Portfolio of colonic polyps in white-light endoscopy (WLE) & narrow band imaging (NBI) with the pathological counterpart. NICE classification learning tool.

1. of
50 colonic polyps
WLE, NBI, NICE classification
and their histological counterpart
PORTFOLIO
by Fabien Wuestenberghs, MD & Philippe Warzée, MD PhD
v. 1 – février 2016

2. INTRODUCTION

3. NICE classification
• = narrow-band imaging (NBI)-based
classification system for differentiating
hyperplastic from adenomatous polyps
• Classification based on color, vessels, and
surface pattern criteria
D. G. Hewett, et al., Validation of a Simple Classification System for
Endoscopic Diagnosis of Small Colorectal Polyps Using Narrow-Band
Imaging. Gastroenterology 2012 ; Vol. 143 (No. 3) : pp. 599-607.

4. Type 1 Type 2 Type 3
Color Same or lighter
than background
Browner relative
to background
Brown to dark
brown relative to
background;
sometimes patchy
whiter areas
Vessels None, or isolated
lacy vessels
Brown vessels
surrounding white
structures
Areas of disrupted
or missing vessels
Surface pattern Dark or white
spots of uniform
size, or
homogeneous
absence of
pattern
Oval, tubular or
branched white
structures
surrounded by
brown vessels
Amorphous or
absent surface
pattern
Most likely
pathology
Hyperplastic Adenoma Cancer
D. G. Hewett, et al., Validation of a Simple Classification System for
Endoscopic Diagnosis of Small Colorectal Polyps Using Narrow-Band
Imaging. Gastroenterology 2012 ; Vol. 143 (No. 3) : pp. 599-607.

5. HOW TO USE

6. Age, sex, polyp localization
NICE
• Type 1
• Type 2
• Type 3
Histopathology
= …
case n° …
(comment)
white-light endoscopy
picture
NBI
picture
1Watch the pics
2Choose the NICE
type (the answer
appears in bold)
3Discover the histology

7. CASES

8. 69 yo female, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 1
(under water)

9. 69 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
Histopathology ?
case 1
(under water)

10. 69 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
Histopathology
= tubular adenoma with
low-grade dysplasia
case 1
(under water)

11. 58 yo female, transverse colon
NICE ?
• Type 1
• Type 2
• Type 3
case 2

12. 58 yo female, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 2
Histopathology ?

13. 58 yo female, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 2
Histopathology
= tubular adenoma with
low-grade dysplasia

14. 44 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 3

15. 44 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 3
Histopathology ?

16. 44 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 3
Histopathology
= hyperplastic polyp

17. 62 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 4

18. 62 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 4
Histopathology ?

19. 62 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 4
Histopathology
= villous adenoma with
low-grade dysplasia
+ focal intramucosal
adenocarcinoma

20. 30 yo male, descending colon
NICE ?
• Type 1
• Type 2
• Type 3
case 5

21. 30 yo male, descending colon
NICE
• Type 1
• Type 2
• Type 3
case 5
Histopathology ?

22. 30 yo male, descending colon
NICE
• Type 1
• Type 2
• Type 3
case 5
Histopathology
= hyperplastic polyp

23. 58 yo female, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 6

24. 58 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 6
Histopathology ?

25. 58 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 6
Histopathology
= tubulo-villous adenoma
with low-grade dysplasia

26. 50 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 7

27. 50 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 7
Histopathology ?

28. 50 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 7
Histopathology
= tubular adenoma with
low-grade dysplasia

29. 58 yo female, hepatic flexure
NICE ?
• Type 1
• Type 2
• Type 3
case 8

30. 58 yo female, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 8
Histopathology ?

31. 58 yo female, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 8
Histopathology
= sessile serrated
adenoma with low-
grade dysplasia

32. 64 yo male, splenic flexure
NICE ?
• Type 1
• Type 2
• Type 3
case 9

33. 64 yo male, splenic flexure
NICE
• Type 1
• Type 2
• Type 3
case 9
Histopathology ?

