***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The purpose of this study is to evaluate an endoscopic trimodal imaging ( ETMI ) system ( high resolution , autofluorescence , and NBI ) in the detection and differentiation of  colorectal adenomas .  Methods A prospect i ve r and omised trial of t and em colonoscopies was carried out using the Olympus XCF-FH260AZI system . Each colonic segment was examined twice for lesions , once with HRE and once with AFI , in r and om order per patient . All detected lesions were assessed with NBI for pit pattern and with AFI for colour . All lesions were removed and sent for histology . Any lesion identified on the second examination was considered as missed by the first examination . Outcome measures are adenoma miss rates of AFI and HRE , and diagnostic accuracy of NBI and AFI for differentiating neoplastic from non-neoplastic lesions . Results Ninety-four patients underwent colonoscopy with ETMI ( 47 in each group ) . Among 47 patients examined with AFI first , 31 adenomas in 15 patients were detected initially [ detection rate 0.66 ( 0.52–0.75 ) ] . Subsequent HRE inspection identified six additional adenomas . Among 47 patients examined with HRE first , 29 adenomas in 14 patients were detected initially [ detection rate 0.62 ( 0.53–0.79 ) ] . Successive AFI yielded seven additional adenomas . Adenoma miss rates of AFI and HRE were 14 % and 16.2 % , respectively ( p = 0.29 ) . Accuracy of AFI alone for differentiation was lower than NBI ( 63 % vs. 80 % , p < 0.001 ) . Combined use of AFI and NBI achieved improved accuracy for differentiation ( 84 % ) , showing a trend for superiority compared with NBI alone ( p = 0.064 ) . Conclusions AFI did not significantly reduce the adenoma miss rate compared with HRE . AFI alone had a disappointing accuracy for adenoma differentiation , which could be improved by combination of AFI and NBI BACKGROUND AND STUDY AIMS Recent studies have shown that narrow-b and imaging ( NBI ) is a powerful diagnostic tool for differentiating between neoplastic and nonneoplastic colorectal polyps . The aim of the present study was to develop and evaluate a computer-based method for automated classification of colorectal polyps on the basis of vascularization features . PATIENTS AND METHODS In a prospect i ve pilot study with 128 patients who were undergoing zoom NBI colonoscopy  , 209 detected polyps were visualized and subsequently removed for histological analysis . The proposed computer-based method consists of image preprocessing , vessel segmentation , feature extraction , and classification . The results of the automated classification were compared to those of human observers blinded to the histological gold st and ard . RESULTS Consensus decision between the human observers result ed in a sensitivity of 93.8 % and a specificity of 85.7 % . A " safe " decision , i. e. , classifying polyps as neoplastic in cases when there was interobserver discrepancy , yielded a sensitivity of 96.9 % and a specificity of 71.4 % . The overall correct classification rates were 91.9 % for the consensus decision and 90.9 % for the safe decision . With ideal setting s the computer-based approach achieved a sensitivity of approximately 90 % and a specificity of approximately 70 % , while the overall correct classification rate was 85.3 % . The computer-based classification showed a specificity of 61.2 % when a sensitivity of 93.8 % was selected , and a 53.1 % specificity with a sensitivity of 96.9 % . CONCLUSIONS Automated classification of colonic polyps on the basis of NBI vascularization features is feasible , but classification by observers is still superior . Further research is needed to clarify whether the performance of the automated classification system can be improved BACKGROUND AND STUDY AIMS A newly developed narrow-b and imaging ( NBI ) technique , in which modified optical filters were used in the light source of a video endoscope system , was applied during colonoscopy in a clinical setting . This pilot study evaluated the clinical feasibility of the NBI system for evaluating colorectal lesions . PATIENTS AND METHODS A total of 43 colorectal lesions in 34 patients were included in the study . The quality of visualization of colorectal lesions and the accuracy of differentiation between neoplastic and