![]() ![]() This study is a multi-center evaluator-blinded randomized controlled noninferiority trial in patients who underwent endoscopic resection (ER) of colorectal tumors. ![]() The NICE and JNET classifications have both improved the quality of endoscopy and many endoscopists have used these methods. The JNET classifies colorectal lesions into four types based on vessel and surface patterns. Going through repeated detailed discussion and a web-based prospective trial, JNET achieved consensus regarding NBI classification, and a new NBI colorectal magnifying classification (the JNET classification) was proposed in 2014. To resolve this issue, the Japanese NBI Expert Team (JNET) of Japanese magnifying colonoscopists was organized in 2011. This is because these lesions sometimes have vascular or lymphatic invasion or lymph node metastasis and require accurate pathological diagnosis. Clinically, it is important to resect intramucosal carcinoma and s-SM invasive carcinoma en-bloc by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). However, NICE Type 2 includes from low-grade dysplasia (LGD) to intramucosal carcinoma and shallow submucosal (s-SM) invasive carcinoma, and it is difficult to differentiate high-grade dysplasia (HGD) or s-SM carcinoma from LGD. The NICE classification is divided into Type 1-3, Type 1 indicates non-neoplastic lesions, such as hyperplastic polyp (HP) and sessile serrated lesions (SSL) Type 2 indicates adenomatous lesions and Type 3 indicates deep submucosal (d-SM) invasive carcinoma (Supplemental Figure 1). The NBI international colorectal endoscopic (NICE) classification has been proposed and has been reported to be effective for colorectal lesions. There are many reports on the usefulness of NBI for detection and diagnosis of colorectal neoplasm. Since then, in most countries where gastrointestinal endoscopies are performed, NBI is one of the most frequently used optical digital methods of performing IEE. Narrow band imaging (NBI), one of the optical digital methods of IEE, was launched in 2005 by Olympus Medical Systems. However, crystal violet staining and magnified observation are costly, time-consuming and labor-intensive therefore, simpler methods are required. So far, the method with the highest diagnostic accuracy is the pit pattern classification using crystal violet, as reported by Kudo et al. IEE involves various means of enhancing contrast during endoscopy, using equipment, to improve visualization of lesions and potentially gain insight into the pathology of the lesions. Image-enhanced endoscopy (IEE) is useful for improving the qualitative diagnosis of colorectal tumors, and knowledge of it has increased in recent years. This trial was registered as UMIN000032107. This is first trial to compare the diagnostic accuracy with NBI, Laser-BLI and LED-BLI and useful to understand the position of each IEE. Laser-BLI and LED-BLI had high diagnostic accuracy and non-inferiority of NBI, especially for hyperplastic polyp/sessile serrated lesion and low-grade dysplasia. In non-inferiority test, Laser-BLI and LED-BLI revealed non-inferiority to NBI in all NICE and JNET categories ( p<0.001). The diagnostic accuracy of NBI for NICE 1, NICE 2, NICE 3 was 90.6%, 90.3% and 99.5%, respectively and for JNET 1, JNET 2A, JNET 2B and JNET 3, it was 94.6%, 72.0%, 79.2% and 99.1%, respectively. ResultsĪ total of 619 colonic tumors were resected from 230 patients and evaluated by external four evaluators. The diagnostic accuracy of each endoscopy system was compared with non-inferiority test. Cropped images were sent to blinded external evaluators and diagnosed according to NICE and JNET classifications. The patients were randomly assigned to NBI, Laser-BLI or LED-BLI. This was a multi-center evaluator-blinded, randomized control trial of patients who underwent endoscopic colorectal tumor resection. The present study aimed to compare the diagnostic accuracy of the three methods for colorectal tumor using the NBI international colorectal endoscopic (NICE) classification and the Japanese NBI Expert Team (JNET) classifications. No studies have directly compared the diagnostic accuracy of narrow band imaging (NBI), Laser-BLI and LED-BLI for colorectal tumors. New image-enhanced endoscopy (IEE), blue Light Imaging (LED-BLI) is launched in USA and Europe, whereas Blue Laser Imaging (Laser-BLI) is available only Asian and some countries. ![]()
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