TOPLINE:

Narrow-band imaging demonstrated superior visibility of colorectal lesions, with a significantly lower miss rate than white-light imaging or texture and color enhancement imaging modes. Detection times were also shortest with narrow-band imaging compared with the other modalities.

METHODOLOGY:

• Colorectal cancer mortality remains high, making early detection and removal of lesions vital; white-light colonoscopy misses about 20%-26% of adenomas, prompting the development of image-enhanced methods such as narrow-band imaging and blue laser imaging.
• The study aimed to objectively evaluate colorectal lesion visibility using white-light imaging, narrow-band imaging, and texture and color enhancement imaging with an eye tracking system.
• Overall, 12 endoscopists (three experts and nine nonexperts) assessed 120 images of 30 colorectal lesions (≤ 10 mm; 29 adenomas and 1 sessile serrated lesion) captured using four modalities: white-light imaging, narrow-band imaging, texture and color enhancement imaging mode-1, and texture and color enhancement imaging mode-2.
• Expert endoscopists were defined as those who had performed more than 5000 colonoscopies, whereas nonexperts had performed fewer than 5000 procedures.
• The endpoints were miss rate and detection time per modality: Detection time was the interval from image display to the start of gaze on the lesion, and miss rates were calculated as the proportion of missed lesions across 360 image assessments.

TAKEAWAY:

• Narrow-band imaging demonstrated the lowest miss rate at 6.4%, significantly lower than the miss rates of white-light imaging (16.4%) and texture and color enhancement imaging mode-2 (16.7%; P < .001 for both).
• Detection times were the shortest with narrow-band imaging (median, 0.54 seconds), significantly shorter than those with white-light imaging (median, 0.71 seconds) and texture and color enhancement imaging mode-2 (median, 0.64 seconds; P < .001 for both) and shorter than those with texture and color enhancement imaging mode-1 (median, 0.63 seconds; P = .005).
• Although experts showed no difference in miss rates across modalities, narrow-band imaging markedly reduced miss rates and detection times for nonexperts and produced shorter detection times for experts.

IN PRACTICE:

“NBI [narrow-band imaging] enhances superficial vascular structures, rendering them clearly visible as brownish patterns in adenomas with fine vascular networks on the surface,” the authors of the study wrote. “NBI may be a useful modality for detecting flat colorectal lesions.”

SOURCE:

The study was led by Aiji Hattori, MD, Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan. It was published online in the Journal of Gastroenterology and Hepatology.

LIMITATIONS:

The study was conducted at a single center with a limited number of enrolled endoscopists, particularly experts. The analysis used images containing only single lesions, which may not reflect real-world clinical settings. Additionally, the evaluation was limited to still images without including video materials.

DISCLOSURES:

One author disclosed receiving research funding from Olympus Medical Corporation. The remaining authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.