34. 64 yo male, splenic flexure
NICE
• Type 1
• Type 2
• Type 3
case 9
Histopathology
= tubulo-villous adenoma
with low-grade dysplasia

35. 63 yo female, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 10

36. 63 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 10
Histopathology ?

37. 63 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 10
Histopathology
= tubulo-villous adenoma
with high-grade
dysplasia
+ focal infiltrating
adenocarcinoma

38. 68 yo female, ascending colon
NICE ?
• Type 1
• Type 2
• Type 3
case 11

39. 68 yo female, ascending colon
NICE
• Type 1
• Type 2
• Type 3
case 11
Histopathology ?

40. 68 yo female, ascending colon
NICE
• Type 1
• Type 2
• Type 3
case 11
Histopathology
= tubular adenoma with
low-grade dysplasia

41. 59 yo male, transverse colon
NICE ?
• Type 1
• Type 2
• Type 3
case 12

42. 59 yo male, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 12
Histopathology ?

43. 59 yo male, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 12
Histopathology
= tubulo-villous adenoma
with low-grade dysplasia

44. 50 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 13

45. 50 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 13
Histopathology ?

46. 50 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 13
Histopathology
= villous adenoma with low-
grade dysplasia
+ focal high-grade
dysplasia & intramucosal
adenocarcinoma

47. 59 yo male, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 14

48. 59 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 14
Histopathology ?

49. 59 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 14
Histopathology
= tubulo-villous adenoma
with low-grade dysplasia

50. 72 yo female, hepatic flexure
NICE ?
• Type 1
• Type 2
• Type 3
case 15
(underlying melanosis coli)

51. 72 yo female, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 15
Histopathology ?
(underlying melanosis coli)

52. 72 yo female, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 15
Histopathology
= tubulo-villous adenoma
with low-grade dysplasia
(underlying melanosis coli)

53. 85 yo female, cecum
NICE ?
• Type 1
• Type 2
• Type 3
case 16

54. 85 yo female, cecum
NICE
• Type 1
• Type 2
• Type 3
case 16
Histopathology ?

55. 85 yo female, cecum
NICE
• Type 1
• Type 2
• Type 3
case 16
Histopathology
= tubulo-villous adenoma
with low-grade dysplasia

56. 35 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 17

57. 35 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 17
Histopathology ?

58. 35 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 17
Histopathology
= tubular adenoma with
low-grade dysplasia

59. 61 yo female, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 18

60. 61 yo female, rectum
NICE
• Type 1
• Type 2
• Type 3
case 18
Histopathology ?

61. 61 yo female, rectum
NICE
• Type 1
• Type 2
• Type 3
case 18
Histopathology
= adenoma with high-
grade dysplasia &
infiltrating
adenocarcinoma (Sm2)

62. 51 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 19

63. 51 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 19
Histopathology ?

64. 51 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 19
Histopathology
= sessile serrated
adenoma

65. 69 yo female, transverse colon
NICE ?
• Type 1
• Type 2
• Type 3
case 20

66. 69 yo female, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 20
Histopathology ?

67. 69 yo female, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 20
Histopathology
= sessile serrated
adenoma

68. 73 yo female, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 21
(under water)

69. 73 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 21
Histopathology ?
(under water)

70. 73 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 21
Histopathology
= tubular adenoma with
low-grade dysplasia
(under water)

71. 68 yo female, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 22

72. 68 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 22
Histopathology ?

73. 68 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 22
Histopathology
= tubular adenoma with
low-grade dysplasia

74. 59 yo male, cecum
NICE ?
• Type 1
• Type 2
• Type 3
case 23

75. 59 yo male, cecum
NICE
• Type 1
• Type 2
• Type 3
case 23
Histopathology ?

