Diagnostic performance of endoscopic classifications for neoplastic lesions in patients with ulcerative colitis: A retrospective case-control study

doi:10.3748/wjg.v28.i10.1055

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Mar 14, 2022; 28(10): 1055-1066
Published online Mar 14, 2022. doi: 10.3748/wjg.v28.i10.1055

Table 1 Clinical characteristics of ulcerative colitis patients with neoplastic lesions (mean ± SD)

	UCAN group (n = 19)	SN group (n = 22)	P value
Age at UC onset (yr)	35.7 ± 10.9	48.8 ± 14.6	0.003^a
Disease duration (yr)	17.8 ± 9.4	12.9 ± 10.7	0.120^a
Sex			0.829^b
Male	11	12
Female	8	10
Extent of disease			0.231^b
Total colitis	16	14
Left-sided colitis	3	6
Proctitis	0	2
Clinical type			0. 139^b
Relapse and remission	10	15
Chronic persistent	9	5
First attack	0	2
Pathological type			< 0.001^b
LGD	2	16
HGD	11	5
Shallow submucosal invasive carcinoma	3	0
Deep submucosal invasive carcinoma	5	2
Primary sclerosing cholangitis	1	0	0.463^c
Family history of colorectal cancer	1	2	0.639^c

^aStudent t-test.

^bChi-square test.

^cFisher’s exact test.

P < 0.05 was considered statistically significant. SD: Standard deviation; HGD: High-grade dysplasia; LGD: Low-grade dysplasia; SN: Sporadic neoplasms; UC: Ulcerative colitis; UCAN: Ulcerative colitis-associated neoplasms.

Table 2 Characteristics of endoscopic and macroscopic findings

	UCAN group (n = 21)	SN group (n = 23)	P value
Tumor location			0.044^a
Proctosigmoid colon	17	12
Others	4	11
Tumor color			0.032^a
Red	15	9
Pale or the same as the surrounding mucosa	6	14
Lesion border			< 0.001^a
Clear	5	23
Unclear	16	0
Tumor morphology			0.173^a
Pedunculated	0	0
Sessile	8	7
Superficial elevated	7	14
Flat	2	0
Depressed	4	2
UCEIS (median, range)	2 (0–4)	0 (0–5)	< 0.001^b

^aChi-square test.

^bMann–Whitney U test.

P < 0.05 was considered statistically significant. SN: Sporadic neoplasms; UCAN: Ulcerative colitis-associated neoplasms; UCEIS: Ulcerative Colitis Endoscopic Index of Severity.

Table 3 Diagnostic performance (95% confidence interval) for each type in the Japan Narrow-Band Imaging Expert Team classification

	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)
UCAN JNET type 2A
Experts	50.0 (10.2–85.6)	94.7 (90.5–98.5)	50.0 (10.2–85.6)	94.7 (90.5–98.5)	90.5 (82.9–97.3)
Non-experts	100 (36.9–100)	78.9 (72.3–78.9)	33.3 (12.3–33.3)	100 (91.6–100)	81.0 (68.9–81.0)
UCAN JNET type 2B
Experts	78.6 (64.6–89.5)	57.1 (29.2–79.1)	78.6 (64.6–89.5)	57.1 (29.2–79.1)	71.4 (52.8–86.1)
Non-experts	78.6 (63.8–87.9)	71.4 (41.9–90.0)	84.6 (68.7–94.6)	62.5 (36.6–78.8)	76.2 (56.5–88.6)
UCAN JNET type 3
Experts	60.0 (27.5–75.9)	93.8 (83.6–98.7)	75.0 (34.4–94.9)	88.2 (78.7–92.9)	85.7 (70.3–93.3)
Non-experts	40.0 (14.9–40.0)	100 (92.2–100)	100 (37.3–100)	84.2 (77.6–84.2)	85.7 (73.8–85.7)
SN JNET type 2A
Experts	75.0 (62.6–75.0)	100 (71.6–100)	100 (83.4–100)	63.6 (45.5–63.6)	82.6 (65.3–82.6)
Non-experts	87.5 (74.7–92.5)	85.7 (56.4–97.1)	93.3 (79.6–98.7)	75.0 (49.3–85.0)	87.0 (69.1–93.9)
SN JNET type 2B
Experts	100 (63.4–100)	83.3 (73.2–83.3)	62.5 (39.6–62.5)	100 (87.8–100)	87.0 (71.0–87.0)
Non-experts	80.0 (42.6–96.1)	83.3 (72.9–87.8)	57.1 (30.4–68.7)	93.8 (82.1–98.8)	82.6 (66.4–89.6)
SN JNET type 3
Experts	50.0 (11.2–50.0)	100 (96.3–100)	100 (22.4–100)	95.5 (91.9–95.5)	95.7 (88.9–95.7)
Non-experts	50.0 (11.2–50.0)	100 (96.3–100)	100 (22.4–100)	95.5 (91.9–95.5)	95.7 (88.9–95.7)

CI: Confidence interval; NPV: Negative predictive value; PPV: Positive predictive value; SN: Sporadic neoplasms; UCAN: Ulcerative colitis-associated neoplasms; JNET: Japan Narrow-Band Imaging Expert Team.

