Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2021; 13(1): 58-68
Published online Jan 15, 2021. doi: 10.4251/wjgo.v13.i1.58
Diagnostic performance of narrow-band imaging international colorectal endoscopic and Japanese narrow-band imaging expert team classification systems for colorectal cancer and precancerous lesions
Yun Wang, Wen-Kun Li, Ya-Dan Wang, Kui-Liang Liu, Jing Wu
Yun Wang, Department of Gastroenterology, Peking University Ninth School of Clinical Medicine, Beijing 100038, China
Wen-Kun Li, Ya-Dan Wang, Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Kui-Liang Liu, Jing Wu, Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China
Author contributions: Wu J, Wang Y, Wang YD, and Li WK devised the study concept and design; Wang Y, Wang YD and Li WK acquired the data; Wang Y completed the statistical analysis and drafting of the manuscript; Wang YD and Liu KL performed the colonoscopy; Wu J and Liu KL provided critical review of the manuscript; All authors read and approved the final version.
Supported by Digestive Medical Coordinated Development Center of Beijing Hospitals Authority, No. XXZ015; Capital Citizens Health Cultivation Project of Beijing Municipal Science & Technology Commission, No. Z161100000116084; Medical and Health Public Foundation of Beijing, No. YWJKJJHKYJJ-B17262-067; and Science and Technology Development Project of China State Railway Group, No. N2019Z004.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Beijing Shijitan Hospital, Capital Medical University, No. 2018-59.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this paper.
Data sharing statement: Dataset available from the corresponding author at bjsjtyywj@ccmu.edu.cn.
STROBE statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised according to the STROBE Statement - checklist of items.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Wu, PhD, Director, Professor, Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. bjsjtyywj@ccmu.edu.cn
Received: October 31, 2020
Peer-review started: October 31, 2020
First decision: November 30, 2020
Revised: December 5, 2020
Accepted: December 17, 2020
Article in press: December 17, 2020
Published online: January 15, 2021
Processing time: 67 Days and 17.5 Hours
ARTICLE HIGHLIGHTS
Research background

Detecting and treating early stage colorectal cancer (CRC) and precancerous lesions is the most effective method to reduce the morbidity and mortality of CRC. Narrow-band imaging (NBI) endoscopy has been a very useful technique that has contributed to improving the detection rate of early stage CRC and precancerous lesions. Researchers have proposed a variety of NBI classifications to judge the nature of lesions accurately and select treatment strategy appropriately.

Research motivation

For the past few years, two new NBI classifications have been proposed: The NBI international colorectal endoscopic (NICE) classification and Japanese NBI expert team (JNET) classification. Most validation studies of the two new NBI classifications were conducted in originating centers by experienced endoscopists, but application in different centers among endoscopists with varying endoscopic skills remains unknown.

Research objectives

To achieve external validity, we evaluated the clinical application and possible problems of the NICE and JNET classifications for differential diagnosis of colorectal cancer and precancerous lesions.

Research methods

Six endoscopists with varying levels of experience were divided into two groups: Highly experienced endoscopists (HEEs) and less-experienced endoscopists (LEE). Eighty-seven consecutive patients with a total of 125 lesions were photographed during non-magnifying conventional white-light colonoscopy, non-magnifying NBI, and magnifying NBI. The three groups of endoscopic pictures of each lesion were evaluated by the six endoscopists in a randomized order using the NICE and JENT classifications separately. We calculated sensitivity, specificity, accuracy, positive and negative predictive value for each category of the two classifications.

Research results

In both the HEE and LEE groups, the specificity of JNET classification type 1 and 3 and NICE classification type 3 was > 95%, and the overall interobserver agreement was good in both groups. However, the sensitivity of JNET classification type 2B lesions for the diagnosis of high-grade dysplasia or superficial submucosal invasive carcinoma in both the HEE and LEE groups was < 55%. Compared with other types of NICE and JNET classification, the diagnostic ability of JNET type 2B was the weakest.

Research conclusions

Due to the poor diagnostic capabilities of JNET type 2B, the type 2B lesions is still the biggest challenge for the endoscopists. So, lesions of type 2B need an additional examination to choose an appropriate treatment strategy.

Research perspectives

The JNET type 2B lesions are the most important for curation and the most difficult to be diagnosed endoscopically, and accurate diagnosis of JNET 2B lesions still requires further efforts.