Proposal of a new ‘resect and discard’ strategy using magnifying narrow band imaging: Pilot study of diagnostic accuracy

Background and Aim A ‘resect and discard’ strategy using non-magnifying narrow band imaging (N-NBI) has been proposed for reducing screening colonoscopy costs, but it does not take into consideration advanced histology and magnifying NBI (M-NBI) that can potentially further improve the ‘resect and discard’ strategy. We conducted a pilot study to investigate the feasibility of M-NBI for the new ‘resect and discard’ strategy with consideration for advanced histology. Methods The present study involved 63 patients. For each polyp, optical diagnosis was independently made using N-NBI and M-NBI, a decision (discard or send for pathology) was made based on the M-NBI findings, and histological and optical diagnosis results were compared. Results Sensitivity, specificity and accuracy (95% confidence interval) of M-NBI for lesions with advanced histology were 1.00 (0.36–1.00), 0.92 (0.91–0.92) and 0.92 (0.90–0.92), respectively. Whereas the management of 86% of small polyps could be decided without formal histopathology, lesions with advanced histology were not discarded using M-NBI. The diagnostic accuracy of M-NBI in distinguishing neoplastic from non-neoplastic lesions was higher than that of N-NBI. Conclusions We propose a new resect and discard strategy with advanced histology using M-NBI that is a promising strategy to reduce the costs of histopathology and to minimize the risk of discarding important lesions.