non-neoplastic lesions using the NBI system were evaluated in comparison with results from conventional colonoscopy and with chromoendoscopy . RESULTS For pit pattern delineation , NBI was superior to conventional endoscopy ( P < 0.001 ) , but inferior to chromoendoscopy ( P < 0.05 ) . NBI achieved better visualization of the mucosal vascular network and of the hue of lesions than conventional endoscopy ( P < 0.05 ) . However there was no significant difference between NBI and chromoendoscopy in differentiating neoplastic from non-neoplastic lesions ( both techniques had a sensitivity of 100 % and a specificity 75 % ) . This was better than the results of conventional colonoscopy ( sensitivity 83 % , specificity 44 % ; P < 0.05 for specificity ) . CONCLUSIONS These results suggest that in the examination of colonic lesions the NBI system provides imaging features additional to those of both conventional endoscopy and chromoendoscopy . For distinguishing neoplasms from non-neoplastic lesions , NBI was equivalent to chromoendoscopy OBJECTIVES : St and ard white light colonoscopy has limited ability to differentiate between polyp types ( adenomatous vs. hyperplastic ) . Narrow b and imaging ( NBI ) highlights the superficial mucosal/vascular patterns on polyps and may facilitate real-time characterization of polyp histology . The aim of this study was to prospect ively evaluate and compare the diagnostic characteristics of high-definition white light colonoscopy ( HDWL ) and NBI without magnification in the real-time prediction of polyp histology ( adenomatous vs. hyperplastic ) by evaluating the surface mucosal and vascular patterns . METHODS : We conducted a prospect i ve comparative study in a tertiary referral center . A total of 100 patients referred for screening or surveillance colonoscopy were prospect ively enrolled and underwent colonoscopy using a high-definition colonoscope with NBI capability . Every polyp detected was initially evaluated with HDWL followed by NBI for the presence of surface mucosal/vascular patterns . Based on these patterns , polyp histology was predicted by both modalities . The main outcome measurements were : ( i ) diagnostic characteristics of HDWL and NBI in predicting polyp histology and ( ii ) impact of polyp size and learning effect ( first half of study vs. second half ) on the ability of NBI to predict adenomas . RESULTS : A total of 236 polyps were detected in 100 patients —143 adenomas , 77 hyperplastic , and 16 others .  Surface patterns ( type A : hyperplastic ; type B : adenomatous ) were recognized in all polyps with NBI ( 100 % ) compared to 45 % with HDWL . For predicting adenomas , NBI had a significantly higher sensitivity and greater accuracy ( 96 and 93 % respectively ) compared with HDWL ( 38 and 61 % respectively ) ( all P<0.0001 ) . Although the accuracy of NBI for predicting adenomas improved with increasing polyp size ( ≤5 mm ; 6–9 mm ; ≥10 mm ) and in the second half compared with the first half of the study , these differences were not statistically significant . CONCLUSIONS : Using a simple surface mucosal/vascular pattern classification , NBI without magnification was highly accurate and significantly superior to HDWL for the real-time prediction of adenomas BACKGROUND Digital chromoendoscopy ( DCE ) has the potential for the in vivo optical diagnosis of colon polyps . However , no comparison of different DCE technologies currently exists . OBJECTIVE To compare the diagnostic efficacies of narrow-b and imaging ( NBI ) with those of I-Scan for the real-time histological prediction of diminutive colonic polyps ( DCPs ) ( ≤5 mm ) by using the simple unified endoscopic classification . DESIGN Prospect i ve cohort study . SETTING Academic hospital . PATIENTS In total , 296 DCPs from 142 patients undergoing screening or surveillance colonoscopy were assessed . INTERVENTIONS All DCPs detected during withdrawal were evaluated for the surface details by using high-definition white-light colonoscopy , and thereafter by using DCE ( NBI or I-Scan ) without optical magnification . The histology of all polyps was predicted in real-time and confirmed through the evaluation of biopsy or polypectomy specimens . MAIN OUTCOME MEASUREMENTS Diagnostic efficacies of NBI and I-Scan . RESULTS NBI and I-Scan displayed a significantly higher