Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2658-2665
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2658
Effective use of the Japan Narrow Band Imaging Expert Team classification based on diagnostic performance and confidence level
Daizen Hirata, Hiroshi Kashida, Mineo Iwatate, Tomomasa Tochio, Akira Teramoto, Yasushi Sano, Masatoshi Kudo
Daizen Hirata, Mineo Iwatate, Tomomasa Tochio, Akira Teramoto, Yasushi Sano, Gastrointestinal Center and Institute of Minimally-invasive Endoscopic Care, Sano Hospital, Kobe 6550031, Japan
Daizen Hirata, Hiroshi Kashida, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University, Osaka 5895811, Japan
Author contributions: Hirata D, Kashida H, Sano Y and Kudo M designed research; Hirata D, Iwatate M, Tochio T, Teramoto A and Sano Y performed research; Hirata D and Iwatate M performed literature review; Hirata D and Iwatate M analyzed data; HirataD wrote the paper; Kashida H and Kudo M contributed critical revision and editing.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Daizen Hirata, MD, Doctor, Gastrointestinal Center and Institute of Minimally-invasive Endoscopic Care, Sano Hospital, 2-5-1 Shimizugaoka, Tarumi-ku, Kobe 6550031, Japan. daizenhirata@gmail.com
Telephone: +81-78-7851000Fax: +81-78-7850077
Received: June 4, 2019
Peer-review started: June 4, 2019
First decision: July 21, 2019
Revised: August 18, 2019
Accepted: August 27, 2019
Article in press: August 26, 2019
Published online: September 26, 2019
Processing time: 112 Days and 22.9 Hours
Abstract

Five years have passed since the Japan Narrow Band Imaging Expert Team (JNET) classification was proposed in 2014. However, the diagnostic performance of this classification has not yet been established. We conducted a retrospective study and a systematic search of Medical Literature Analysis and Retrieval System On-Line. There were three retrospective single center studies about the diagnostic performance of this classification. In order to clarify this issue, we reviewed our study and three previous studies. This review revealed the diagnostic performance in regards to three important differentiations. (1) Neoplasia from non-neoplasia; (2) malignant neoplasia from benign neoplasia; and (3) deep submucosal invasive cancer (D-SMC) from other neoplasia. The sensitivity in differentiating neoplasia from non-neoplasia was 98.1%-99.8%. The specificity in differentiating malignant neoplasia from benign neoplasia was 84.7%-98.2% and the specificity in the differentiation D-SMC from other neoplasia was 99.8%-100.0%. This classification would enable endoscopists to identify almost all neoplasia, to appropriately determine whether to perform en bloc resection or not, and to avoid unnecessary surgery. This article is the first review about the diagnostic performance of the JNET classification. Previous reports about the diagnostic performance have all been retrospective single center studies. A large-scale prospective multicenter evaluation study is awaited for the validation.

Keywords: Japan Narrow Band Imaging Expert Team; Classification; Magnifying endoscopy; Narrow-band imaging; Validation; Diagnostic performance; Colonoscopy; Colorectal neoplasms

Core tip: This is the first review of the Japan Narrow Band Imaging Expert Team classification regarding the diagnostic performance. There are three important differentiations: neoplasia from non-neoplasia, malignant neoplasia from benign neoplasia, and deep submucosal invasive cancer (D-SMC) from other neoplasia. The sensitivity in differentiating neoplasia from non-neoplasia was 98.1%-99.8%. The specificity in differentiating malignant neoplasia from benign neoplasia was 84.7%-98.2% and the specificity in differentiating D-SMC from other neoplasia was 99.8%-100.0%. This classification will enable endoscopists to identify almost all neoplasia, to appropriately determine whether to perform en bloc resection or not, and to avoid unnecessary surgery.