Endoscopy 2017; 49(06): 564-580
DOI: 10.1055/s-0043-103014
© Georg Thieme Verlag KG Stuttgart · New York

Narrow-band imaging in the diagnosis of deep submucosal colorectal cancers: a systematic review and meta-analysis

Qing-Wei Zhang*, 1, La-Mei Teng*, 1, 2, Xin-Tian Zhang1, Jing-Jing Zhang1, Ying Zhou1, Zhi-Rui Zhou3, Yi-Chao Hou1, Zhi-Zheng Ge1, Xiao-Bo Li1
  • 1Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
  • 2Division of Gastroenterology and Hepatology, Liqun Clinical Medicine College, The Second Military Medical University, Liqun Hospital, Shanghai, China
  • 3Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
Further Information

Publication History

submitted 08 August 2016

accepted after revision 09 January 2017

Publication Date:
04 May 2017 (eFirst)


Background and aims Magnifying endoscopy with narrow-band imaging (M-NBI) has been widely used in the differential diagnosis of deep submucosal colorectal cancers (dSMCs) from superficial submucosal cancers (sSMCs) and intramucosal neoplasms. We aimed to pool the diagnostic efficacy of M-NBI and compare it with that of magnifying chromoendoscopy (M-CE) in diagnosing colorectal dSMC.

Methods PubMed, EMBASE, and the Cochrane Library were searched to identify eligible studies. Meeting abstracts were also searched. A bivariate mixed-effects binary regression model was used in the meta-analysis to calculate the pooled diagnostic efficacy of M-NBI and compare it with that of M-CE in the diagnosis of dSMC. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity.

Results We included 17 studies: 14 full texts and 3 meeting abstracts. The pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve (AUC) with 95 % confidence intervals (CIs) in diagnosing dSMC were 74 % (66 % – 81 %; I2 = 84.6 %), 98 % (94 % – 99 %; I2 = 94.4 %), and 0.91 (0.88 – 0.93), respectively, for M-NBI. The pooled sensitivity, specificity and AUC (95 %CI) were 84 % (76 % – 89 %; I2 = 76.9 %), 97 % (94 % – 99 %; I2 = 90.2 %), and 0.97 (0.95 – 0.98), respectively, for M-CE. M-NBI had lower sensitivity (P < 0.01) than M-CE with similar specificity (P = 0.32). Subgroup analyses and meta-regression indicated that endoscopic diagnostic criteria, study type, endoscope type, risk of index test bias, and histopathological diagnostic criteria might be the sources of heterogeneity.

Conclusions M-NBI and M-CE had comparable specificities in diagnosing dSMC, but the sensitivity of M-NBI was slightly lower than that of M-CE.

* These authors contributed equally to this work.

Appendix e1 – e2