An article published Online First and in The Lancet Oncology reports that optical diagnosis is a reliable method of correctly diagnosing small colorectal polyps during routine colonoscopy. This approach could be a more efficient and cost effective alternative to conventional histopathology. Therefore, optical diagnosis could replace formal histopathology for the diagnosis and management of most small polyps in routine clinical practice.

In developed countries, colorectal cancer is the second leading cause of cancer death. However, when detected early it has one of the highest cure rates. Screening programmes for colorectal cancer seek to detect and remove pre-cancerous polyps.

Narrow-band imaging (NBI) is a new optical technology that uses blue light to enhance an image and provide more detail of the lining of the colon including polyps from which most colorectal cancer develops. Using white-light colonoscopy (WLC) and non-magnifying NBI, new optical technologies and chromoendoscopy have improved the ability to diagnose and manage small polyps seen at routine colonoscopy. They dispense the need for formal histopathology which is time consuming, resource intensive, and results in delays in giving patients advice on future cancer risk and screening intervals.

There is indication that these optical technologies could make colonoscopy more efficient and cost effective. In the USA alone, they could potentially save an estimated $95 million each year in histopathology costs.

Ana Ignjatovic and colleagues, from the St Mark’s Hospital and the Imperial College London sought to confirm the efficiency, safety, and clinical benefit of these simple and widely available optical techniques. They compared the diagnosis of 363 small colorectal polyps (

Written by Stephanie Brunner (B.A.)