBI depicted brownish change on the basis of surface capillaries in 6% (1/16) of hyperplasia and 99% (83/84) of tubular adenomas. This difference in color depiction was significant. This study was performed in single center. Determination of pit patterns of colorectal neoplasias by NBI magnification was nearly the same as that by standard magnification with chromoendoscopy. Furthermore, NBI can distinguish neoplastic and nonneoplastic lesions without chromoendoscopy.

PIT PATTERN DIAGNOSIS FOR COLORECTAL NEOPLASIA USING NARROW BAND IMAGING MAGNIFICATION

Narrow band imaging (NBI) is a newly developed technology that uses optical filters for RGB sequential illumination and narrows the bandwidth of spectral transmittance. NBI enables the observation of the fine capillaries in the superficial mucosa of the gastrointestinal tract. In this report, the authors assessed the clinical usefulness of NBI magnification in pit pattern diagnosis for colorectal neoplasia. A total of 90 colorectal lesions including nine cases of hyperplasia, 60 of tubular adenoma and 21 of early carcinoma were analyzed. Histologic diagnosis was undertaken according to World Health Organization classifications. Magnified observation of the lesions was performed using NBI without chromoendoscopy, and pit pattern diagnosis was then recorded. After endoscopic or surgical resection of the lesion, the authors performed stereoscopic examination to confirm the pit pattern. From these data, the authors estimated the ability to diagnose pit patterns using NBI magnification without chromoendoscopy. The correspondence rate of pit pattern diagnosis between NBI magnification without chromoendoscopy and stereoscopic findings was 100% (9/9) for type II, 100% (56/56) for type IIIl, 100% (3/3) for type IV, 80% (12/15) for type Vi, and 57% (4/7) for type Vn. NBI magnification without chromoendoscopy demonstrated good results for pit pattern diagnosis of colorectal neoplasia, especially for lesions with regular pit pattern.