76. 59 yo male, cecum
NICE
• Type 1
• Type 2
• Type 3
case 23
Histopathology
= tubular adenoma with
low-grade dysplasia

77. 53 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 24

78. 53 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 24
Histopathology ?

79. 53 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 24
Histopathology
= hyperplastic polyp

80. 59 yo male, transverse colon
NICE ?
• Type 1
• Type 2
• Type 3
case 25

81. 59 yo male, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 25
Histopathology ?

82. 59 yo male, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 25
Histopathology
= tubular adenoma with
low-grade dysplasia

83. 87 yo male, hepatic flexure
NICE ?
• Type 1
• Type 2
• Type 3
case 26

84. 87 yo male, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 26
Histopathology ?

85. 87 yo male, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 26
Histopathology
= tubular adenoma with
low-grade dysplasia

86. 59 yo male, transverse colon
NICE ?
• Type 1
• Type 2
• Type 3
case 27

87. 59 yo male, transverse colon
NICE ?
• Type 1
• Type 2
• Type 3
case 27
Histopathology ?

88. 59 yo male, transverse colon
NICE ?
• Type 1
• Type 2
• Type 3
case 27
Histopathology
= tubular adenoma with
low-grade dysplasia

89. 75 yo male, ascending colon
NICE ?
• Type 1
• Type 2
• Type 3
case 28

90. 75 yo male, ascending colon
NICE
• Type 1
• Type 2
• Type 3
case 28
Histopathology ?

91. 75 yo male, ascending colon
NICE
• Type 1
• Type 2
• Type 3
case 28
Histopathology
= tubular adenoma with
low-grade dysplasia

92. 87 yo male, descending colon
NICE ?
• Type 1
• Type 2
• Type 3
case 29

93. 87 yo male, descending colon
NICE
• Type 1
• Type 2
• Type 3
case 29
Histopathology ?

94. 87 yo male, descending colon
NICE
• Type 1
• Type 2
• Type 3
case 29
Histopathology
= tubular adenoma with
low-grade dysplasia

95. 75 yo male, hepatic flexure
NICE ?
• Type 1
• Type 2
• Type 3
case 30

96. 75 yo male, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 30
Histopathology ?

97. 75 yo male, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 30
Histopathology
= tubular adenoma with
low-grade dysplasia

98. 88 yo female, transverse colon
NICE ?
• Type 1
• Type 2
• Type 3
case 31

99. 88 yo female, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 31
Histopathology ?

100. 88 yo female, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 31
Histopathology
= sessile serrated
adenoma without
dysplasia

101. 75 yo male, transverse colon
NICE ?
• Type 1
• Type 2
• Type 3
case 32

102. 75 yo male, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 32
Histopathology ?

103. 75 yo male, transverse colon
NICE
• Type 1
• Type 2
• Type 3
case 32
Histopathology
= tubular adenoma with
low-grade dysplasia

104. 75 yo male, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 33

105. 75 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 33
Histopathology ?

106. 75 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 33
Histopathology
= hyperplastic polyp

107. 72 yo male, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 34

108. 72 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 34
Histopathology ?

109. 72 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 34
Histopathology
= tubulo-villous adenoma
with low-grade dysplasia
+ focal high-grade dysplasia

110. 72 yo female, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 35

111. 72 yo female, rectum
NICE
• Type 1
• Type 2
• Type 3
case 35
Histopathology ?

112. 72 yo female, rectum
NICE
• Type 1
• Type 2
• Type 3
case 35
Histopathology
= tubular adenoma with
low-grade dysplasia

113. 69 yo female, ascending colon
NICE ?
• Type 1
• Type 2
• Type 3
case 36

114. 69 yo female, ascending colon
NICE
• Type 1
• Type 2
• Type 3
case 36
Histopathology ?

115. 69 yo female, ascending colon
NICE
• Type 1
• Type 2
• Type 3
case 36
Histopathology
= tubular adenoma with
low-grade dysplasia

116. 56 yo male, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 37

117. 56 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 37
Histopathology ?