Table 4 Diagnostic performance (95% confidence interval) for each type in the pit pattern classification

	Sensitivity, (%)	Specificity, (%)	PPV, (%)	NPV, (%)	Accuracy, (%)
UCAN pit pattern type III/IV
Experts	100 (37.3–100)	84.2 (77.6–84.2)	40.0 (14.9–40.0)	100 (92.2–100)	85.7 (73.8–85.7)
Non-experts	100 (36.4–100)	57.9 (51.2–57.9)	20.0 (7.3–20.0)	100 (88.4–100)	61.9 (49.8–61.9)
UCAN pit pattern type V_I low irregularity
Experts	50.0 (35.2–59.8)	71.4 (41.9–91.0)	77.8 (54.8–93.0)	41.7 (24.4–53.1)	57.1 (37.5–70.2)
Non-experts	42.9 (28.4–48.7)	85.7 (56.7–97.3)	85.7 (56.7–97.3)	42.9 (28.4–48.7)	57.1 (37.8–64.9)
UCAN pit pattern type V_I high irregularity/V_N
Experts	60.0 (26.1–85.8)	81.3 (70.7–89.3)	50.0 (21.8–71.5)	86.7 (75.4–95.3)	76.2 (60.1–88.5)
Non-experts	60.0 (27.5–75.9)	93.8 (83.6–98.7)	75.0 (34.4–94.9)	88.2 (78.7–92.9)	85.7 (70.3–93.3)
SN pit pattern type III/IV
Experts	87.5 (75.6–87.5)	100 (72.8–100)	100 (86.4–100)	77.8 (56.6–77.8)	91.3 (74.8–91.3)
Non-experts	81.3 (68.1–86.3)	85.7 (55.6–97.3)	92.9 (77.8–98.6)	66.7 (43.3–75.6)	82.6 (64.3–89.6)
SN pit pattern type V_I low irregularity
Experts	100 (63.4–100)	83.3 (73.2–83.3)	62.5 (39.6–62.5)	100 (87.8–100)	87.0 (71.0–87.0)
Non-experts	60.0 (26.0–85.9)	83.3 (73.9–90.5)	50.0 (21.7–71.6)	88.2 (78.2–95.8)	78.3 (63.5–89.5)
SN pit pattern type V_I high irregularity/V_N
Experts	50.0 (11.2–50.0)	100 (96.3–100)	100 (22.4–100)	95.5 (91.9–95.5)	95.7 (88.9–95.7)
Non-experts	50.0 (10.2–85.6)	95.2 (91.4–98.6)	50.0 (10.2–85.6)	95.2 (91.4–98.6)	91.3 (84.4–97.5)

CI: Confidence interval; NPV: Negative predictive value; PPV: Positive predictive value; SN: Sporadic neoplasms; UCAN: Ulcerative colitis-associated neoplasms.

Table 5 Intra-observer agreement

	Experts	Non-experts
UCAN
JNET classification	0.387 (0.369–0.521)	0.640 (0.566–0.708)
Pit pattern classification	0.454 (0.391–0.509)	0.569 (0.422–0.599)
SN
JNET classification	0.803 (0.581–0.832)	0.828 (0.686–0.849)
Pit pattern classification	0.567 (0.477–0.595)	0.628 (0.422–0.766)

JNET: Japan Narrow-Band Imaging Expert Team; SN: Sporadic neoplasms; UCAN: Ulcerative colitis-associated neoplasms.

Table 6 Inter-observer agreement

	Experts	Non-experts
UCAN
JNET classification	0.401	0.237
Pit pattern classification	0.364	0.378
SN
JNET classification	0.666	0.503
Pit-pattern classification	0.597	0.437

JNET: Japan Narrow-Band Imaging Expert Team; SN: Sporadic neoplasms; UCAN: Ulcerative colitis-associated neoplasms.

Table 7 Diagnostic results of Japan Narrow-Band Imaging Expert Team classification type 2A and pit pattern classification type III/IV in ulcerative colitis-associated neoplasms

	Number	Pathological result
	Number	LGD (n = 2)	HGD-sSM (n = 14)	dSM (n = 5)
Endoscopist 1
JNET type 2A	8	1	7	0
Pit type III/IV	7	2	3	2
Endoscopist 2
JNET type 2A	2	1	1	0
Pit type III/IV	5	2	3	0
Endoscopist 3
JNET type 2A	2	0	1	1
Pit type III/IV	7	2	5	0
Endoscopist 4
JNET type 2A	9	2	6	1
Pit type III/IV	8	2	5	1
Endoscopist 5
JNET type 2A	5	2	2	1
Pit type III/IV	8	2	6	0
Endoscopist 6
JNET type 2A	7	2	5	0
Pit type III/IV	9	2	6	1

LGD: Low-grade dysplasia; HGD: High-grade dysplasia; sSM: Shallow submucosal invasive carcinoma; dSM: Deep submucosal invasive carcinoma; JNET: Japan Narrow-Band Imaging Expert Team; UCAN: Ulcerative colitis-associated neoplasms.

Citation: Kida Y, Yamamura T, Maeda K, Sawada T, Ishikawa E, Mizutani Y, Kakushima N, Furukawa K, Ishikawa T, Ohno E, Kawashima H, Nakamura M, Ishigami M, Fujishiro M. Diagnostic performance of endoscopic classifications for neoplastic lesions in patients with ulcerative colitis: A retrospective case-control study. World J Gastroenterol 2022; 28(10): 1055-1066
URL: https://www.wjgnet.com/1007-9327/full/v28/i10/1055.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i10.1055