NBI Matrix • International Polyp Lexicon
NICE Category
Select the NBI pattern from the endoscopy report to visualize the NICE classification clinical profile.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
Characterization of colorectal polyps during screening colonoscopy using Narrow Band Imaging (NBI)
Designed for non-magnified (real-time) endoscopic assessment
To guide the decision to "Discard" small distal polyps or "Resect and Discard"
To identify lesions suspicious for deep submucosal invasion in a non-specialist setting
Optical Advantage
NBI uses filtered blue (415nm) and green (540nm) light to highlight surface micro-vessels and mucosal pits. Unlike JNET, NICE does not require magnification, making it universally applicable on all NBI-enabled scopes.
How it Works
The 3 NICE Types
| Type 1 | Light color; No vessels; Regular pits (Hyperplastic/SSL) |
| Type 2 | Brown color; Distinct vessels; Tubular pits (Adenoma) |
| Type 3 | Deep Brown/Black; Loose/Disrupted vessels; Amorphous surface (Deep SM Invasion) |
Evaluation Domains
01
Domain 1: Color (Light vs. Brown vs. Dark).
02
Domain 2: Vessel Architecture (None vs. Regular surrounding pits vs. Disrupted).
03
Domain 3: Surface Pattern (Dark/White pits vs. Tubular vs. Distorted).
Clinical Pearls
NICE Type 1 — The Discard Rule
Type 1 polyps located in the rectosigmoid that are < 5mm can be diagnosed with "High Confidence" by an expert endoscopist and discarded without pathology. This "PIVET" policy (ASGE) significantly reduces healthcare costs and pathology burden.
Type 2 vs. Type 3
Type 2 polyps are benign adenomas and can be cured with simple EMR. Type 3 polyps represent invasive cancer and should either be biopsied for staging or referred directly for cross-sectional imaging and surgery.
Clinical Pearls
A "Dark Brown" appearance in Type 2 polyps is caused by the high vascular density of adenomatous tissue
Lack of visible vessels in Type 1 polyps confirms the non-neoplastic nature of hyperplastic lesions
Always combine NICE with the Paris classification to assess the technical "resectability" of a lesion
Next Steps
Clinical Action
01
NICE Type 1 (Distal): Leave-in-situ or Cold Snare and discard.
02
NICE Type 2: Curative EMR/Polypectomy.
03
NICE Type 3: Surgical staging; Avoid endoscopic resection within the black/amorphous area.
The Evidence
The Foundational Classification
Validation of a simple classification system (NICE) for colonoscopy using narrow-band imaging without magnification.
Hewett DG et al. • Gastroenterology. 2012;143(3):599-607. The large-scale validation of the NICE criteria.
View Source• . ;
Origins & History
NBI International Colorectal Endoscopic (NICE) Group
Created by a global working group to provide a "universal" and simplified language for NBI interpretation. It reflects the collaborative effort between Japanese expertise in optical analysis and Western requirements for non-magnified real-time screening.
Last Comprehensive Review: 2026-07-17