Polyp Classification: NICE

Polyp Classification: NICE

The NICE (NBI International Colorectal Endoscopic) Classification is based on narrow-band images of colon polyps. The classification uses staining, vascular patterns, and surface patterns to distinguish between hyperplastic and adenomatous colon polyps. Although it is linked to the Olympus company’s endoscopes, similar differential-diagnostic approaches have also been reported for devices manufactured by other companies. Clinically, the classification is used for small polyps (< 5 mm or < 10 mm).

Type 1 — characteristic for hyperplastic polyp

Vessels: lighter than or similar to the surroundings
Gefäße: small vessels or a sparse network, with no recognizable pattern

Surface: circular pattern with small dots — pattern with a darker area in the center, surrounded by lighter mucosa

Further examples:

Type 2 — characteristic for adenoma

Color: darker (browner) than the surroundings
Vessels: a lighter area in the center, surrounded by thicker brown vessels

Surface: oval, tubular, gyrate — presence of tubuli, linear or bundled, light area in center, surrounded by brown vessels

Further examples:

Type 3 — characteristic for malignancy (SM)

Color: darker than the surroundings, brownish, sometimes with lighter patches
Vessels: areas with interrupted or absent vessels
Surface: amorphous or no surface pattern

NICE Classification

Type 1 Type 2 Type 3
Color Same or lighter than background Brown relative to background (verify color arises from vessels) Brown to dark brown relative to background; sometimes patchy whiter areas
Vessels None, or isolated lacy vessels may be present coursing across the lesion Brown vessels surrounding white structures* Has area(s) of disrupted or missing vessels
Surface patterns Dark or white spots of uniform size, or homogeneus absence of pattern Oval, tubular or branched white structures* surrounded by brown vessels Amorphous or absent surface pattern
Most likely pathology Hyperplastic Adenoma** Deep submucosal invasive cancer
Sample Image NICE-Klassifikation-zur-Colonpolypen-Differentialdiagnose-csm_Tabelle_Bild_01 NICE-Klassifikation-zur-Colonpolypen-Differentialdiagnose-csm_Tabelle_Bild_02 NICE-Klassifikation-zur-Colonpolypen-Differentialdiagnose-csm_Tabelle_Bild_03
This classification can be applied using colonoscopes both with or without optical (zoom) magnification.
* These structures (regular or irregular) may represent the pits and the epithelium of the crypt opening.
** Type 2 consists of Vienna classification types 3, 4 and superficial 5 (all adenomas with either low or high grade dysplasia, or with superficial submucosal carcinoma).
The presence of high grade dysplasia or superficial submucosal carcinoma may be suggested by an irregular vessel or surface pattern, and is often associated with atypical morphology (e.g., depressed area).


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