Usefulness of the Japan narrow-band imaging expert team classification system for the diagnosis of sessile serrated lesi
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and Other Interventional Techniques
Usefulness of the Japan narrow‑band imaging expert team classification system for the diagnosis of sessile serrated lesion with dysplasia/carcinoma Takashi Murakami1 · Naoto Sakamoto1 · Hirofumi Fukushima1 · Tomoyoshi Shibuya1 · Takashi Yao2 · Akihito Nagahara1 Received: 2 March 2020 / Accepted: 27 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Sessile serrated lesion (SSL) is a colorectal polyp that has malignant potential. However, the dysplastic components within an SSL can be difficult to diagnose with conventional endoscopy, because most SSLs with dysplasia/carcinoma have subtle mucosal features. Many studies have indicated that narrow-band imaging (NBI) observations of colorectal polyps are very useful, accurate predictors of histology. We aimed to verify the usefulness of the Japan NBI Expert Team (JNET) classification system for the diagnosis of SSLs with dysplasia/carcinoma. Methods We examined 709 endoscopically or surgically resected lesions that were pathologically diagnosed as SSL, including 647 with no dysplasia, 37 with low-grade dysplasia, 15 with high-grade dysplasia, and 10 with submucosal invasive carcinoma. We retrospectively evaluated their clinicopathologic characteristics and conventional endoscopic and magnifying NBI endoscopic findings using the JNET system. Results Cases in all groups were more frequently located in the proximal colon. Submucosal invasive carcinomas were significantly larger than no dysplasia and low-grade dysplasia lesions. Almost all studied lesions (96.3%) were covered with a mucus cap. Five hundred and eighty (81.8%) lesions exhibited dark spots inside the crypts, which are NBI findings’ characteristic of SSL. As for the JNET classification of magnifying NBI endoscopic findings, all 709 lesions showed Type 1. Six hundred and eighteen (95.5%) SSLs with no dysplasia lesions exhibited Type 1 only, whereas 52 (83.9%) SSLs with dysplasia/carcinoma had a combination of Type 1 and Type 2A, 2B, or 3, corresponding to SSL and dysplasia/carcinoma, respectively. The JNET classification had high sensitivity (83.9%), specificity (95.5%), and overall diagnostic accuracy (94.5%) for diagnosing SSLs with dysplasia/carcinoma. Conclusions Use of magnifying NBI endoscopy with the JNET classification might be useful for diagnosing SSLs with dysplasia/carcinoma. This increased awareness may also improve the recognition of SSLs with dysplasia/carcinoma. Keywords Narrow-band imaging (NBI) · Japan NBI expert team (JNET) · Sessile serrated adenoma/polyp (SSA/P) · Sessile serrated lesion (SSL) · SSL with dysplasia Colorectal serrated lesions known as “hyperplastic polyps” have been regarded harmless for decades. However, Torlakovic et al. [1] described abnormal proliferations in colorectal
* Takashi Murakami t‑[email protected] 1
Department of Gastroenterology, Juntendo University School of Medicine, 2‑1‑1 Hongo, Bunkyo‑ku, Tokyo 113‑8421, Japan
Department of Human Pathology, Juntendo
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