**3. Conclusion**

**NICE criterion Type 1 Type 2**

Most likely pathology Hyperplastic Adenoma

**2.3. Fujinon intelligent color enhancement system (FICE) and i-Scan**

Vessels None, or isolated lacy vessels coursing across the lesion

Surface pattern Dark or white spots of uniform size, or

186 Colonoscopy and Colorectal Cancer Screening - Future Directions

**Table 5.** The NBI International colorectal endoscopic (NICE) classification

*2.2.7. Learning NBI. Does expertise matters?*

sion [76].

seems broadly similar.

two modalities (kappa index > 0.7).

Color Same or lighter than background Browner relative to background

Most of the published studies have been performed by experts endoscopists, both in Japan and in Western countries. Reliable information about reproducibility of this results is lack‐ ing. Moreover, the overall accuracy in prediction of histology es markedly influenced by expertise in NBI interpretation, as has been shown in a study performed in a non academic setting in which sensitivity for high-confidence prediction was 77% and specificity 78% [73]. Experts have been shown to perform better than non-experts and with a higher interobserv‐ er agreement [74]. Fortunately, NBI interpretation of histology can be easily learned. Several studies have shown significant improvements in diagnostic accuracy and in interobserver agreement after following a computer-based training module [75] or a short teaching ses‐

FICE also narrowes the bandwidth of light components using a computed spectral estima‐ tion technology that aritmetically processes the reflected photons to reconstitute virtual im‐ ages for a choice of different wavelenghts [77]. Therefore, it no depends on optical filters to modify the image. There are less studies using FICE or i-Scan than NBI but its accuracy

In the study by Pohl et al. [77] FICE (with set 4 activated) was used to identify the pit pattern and the vascular pattern intensity in a similar way to NBI. The sensitivity and specificity of FICE for the prediction of adenoma was 93.2% and 61.2%, figures similar to those of chro‐ moendoscopy. Parra et al. [78] showed that FICE performance in predicting histology was inferior to that of chromoendoscopy with magnification. Kim et al. [80] reported that FICE with magnification was better than without magnification especially for diminutive polyps [79]. Regarding i-Scan, a study compared this technology with NBI for histology prediction of diminutive polyps and showed a similar performance with good agreement between the

homogeneous abscence of pattern

Brown vessels surrounding white

Oval, tubular, or branched white structures surrounded by brown

structures

vessels

New image-enhancing technologies may allow in vivo histological assessment of colorectal polyps, avoiding the need to pathological evaluation of all resected polyps. This would rep‐ resent substantial savings and a more direct planning of surveillance intervals [81]. Howev‐ er, there are several steps to achieve before the resect and discard strategy is widely implemented. First a more simple, reproducible and validated way of characterize colon le‐ sions is needed, especially in community practice. Learning the technique is also crucial be‐ cause when learning curve is achieved NBI performs significantly better [68]. Moreover, implementing PIVI guidelines [33] implies accepting a 10% rate of false negative when in vivo assessing histology of rectal polyps. Endoscopists may feel more comfortable with a much lower rate before leaving polyps behind. Finally, if in vivo histology is applied in dai‐ ly practice this represents a turning point in the management of colon polyps, which must be supported by Professional Societies.

In vivo histology seems here to stay, but we are still at the beginning of the way. Improve‐ ment in equipments and development of new technologies will help the medical community to take this step forward.
