Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2016; 22(28): 6539-6546
Published online Jul 28, 2016. doi: 10.3748/wjg.v22.i28.6539
Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo
Hassan Ashktorab, Firoozeh Etaati, Farahnaz Rezaeean, Mehdi Nouraie, Mansour Paydar, Hassan Hassanzadeh Namin, Andrew Sanderson, Rehana Begum, Kawtar Alkhalloufi, Hassan Brim, Adeyinka O Laiyemo, Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
Author contributions: All authors contributed to this work.
Supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (in part), Award No. G12MD007597.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hassan Ashktorab, PhD, Department of Medicine and Cancer Center, Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC 20060, United States. hashktorab@howard.edu
Telephone: +1-202-8066121 Fax: +1-202-6671686
Received: March 4, 2015
Peer-review started: March 5, 2015
First decision: April 24, 2015
Revised: August 24, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: July 28, 2016
Processing time: 506 Days and 2.5 Hours
Abstract

AIM: To study the accuracy of using high definition (HD) scope with narrow band imaging (NBI) vs standard white light colonoscope without NBI (ST), to predict the histology of the colon polyps, particularly those < 1 cm.

METHODS: A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care.

RESULTS: Of participants in the study, 55 (37%) were male and median (interquartile range) of age was 56 (19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope (P = 0.7). The ST scope had a positive predictive value (PPV) and positive likelihood ratio (PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope (68%) compare to ST scope (53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp (HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar.

CONCLUSION: Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.

Keywords: High definition colonoscopy; Narrow band imaging; Polyp detection; Colon cancer screening

Core tip: This study analyzed the size of polyps and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with narrow band imaging (NBI), suggests that high definition scope was more sensitive in diagnosis of adenoma than standard white light colonoscope without NBI scope. Hence we save money for eliminating time and the cost of immunohistochemistry/pathology.