sensitivity and improved accuracy compared with high-definition white-light colonoscopy for the prediction of adenomas ( P < .05 ) . No significant differences were evident between the NBI and I-Scan ( sensitivity , 88.8 % vs 94.6 % ; specificity , 86.8 % vs 86.4 % ; accuracy , 87.8 % vs 90.7 % , respectively ; P > .05 ) . Additionally , substantial levels of intra- and interobserver agreement between the NBI and I-Scan were measured ( κ values > 0.7 ) . LIMITATIONS No r and omized or crossover design . CONCLUSIONS NBI and I-Scan displayed a similar efficacy for the real-time histological prediction of DCPs . The simple unified endoscopic classification can be used for the interpretation of DCE , regardless of the type of technology . ( CLINICAL TRIAL REGISTRATION NUMBER NCT1133041 . ) BACKGROUND Experts can accurately characterize the histology of diminutive polyps with narrow-b and imaging ( NBI ) . There are limited data on the performance of non-experts . OBJECTIVE To assess the impact of a computer-based teaching module on the accuracy of predicting polyp histology with NBI by non-experts ( in academics and community practice ) by using video clips . DESIGN Prospect i ve , observational study . SETTING Academic and community practice . PARTICIPANTS A total of 15 gastroenterologists participated-5 experts in NBI , 5 non-experts in academic practice , and 5 non-experts in community practice . INTERVENTION Participants review ed a 20-minute , computer-based teaching module outlining the different NBI features for hyperplastic and adenomatous polyps . MAIN OUTCOME MEASUREMENTS Performance characteristics in characterizing the histology of diminutive polyps with NBI by using short video clips before ( pretest ) and after ( posttest ) review ing the teaching module . RESULTS Non-experts in academic practice showed a significant improvement in the sensitivity ( 54 % vs 79 % ; P < .001 ) , accuracy ( 64 % vs 81 % ; P < .001 ) , and proportion of high-confidence diagnoses ( 49 % vs 69 % ; P < .001 ) in the posttest . Non-experts in community practice had significantly higher sensitivity ( 58 % vs 75 % ; P = .004 ) , specificity ( 76 % vs 90 % ; P = .04 ) , accuracy ( 64 % vs 81 % ; P < .001 ) , and proportion of high-confidence diagnoses ( 49 % vs 72 % ; P < .001 ) in the posttest . Performance of experts in NBI was significantly better than non-experts in both academic and community practice . LIMITATIONS Selection bias in selecting good quality videos . Performance not assessed during live colonoscopy . CONCLUSION Academic and community gastroenterologists without prior experience in NBI can achieve significant improvements in characterizing diminutive polyp histology after a brief computer-based training . The durability of these results and applicability in everyday practice are uncertain BACKGROUND Missing adenomas and the inability to accurately differentiate between polyp histology remain the main limitations of st and ard-definition white-light ( SD-WL ) colonoscopy . OBJECTIVE To compare the adenoma detection rates of SD-WL with those of high-definition white-light ( HD-WL ) and narrow-b and imaging ( NBI ) as well as the accuracy of predicting polyp histology . DESIGN Multicenter , prospect i ve , r and omized , controlled trial . SETTING Two academic medical centers in the United States . PATIENTS Subjects undergoing screening or surveillance colonoscopy .  INTERVENTION Subjects were r and omized to undergo colonoscopy with one of the following : SD-WL , HD-WL , or NBI . MAIN OUTCOME MEASUREMENTS The proportion of subjects detected with adenomas , adenomas detected per subject , and the accuracy of predicting polyp histology real time . RESULTS A total of 630 subjects were included . The proportion of subjects with adenomas was 38.6 % with SD-WL compared with 45.7 % with HD-WL and 46.2 % with NBI ( P = .17 and P = .14 , respectively ) . Adenomas detected per subject were 0.69 with SD-WL compared with 1.12 with HD-WL and 1.13 with NBI ( P = .016 and P = .014 , respectively ) . HD-WL and NBI detected more subjects with flat and right-sided adenomas compared with SD-WL ( all P values < .005 ) . NBI had a superior sensitivity ( 90 % ) and accuracy ( 82 % ) to predict adenomas compared with SD-WL 
    Output:
    
It shows high potential for real-time endoscopic diagnosis