Polypenklassifikation: NICE

Die NICE (NBI-International-Colorectal-Endoscopic)-Klassifikation beruht auf Narrow Band Imaging-Bildern von Colonpolypen. Hierbei werden Farbe, Gefäßmuster und Oberflächenmuster einbezogen, um eine Unterscheidung von hyperplastischen und adenomatösen Colonpolypen endoskopisch vorzunehmen. Obwohl an Endoskope der Firma Olympus gebunden, sind ähnliche differential­diagnostische Überlegungen auch für Geräte anderer Firmen veröffentlicht. Die klinische Anwendung gilt im Prinzip für kleine Polypen (< 5 mm oder < 10 mm).

Typ 1 – Charakteristisch für hyperplastischen Polyp

Farbe: heller als oder ähnlich wie Umgebung
Gefäße: Keine Gefäße oder spärliches Netzwerk, kein Muster erkennbar

Oberfläche: Kreisförmiges Pattern mit kleinen Flecken (“dots”) — Pattern mit zentral dunklerem Bereich, umgeben von hellerer Schleimhaut

Weitere Beispiele:

Typ 2 – Charakteristisch für Adenom

Farbe: dunkler (brauner) als Umgebung
Gefäße: zentral hellerer Bereich, umgeben von dickeren braunen Gefäßen

Oberfläche: oval, tubulär, gyrös — Vorhandensein von Tubuli, linear oder als Konvolut, zentral hellerer Bereich, umgeben von braunen Gefäßen.

Weitere Beispiele:

Typ 3 – Charakteristisch für Malignom (SM)

Farbe: dunkler als die Umgebung?, bräunlich, manchmal mit helleren Flecken
Gefäße: Areale von unterbrochenen oder fehlenden Gefäßen
Oberfläche: Amorphes oder kein Oberflächenmuster

NICE-Klassifikation

	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
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).

Literaturverzeichnis

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