118. 56 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 37
Histopathology
= tubulo-villous adenoma
with low-grade dysplasia

119. 62 yo female, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 38

120. 62 yo female, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 38
Histopathology ?

121. 62 yo female, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 38
Histopathology
= sessile serrated
adenoma with low-
grade dysplasia

122. 49 yo female, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 39

123. 49 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 39
Histopathology ?

124. 49 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 39
Histopathology
= tubular adenoma with low-
grade dysplasia
+ focal high-grade dysplasia

125. 86 yo female, descending colon
NICE ?
• Type 1
• Type 2
• Type 3
case 40

126. 86 yo female, descending colon
NICE ?
• Type 1
• Type 2
• Type 3
case 40
Histopathology ?

127. 86 yo female, descending colon
NICE ?
• Type 1
• Type 2
• Type 3
case 40
Histopathology
= tubular adenoma with
low-grade dysplasia

128. 72 yo male, hepatic flexure
NICE ?
• Type 1
• Type 2
• Type 3
case 41

129. 72 yo male, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 41
Histopathology ?

130. 72 yo male, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 41
Histopathology
= tubular adenoma with
low-grade dysplasia

131. 51 yo male, cecum
NICE ?
• Type 1
• Type 2
• Type 3
case 42

132. 51 yo male, cecum
NICE
• Type 1
• Type 2
• Type 3
case 42
Histopathology ?

133. 51 yo male, cecum
NICE
• Type 1
• Type 2
• Type 3
case 42
Histopathology
= tubulo-villous adenoma
with low-grade dysplasia

134. 43 yo male, rectum
NICE ?
• Type 1
• Type 2
• Type 3
case 43

135. 43 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 43
Histopathology ?

136. 43 yo male, rectum
NICE
• Type 1
• Type 2
• Type 3
case 43
Histopathology
= tubular adenoma with
low-grade dysplasia

137. 43 yo male, hepatic flexure
NICE ?
• Type 1
• Type 2
• Type 3
case 44

138. 43 yo male, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 44
Histopathology ?

139. 43 yo male, hepatic flexure
NICE
• Type 1
• Type 2
• Type 3
case 44
Histopathology
= sessile serrated
adenoma with low-
grade dysplasia

140. 86 yo female, ascending colon
NICE ?
• Type 1
• Type 2
• Type 3
case 45

141. 86 yo female, ascending colon
NICE
• Type 1
• Type 2
• Type 3
case 45
Histopathology ?

142. 86 yo female, ascending colon
NICE
• Type 1
• Type 2
• Type 3
case 45
Histopathology
= villous adenoma with
low-grade dysplasia

143. 43 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 46

144. 43 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 46
Histopathology ?

145. 43 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 46
Histopathology
= hyperplastic polyp

146. 51 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 47
(Picoprep® prep)

147. 51 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 47
Histopathology ?
(Picoprep® prep)

148. 51 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 47
Histopathology
= tubular adenoma with
low-grade dysplasia
(Picoprep® prep)

149. 50 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 48

150. 50 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 48
Histopathology ?

151. 50 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 48
Histopathology
= hyperplastic polyp

152. 56 yo male, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 49

153. 56 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 49
Histopathology ?

154. 56 yo male, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 49
Histopathology
= hyperplastic polyp

155. 65 yo female, sigmoid colon
NICE ?
• Type 1
• Type 2
• Type 3
case 50

156. 65 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 50
Histopathology ?

157. 65 yo female, sigmoid colon
NICE
• Type 1
• Type 2
• Type 3
case 50
Histopathology
= villous adenoma with
low-grade dysplasia

158. CONCLUSION

159. • We hope that you enjoyed training yourself
in the « art » of polyp characterization…
F. Wuestenberghs & P. Warzée
Thank you to Olympus® for their material support.
[All right reserved – F Wuestenberghs & P. Warzée – february 2016]