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