Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2022; 28(10): 1055-1066
Published online Mar 14, 2022. doi: 10.3748/wjg.v28.i10.1055
Diagnostic performance of endoscopic classifications for neoplastic lesions in patients with ulcerative colitis: A retrospective case-control study
Yuichi Kida, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Yasuyuki Mizutani, Naomi Kakushima, Kazuhiro Furukawa, Takuya Ishikawa, Eizaburo Ohno, Hiroki Kawashima, Masanao Nakamura, Masatoshi Ishigami, Mitsuhiro Fujishiro
Yuichi Kida, Takeshi Yamamura, Eri Ishikawa, Yasuyuki Mizutani, Naomi Kakushima, Kazuhiro Furukawa, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Masatoshi Ishigami, Mitsuhiro Fujishiro, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Aichi, Japan
Keiko Maeda, Tsunaki Sawada, Hiroki Kawashima, Department of Endoscopy, Nagoya University Hospital, Nagoya 466-8560, Aichi, Japan
Mitsuhiro Fujishiro, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Author contributions: Kida Y and Yamamura T contributed to the conception and design; Kida Y, Yamamura T, Kawashima H, Ishikawa E, and Kakushima N contributed to the analysis and interpretation of the data; Kida Y drafted the article; Nakamura M, Ohno E, Sawada T, Maeda K, Ishikawa T, Ishigami M, and Furukawa K contributed to the critical revision of the article for important intellectual content; Mizutani Y, Yamamura T and Nakamura M contributed to statistical analysis; Fujishiro M made the final approval of the article; all authors have read and approved the final manuscript.
Institutional review board statement: The use of patient data for this study was approved by the Ethics Committee of Nagoya University Hospital, No. 2015-0485.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takeshi Yamamura, MD, PhD, Assistant Professor, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Aichi, Japan. tyamamu@med.nagoya-u.ac.jp
Received: September 14, 2021
Peer-review started: September 14, 2021
First decision: November 16, 2021
Revised: November 29, 2021
Accepted: January 29, 2022
Article in press: January 29, 2022
Published online: March 14, 2022
Processing time: 177 Days and 23.7 Hours
Abstract
BACKGROUND

It is unclear whether the Japan Narrow-Band Imaging Expert Team (JNET) classification and pit pattern classification are applicable for diagnosing neoplastic lesions in patients with ulcerative colitis (UC).

AIM

To clarify the diagnostic performance of these classifications for neoplastic lesions in patients with UC.

METHODS

This study was conducted as a single-center, retrospective case-control study. Twenty-one lesions in 19 patients with UC-associated neoplasms (UCAN) and 23 lesions in 22 UC patients with sporadic neoplasms (SN), evaluated by magnifying image-enhanced endoscopy, were retrospectively and separately assessed by six endoscopists (three experts, three non-experts), using the JNET and pit pattern classifications. The results were compared with the pathological diagnoses to evaluate the diagnostic performance. Inter- and intra-observer agreements were calculated.

RESULTS

In this study, JNET type 2A and pit pattern type III/IV were used as indicators of low-grade dysplasia, JNET type 2B and pit pattern type VI low irregularity were used as indicators of high-grade dysplasia to shallow submucosal invasive carcinoma, JNET type 3 and pit pattern type VI high irregularity/VN were used as indicators of deep submucosal invasive carcinoma. In the UCAN group, JNET type 2A and pit pattern type III/IV had a low positive predictive value (PPV; 50.0% and 40.0%, respectively); however, they had a high negative predictive value (NPV; 94.7% and 100%, respectively). Conversely, in the SN group, JNET type 2A and pit pattern type III/IV had a high PPV (100% for both) but a low NPV (63.6% and 77.8%, respectively). In both groups, JNET type 3 and pit pattern type VI-high irregularity/VN showed high specificity. The inter-observer agreement of JNET classification and pit pattern classification for UCAN among experts were 0.401 and 0.364, in the same manner for SN, 0.666 and 0.597, respectively. The intra-observer agreements of JNET classification and pit pattern classification for UCAN among experts were 0.387, 0.454, for SN, 0.803 and 0.567, respectively.

CONCLUSION

The accuracy of endoscopic diagnosis using both classifications was lower for UCAN than for SN. Endoscopic diagnosis of UCAN tended to be underestimated compared with the pathological results.

Keywords: Diagnostic performance; Japan Narrow-Band Imaging Expert Team classification; Pit pattern classification; Sporadic neoplasms; Ulcerative colitis; Ulcerative colitis-associated neoplasms

Core Tip: This retrospective case-control study evaluated the diagnostic performance of the Japan Narrow-Band Imaging Expert Team (JNET) and pit pattern classifications for neoplastic lesions in patients with ulcerative colitis (UC). The JNET and pit pattern classifications did not show high accuracy in diagnosing the pathology and invasion depth of neoplastic lesions in patients with UC. Endoscopic diagnosis of UC-associated neoplasms tended to be underestimated when compared with pathological results. Endoscopic diagnosis of neoplastic lesions in patients with UC is still difficult, and treatment strategies need to be carefully determined.