Efficacy of Narrow Band Imaging in Detecting Lower Gi Lesions and Its Histologic Correlation

Mohammad moin; Afzal Anees; Noora Saeed; Kafil Akhtar

doi:10.21276/apalm.1722

Authors

Mohammad moin
Afzal Anees
Noora Saeed
Kafil Akhtar

DOI:

https://doi.org/10.21276/apalm.1722

Keywords:

GI Lesions, Narrow band imaging, Endoscopy, Histopathology.

Abstract

Background: To evaluate the efficacy of Narrow band imaging (NBI) in detecting lower GI lesions and differentiation on the basis of color, vascular pattern and surface pattern findings on NBI with histopathologic correlation.

Material and Methods: 94 patients of both gender, with lower GI symptoms were subjected for lower GI endoscopy by conventional white light endoscopy and CLV-190 HD colonoscope having Narrow-band imaging (NBI) as standard feature after obtaining an informed consent. Patients who did not give consent, patients with severe inflammatory bowel disease and who lost during follow up were excluded from the study. All NBI findings of suspected lesions were classified according to NICE (NBI International Colorectal Endoscopic) classification, into hyperplastic lesion, adenomatous and invasive carcinoma. Biopsies were taken and stained with Haematoxylin and Eosin as well as Periodic Acid Schiff stain. Statistical analysis was done to compare NBI diagnosis with the histopathological diagnosis.

Results: Majority of the patients were in the third decade of life, with a mean age of 36.22 years. Diarrhea was the commonest clinical presentation, in 60 (63.8%) patients. NBI was suggestive of ulcerative colitis/Inflammatory bowel disease (IBD) in 59 (62.8%) patients, neoplastic polypoidal lesion in 24 patients (25.5%) and polypoidal non-neoplastic lesion in 11 (11.7%) patients. Out of 59 (62.8%) cases of Ulcerative colitis (UC), 35 (37.2%) were polypoidal, among which 24 (68.6%) were suggestive of neoplastic polypoidal lesion (NICE II-III) and 11(31.4%) were non-neoplastic polypoidal lesion (NICE I). Out of 59 cases of UC, clear mucosal vascular pattern (MVP) was found in 11 (18.6%) cases and obscure MVP in 48 (81.4%) cases.

Conclusions: NBI provides a unique image with contrast enhancement and can emphasize the capillary pattern and surface architecture and plays a major role in the differentiation of neoplastic and non-neoplastic colorectal lesion, with high sensitivity and specificity.

References

1. Su MY, Hsu CM, Ho YP, Chen PC, Lin CJ, Chiu CT. Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps. Am J Gastroenterol 2006; 101:2711-16.
2. Lapalus MG, Helbert T, Napoleon B, Rey JF, Houcke P. Does chromoendoscopy with structure enhancement improve the colonoscopic adenoma detection rate? Endoscopy 2006; 38:444-48.
3. Kuznetsov K, Lambert R, Rey JF. Narrow-band imaging: Potential and limitation. Endoscopy 2006; 38:76-81.
4. Konerding MA, Fait E, Gaumann A. 3D microvascular architecture of pre-cancerous lesion and invasive carcinoma of the colon. Br J Cancer 2001; 84:1354-62.
5. East JE. Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity, Endoscopy 2008; 40:811-17.
6. Rastogi A, Pondugula K, Bansal A. Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. Gastrointest Endosc 2009; 69(32):716-22.
7. East JE, Kamm MA, Bassett P, Saunders BP. Magnification panchromo-endoscopy remains the mainstay for colitis dysplasia detection and differentiation. Gastroenterol 2007; 133: 366-67.
8. Singh R, Anagnostopoulos G, Yao K, Karageorgiou H, Fortun P, ShondeA et al. Narrow-band imaging with magnication in barrett's esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy 2008; 40(6): 457-63.
9. Sano Y. Narrow Band Imaging (NBI). Clin Gastroenterol 2009; 24: 47-52.
10. Kudo T, Matsumoto T, Esaki M, Yao T, Iid M. Mucosal vascular pattern in ulcerative colitis: observations using narrow band imaging colonoscopy with special reference to histologic inflammation. Int J Colorectal Dis 2009; 24:495-99.
11. Foss F, West K, McGregor A. Pathology of polyps detected in the bowel cancer screening programme. Diagn Histopathol 2011; 17:495-99.
12. Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroentrology. Am J Gastroenterol 2000; 95: 3053-63.
13. Chiu HM, Chang CY, Chen CC. A prospective comparative study of narrow-band imaging, chromoendoscopy and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut 2007; 56:373-79.
14. Machida H, Sano Y, Hamamoto Y, Muto M, Kozu T, Tajiri H, Yoshida S. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy 2004; 36:1094-98.
15. Wu L, Li Y, Li Z, Cao Y, Gao F. Diagnostic accuracy of narrow- band imaging for the differentiation of neoplastic from non- neoplastic colorectal polyps: a meta-analysis. Colorectal Dis 2013; 15:3-11.
16. Matsumoto T, Kudo T, Yao T, lida M. Auto fluorescence imaging colonoscopy in ulcerative colitis: comparison with conventional and narrow-band imaging colonoscopy. Diag Endosc 2010; 21:139-43.