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Narrow Band Imaging, Magnifying Chromoendoscopy, and Gross Morphological Features for the Optical Diagnosis of T1 Colorectal Cancer and Deep Submucosal Invasion: A Systematic Review and Meta-Analysis

Backes, Y MD1; Moss, A MBBS (Hons), MD2,3; Reitsma, J B MD, PhD4; Siersema, P D MD, PhD1,5; Moons, L M G MD, PhD1

American Journal of Gastroenterology: January 2017 - Volume 112 - Issue 1 - p 54–64
doi: 10.1038/ajg.2016.403
REVIEW: CLINICAL AND SYSTEMATIC REVIEWS
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OBJECTIVES: Optical diagnosis of T1 colorectal cancer (CRC) and T1 CRC with deep submucosal invasion is important in guiding the treatment strategy. The use of advanced imaging is not standard clinical practice in Western countries. A systematic review and meta-analysis were conducted comparing the accuracy of narrow band imaging (NBI), magnifying chromoendoscopy (MCE), and gross morphological features (GMF) seen with conventional view for the optical diagnosis of T1 CRC and deep submucosal invasion.

METHODS: A literature search identified studies on the optical diagnosis of T1 CRC and deep invasion using NBI, MCE, or GMF. Pooled estimates (PE) of sensitivity and specificity across studies reporting on NBI or MCE were compared using a random effects bivariate meta-regression approach, and a paired analysis focusing on studies that performed both techniques within the same patient was performed.

RESULTS: Thirty-three studies with 31,568 polyps were included. For the optical diagnosis of T1 CRC, both NBI (4 studies; PE 0.85, 95% confidence interval (CI) 0.75–0.91) and MCE (5 studies; PE 0.90, 95% CI 0.83–0.94) yielded higher sensitivity as compared with GMF (3 studies; range 0.21–0.46). No significant preference for NBI or MCE was found (sensitivity relative risk (RR) 0.93, 95% CI 0.79–1.09,P=0.37; specificity RR 0.98, 95% CI 0.86–1.11,P=0.74). Similarly, for the optical diagnosis of deep invasion, both NBI (13 studies; PE 0.77, 95% CI 0.68–0.84) and MCE (17 studies; PE 0.81, 95% 0.75–0.87) yielded higher sensitivity as compared with GMF (6 studies; range 0.18–0.88), and no significant preference for either NBI or MCE was found (sensitivity RR 0.92, 95% CI 0.76–1.11,P=0.36; specificity RR 1.00, 95% CI 0.96–1.04,P=0.92).

CONCLUSIONS: This review supports the use of advanced imaging techniques in preference to GMF to reduce the risk of performing piecemeal resection for T1 CRCs or unnecessary surgical referral for lesions amendable to endoscopic resection. A preference for either NBI or MCE could not be observed.

1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

2Department of Endoscopic Services, Western Health, Melbourne, Victoria, Australia

3Department of Medicine, Melbourne Medical School—Western Precinct, The University of Melbourne, St Albans, Victoria, Australia

4Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

5Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands

Correspondence: Leon MG Moons, MD, PhD, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. E-mail: l.m.g.moons@umcutrecht.nl

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A357

Received 01 March 2016; accepted 02 July 2016

Guarantor of the article: L.M.G. Moons, MD, PhD.

Specific author contributions: Study concept and design, literature search, acquisition of data, quality assessment, analysis and interpretation of data, drafting of the manuscript, and statistical analysis: Yara Backes; Interpretation of data and manuscript review: Alan Moss; Statistical analysis, interpretation of data, and manuscript review: Johannes B. Reitsma; Interpretation of data and manuscript review: Peter D. Siersema; Study concept and design, acquisition of data, quality assessment, interpretation of data, manuscript review, and supervising: Leon M.G. Moons. All authors approved the final version of the manuscript.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2017. All Rights Reserved.
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