Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2020; 26(40): 6279-6294
Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6279
Diagnostic efficacy of the Japan Narrow-band-imaging Expert Team and Pit pattern classifications for colorectal lesions: A meta-analysis
Yu Zhang, Hui-Yan Chen, Xiao-Lu Zhou, Wen-Sheng Pan, Xin-Xin Zhou, Hang-Hai Pan
Yu Zhang, Wen-Sheng Pan, Hang-Hai Pan, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Hui-Yan Chen, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
Xiao-Lu Zhou, Department of Medical College, The Medical College of Qingdao University, Qingdao 266071, Shandong Province, China
Xin-Xin Zhou, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Zhang Y contributed to the conception and design of the study, and critical revision; Pan HH and Zhou XX contributed to the acquisition of data and data analysis; Pan HH, Zhou XX, Pan WS, Chen HY and Zhou XL contributed to the interpretation of data; Pan HH and Zhou XX drafted the article; Pan WS, Chen HY and Zhou XL revised the manuscript; all authors contributed to the final approval of the manuscript.
Supported by the Natural Science Foundation of Zhejiang Province, No. LQ20H160061; and Medical Health Science and Technology Project of Zhejiang Provincial Health Commission, No. 2018255969
Conflict-of-interest statement: No potential conflicts of interest exist.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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:
Corresponding author: Hang-Hai Pan, MD, Attending Doctor, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People's Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China.
Received: June 21, 2020
Peer-review started: June 21, 2020
First decision: August 21, 2020
Revised: August 26, 2020
Accepted: September 23, 2020
Article in press: September 23, 2020
Published online: October 28, 2020
Research background

The Pit pattern classification using magnifying chromoendoscopy is the established and traditional choice for diagnosing colorectal lesions. The Japan Narrow-band imaging (NBI) Expert Team (JNET) classification is a novel NBI magnifying endoscopic classification, which focuses on vessel and surface patterns to diagnose colorectal lesions. However, the comparative diagnostic efficacy of the JNET classification is inconclusive.

Research motivation

Several studies have proposed that the JNET classification of colorectal lesions via NBI magnifying endoscopy is a useful and objective tool for differentiating the gross type of colorectal lesions. However, to what extent we can trust the results of the JNET classification, and whether the Pit pattern classification can be replaced by the JNET classification are aspects that remain unclear.

Research objectives

To perform a systematic review and meta-analysis on the diagnostic efficacy of each category of the JNET and Pit pattern classifications for colorectal lesions.

Research methods

A systematic literature search was performed using PubMed, Embase, the Cochrane Library and Web of Science. The pooled sensitivity, specificity, diagnostic odds ratio, and area under the curve (AUC) of each category of the JNET and Pit pattern classifications were calculated.

Research results

A total of 19227 colorectal lesions in 31 studies were included. The diagnostic performance of the JNET classification was equivalent to the Pit pattern classification in each corresponding category. The pooled sensitivity, specificity, and AUC for each category of the JNET classification were as follows: 0.73 (95%CI: 0.55-0.85), 0.99 (95%CI: 0.97-1.00), and 0.97 (95%CI: 0.95-0.98), respectively, for Type 1; 0.88 (95%CI: 0.78-0.94), 0.72 (95%CI: 0.64-0.79), and 0.84 (95%CI: 0.81-0.87), respectively, for Type 2A; 0.56 (95%CI: 0.47-0.64), 0.91 (95%CI: 0.79-0.96), and 0.72 (95%CI: 0.68-0.76), respectively, for Type 2B; 0.51 (95%CI: 0.42-0.61), 1.00 (95%CI: 1.00-1.00), and 0.90 (95%CI: 0.87-0.93), respectively, for Type 3.

Research conclusions

Our study found that the diagnostic efficacy of the JNET classification is equivalent to that of the Pit pattern classification as both classifications are divided into four major categories according to similar histopathology.

Research perspectives

The JNET classification is easier for guiding the choice of treatment strategy, which suggests that we can promote the application of the JNET classification for colorectal lesions in the clinic. However, future prospective multi-center studies with uniform endoscopic and histopathology protocol are required to validate our results.