Validation study for development of the Japan NBI Expert Team classification of colorectal lesions

  • Mineo Iwatate
    Gasrtrointestinal Center and Institute of Minimally‐Invasive Endoscopic Care (iMEC) Sano Hospital Kobe Japan
  • Yasushi Sano
    Gasrtrointestinal Center and Institute of Minimally‐Invasive Endoscopic Care (iMEC) Sano Hospital Kobe Japan
  • Shinji Tanaka
    Department of Endoscopy Hiroshima University Hiroshima Japan
  • Shin‐ei Kudo
    Digestive Disease Center Showa University Northern Yokohama Hospital Yokohama Japan
  • Shoichi Saito
    Department of Gastroenterology Cancer Institute Hospital Tokyo Japan
  • Takahisa Matsuda
    Cancer Screening Center Tokyo Japan
  • Yoshiki Wada
    Wada Clinic Wakayama Japan
  • Takahiro Fujii
    Takahiro Fujii Clinic Tokyo Japan
  • Hiroaki Ikematsu
    Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Kashiwa Japan
  • Toshio Uraoka
    Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Maebashi Japan
  • Nozomu Kobayashi
    Department of Gastroenterology Tochigi Cancer Center Utsunomiya Japan
  • Hisashi Nakamura
    Akasaka Endoscopic Clinic Tokyo Japan
  • Kinichi Hotta
    Division of Endoscopy Shizuoka Cancer Center Suntogun Japan
  • Takahiro Horimatsu
    Department of Therapeutic Oncology Kyoto University Kyoto Japan
  • Naoto Sakamoto
    Department of Gastroenterology Juntendo University Tokyo Japan
  • Kuang‐I Fu
    Department of Gastroenterology Kanma Memorial Hospital Nasushiobara Japan
  • Osamu Tsuruta
    Division of Gastroenterology Kurume University Kurume Japan
  • Hiroshi Kawano
    Department of Gastroenterology St. Mary's Hospital Kurume Japan
  • Hiroshi Kashida
    Department of Gastroenterology and Hepatology Kindai University Osaka‐Sayama Japan
  • Yoji Takeuchi
    Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan
  • Hirohisa Machida
    Internal Medicine Machida Gastrointestinal Hospital Osaka Japan
  • Toshihiro Kusaka
    Department of Gastroenterology and Hepatology Kyoto Katsura Hospital Kyoto Japan
  • Naohisa Yoshida
    Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Japan
  • Ichiro Hirata
    Department of Gastroenterology Osaka Central Hospital Osaka Japan
  • Takeshi Terai
    Terai Clinic Tokyo Japan
  • Hiro‐o Yamano
    Department of Gastroenterology and Hepatology Sapporo Medical University School of Medicine Sapporo Japan
  • Takeshi Nakajima
    Endoscopy Division National Cancer Center Hospital Tokyo Japan
  • Taku Sakamoto
    Endoscopy Division National Cancer Center Hospital Tokyo Japan
  • Yuichiro Yamaguchi
    Tokura Yamaguchi Clinic Mishima Japan
  • Naoto Tamai
    Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
  • Naoko Nakano
    Department of Gastroenterology Fujita Health University Toyoake Japan
  • Nana Hayashi
    Department of Endoscopy Hiroshima University Hiroshima Japan
  • Shiro Oka
    Department of Endoscopy Hiroshima University Hiroshima Japan
  • Hideki Ishikawa
    Department of Molecular‐Targeting Cancer Prevention Kyoto Prefectural University of Medicine Kyoto Japan
  • Yoshitaka Murakami
    Toho University Tokyo Japan
  • Shigeaki Yoshida
    CEO Aomori Prefectural Central Hospital Administration Aomori Japan
  • Yutaka Saito
    Endoscopy Division National Cancer Center Hospital Tokyo Japan

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<jats:sec><jats:title>Background and Aim</jats:title><jats:p>The Japan narrow‐band imaging (NBI) Expert Team (JNET) was organized to unify four previous magnifying NBI classifications (the Sano, Hiroshima, Showa, and Jikei classifications). The JNET working group created criteria (referred to as the NBI scale) for evaluation of vessel pattern (VP) and surface pattern (SP). We conducted a multicenter validation study of the NBI scale to develop the JNET classification of colorectal lesions.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Twenty‐five expert JNET colonoscopists read 100 still NBI images with and without magnification on the web to evaluate the NBI findings and necessity of the each criterion for the final diagnosis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Surface pattern in magnifying NBI images was necessary for diagnosis of polyps in more than 60% of cases, whereas VP was required in around 90%. Univariate/multivariate analysis of candidate findings in the NBI scale identified three for type 2B (variable caliber of vessels, irregular distribution of vessels, and irregular or obscure surface pattern), and three for type 3 (loose vessel area, interruption of thick vessel, and amorphous areas of surface pattern). Evaluation of the diagnostic performance for these three findings in combination showed that the sensitivity for types 2B and 3 was highest (44.9% and 54.7%, respectively), and that the specificity for type 3 was acceptable (97.4%) when any one of the three findings was evident. We found that the macroscopic type (polypoid or non‐polypoid) had a minor influence on the key diagnostic performance for types 2B and 3.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Based on the present data, we reached a consensus for developing the JNET classification.</jats:p></jats:sec>

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