Retrospective Study
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World J Gastrointest Endosc. Dec 16, 2014; 6(12): 600-605
Published online Dec 16, 2014. doi: 10.4253/wjge.v6.i12.600
Narrow-band imaging observation of colorectal lesions using NICE classification to avoid discarding significant lesions
Santa Hattori, Mineo Iwatate, Wataru Sano, Noriaki Hasuike, Hidekazu Kosaka, Taro Ikumoto, Masahito Kotaka, Akihiro Ichiyanagi, Chikara Ebisutani, Yasuko Hisano, Takahiro Fujimori, Yasushi Sano
Santa Hattori, Mineo Iwatate, Wataru Sano, Noriaki Hasuike, Hidekazu Kosaka, Taro Ikumoto, Masahito Kotaka, Akihiro Ichiyanagi, Yasushi Sano, Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care, Sano Hospital, Hyogo 655-0031, Japan
Chikara Ebisutani, Department of Gastroenterology, Kobe Minimally Invasive Treatment Center of Cancer, Hyogo 650-0046, Japan
Yasuko Hisano, Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Hyogo 650-0017, Japan
Takahiro Fujimori, Department of Pathology, Shinko Hospital, Hyogo 651-0072, Japan
Author contributions: Hattori S, Iwatate M, Sano W, Hasuike N, Kosaka H, Ikumoto T, Kotaka M, Ichiyanagi A, Ebisutani C, Hisano Y, Fujimori T and Sano Y designed the study; Hattori S collected data; Hattori S and Sano Y drafted this study, analyzed data and wrote the manuscript.
Supported by Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, No. 2014-02
Correspondence to: Santa Hattori, MD, PhD, Gastrointestinal Center and Institution of Minimally Invasive Endoscopic Care, Sano Hospital, 2-5-1 Shimizugaoka, Tarumi-ku, Kobe, Hyogo 655-0031, Japan. sahattor@hotmail.com
Telephone: +81-78-7851000 Fax: +81-78-7850077
Received: June 28, 2014
Revised: October 31, 2014
Accepted: November 7, 2014
Published online: December 16, 2014
Processing time: 173 Days and 5.4 Hours
Abstract

AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the “resect and discard” policy.

METHODS: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancers and their endoscopic features were assessed.

RESULTS: In total, we found 681 cases of diminutive (1-5 mm) lesions in 402 patients and 197 cases of small (6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal (SM) scanty invasive carcinomas, 1 and 1 were SM-d carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 endoscopically.

CONCLUSION: The risk of failing to detect diminutive and small colorectal invasive cancer with the “resect and discard” strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.

Keywords: Image-enhanced endoscopy; Narrow-band imaging; Resect and discard; NICE classification; Magnifying endoscope; Colonoscopy; SM-d

Core tip: Discarding a polyp without performing histological evaluation runs the risk of failing to detect small invasive colorectal cancer. Retrospectively, we aimed to assess the risk of failing to detect diminutive and small colorectal invasive cancer with the “resect and discard” strategy by using the NICE classification scheme with a magnifying endoscope. We reviewed and assessed 878 polyps less than 1 cm in diameter detected in our hospital. Among them, 2 SM-d carcinomas were found and both of their optical features were classified as NICE type 3. We concluded that the risk of failing to detect diminutive and small invasive colorectal cancer with the “resect and discard” strategy might be prevented by employing NICE classification under narrow-band imaging magnification.