Meta-analysis: narrow band imaging for lesion characterization in the colon, oesophagus, duodenal ampulla and lung

Background Narrow band imaging is a new endoscopic technology that highlights mucosal surface structures and microcapillaries, which may be indicative of neoplastic change. Aim To assess the diagnostic precision of narrow band imaging for the diagnosis of epithelial neoplasia compared to conventional histology both overall and in specific organs. Methods We performed a meta-analysis of studies which compared narow band imaging-based diagnosis of neoplasia with histopathology as the gold standard. Search terms: 'endoscopy' and 'narrow band imaging'. Results Five hundred and eighty-two patients and 1108 lesions in 11 studies were included. Overall, sensitivity was 0.94 (95% confidence interval 0.92-0.95), specificity 0.83 (0.80-0.86); weighted area under the curve was 0.96 (standard error 0.02), diagnostic odds ratio (DOR) 72.74 (34.11-155.15). DORs were 66.65 (25.84-171.90), 61.19 (7.09-527.97), 69.74 (8.04-605.24) for colon, oesophagus and lung respectively. Studies with more than 50 patients had higher diagnostic precision, relative DOR 4.96 (1.28-19.27), P = 0.022. There was no difference in accuracy between microvessel and mucosal (pit) pattern based measures, relative DOR 1.29 (0.05-35.16), P = 0.87. There was significant heterogeneity overall between studies, Q = 31.2, P = 0.003. Conclusion Narrow band imaging is accurate with high diagnostic precision for in vivo diagnosis of neoplasia across a range of organs, using simple microvessel-based measures.