Download PDF
Endoscopy 2019; 51(03): 244-252
DOI: 10.1055/a-0759-1605
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Optical diagnosis expanded to small polyps: post-hoc analysis of diagnostic performance in a prospective multicenter study[*]

Jasper L. A. Vleugels
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
,
Yark Hazewinkel
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
,
Marcel G. W. Dijkgraaf
2   Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
,
Lianne Koens
3   Department of Pathology, Amsterdam University Medical Center, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
,
Paul Fockens
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
,
Evelien Dekker   *
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
,
on behalf of the DISCOUNT study group › Author AffiliationsTRIAL REGISTRATION: Prospective, multicenter, randomized controlled trial NCT02407925 at clinicaltrials.gov
Further Information

Publication History

submitted 31 May 2018

accepted after revision 21 September 2018

Publication Date:
13 December 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Background: Optical diagnosis can replace histopathology of diminutive (1 – 5 mm) polyps if surveillance intervals based on optical diagnosis of polyps have ≥ 90 % agreement with intervals based on polyp histology and if the negative predictive value (NPV) for predicting neoplastic histology in the rectosigmoid is ≥ 90 %. This study aims to assess whether small (6 – 9 mm) polyps can be included in optical diagnosis strategies.

Method: This is a post-hoc analysis of a prospective multicenter study in which 27 endoscopists, all performing endoscopies for the Dutch screening program, were trained in optical diagnosis. For 1 year, endoscopists recorded the predicted histology for all lesions detected using narrow-band imaging during 3144 consecutive colonoscopies after a positive fecal immunochemical test, along with confidence levels. Surveillance interval agreement and NPV were calculated for high confidence predictions for polyps of 1 – 9 mm and compared with histopathology. Surveillance interval agreement was calculated using the European Society of Gastrointestinal Endoscopy surveillance guideline.

Results: Surveillance interval agreement was 95.4 % (confidence interval [CI] 94.2 % – 96.4 %), and NPV for predicting neoplastic histology in the rectosigmoid 90.0 % (CI 87.3 % – 92.2 %). The reduction in histology (45.9 % vs. 30.5 %) and the proportion of patients who could have received direct surveillance advice (15.6 % vs. 7.3 %) was higher when small polyps were included (P < 0.001). T1 cancer was found in seven small polyps (0.33 %), five of which would have been discarded without histopathology.

Conclusion: Including small polyps in the optical diagnosis strategy improves its efficacy while maintaining performance thresholds. However, there is a small risk of missing T1 cancers when small polyps are included in the optical diagnosis strategy.

* See end of article for the full list of members of the DISCOUNT study group


Table e3

 

  • References

  • 1 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
    CrossrefPubMedSearch in Google Scholar
  • 2 Siegel R, DeSantis C, Virgo K. et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 2012; 62: 220-241
    CrossrefPubMedSearch in Google Scholar
  • 3 Bettington M, Walker N, Clouston A. et al. The serrated pathway to colorectal carcinoma: current concepts and challenges. Histopathology 2013; 62: 367-386
    CrossrefPubMedSearch in Google Scholar
  • 4 Vogelstein B, Fearon ER, Hamilton SR. et al. Genetic alterations during colorectal-tumor development. NEJM 1988; 319: 525-532
    CrossrefPubMedSearch in Google Scholar
  • 5 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. NEJM 2012; 366: 687-696
    CrossrefPubMedSearch in Google Scholar
  • 6 Pickhardt PJ, Kim DH. Colorectal cancer screening with CT colonography: key concepts regarding polyp prevalence, size, histology, morphology, and natural history. AJR Am J Roentgenol 2009; 193: 40-46
    CrossrefPubMedSearch in Google Scholar
  • 7 Vleugels JL, Hazewinkel Y, Fockens P. et al. Natural history of diminutive and small colorectal polyps: a systematic literature review. Gastrointest Endosc 2017; 85: 1169-1176.e1
    CrossrefPubMedSearch in Google Scholar
  • 8 Ponugoti PL, Cummings OW, Rex DK. Risk of cancer in small and diminutive colorectal polyps. Dig Liver Dis 2017; 49: 34-37
    CrossrefPubMedSearch in Google Scholar
  • 9 Turner KO, Genta RM, Sonnenberg A. Lesions of all types exist in colon polyps of all sizes. American J Gastroenterol 2018; 113: 303-330
    PubMedSearch in Google Scholar
  • 10 Hassan C, Quintero E, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
    CrossrefPubMedSearch in Google Scholar
  • 12 Ignjatovic A, East JE, Suzuki N. et al. Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol 2009; 10: 1171-1178
    CrossrefPubMedSearch in Google Scholar
  • 13 Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 2009; 136: 1174-1181
    CrossrefPubMedSearch in Google Scholar
  • 14 Rex DK, Kahi C, O'Brien M. et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73: 419-422
    CrossrefPubMedSearch in Google Scholar
  • 15 Abu DayyehBK, Thosani N, Konda V. et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2015; 81: 502.e501-502.e516
    CrossrefPubMedSearch in Google Scholar
  • 16 NICE Diagnostics Guidance, No. 28. Virtual chromoendoscopy to assess colorectal polyps during colonoscopy. London: National Institute for Health and Care Excellence (UK); 2017
    PubMedSearch in Google Scholar
  • 17 McGill SK, Evangelou E, Ioannidis JP. et al. Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics. Gut 2013; 62: 1704-1713
    CrossrefPubMedSearch in Google Scholar
  • 18 Wanders LK, East JE, Uitentuis SE. et al. Diagnostic performance of narrowed spectrum endoscopy, autofluorescence imaging, and confocal laser endomicroscopy for optical diagnosis of colonic polyps: a meta-analysis. Lancet Oncol 2013; 14: 1337-1347
    CrossrefPubMedSearch in Google Scholar
  • 19 Kaminski MF, Hassan C, Bisschops R. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2014; 46: 435-449
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Vleugels JLA, Dijkgraaf MGW, Hazewinkel Y. et al. Effects of training and feedback on accuracy of predicting rectosigmoid neoplastic lesions and selection of surveillance intervals by endoscopists performing optical diagnosis of diminutive polyps. Gastroenterology 2018; 154: 1682-1693.e1
    CrossrefPubMedSearch in Google Scholar
  • 21 Bossuyt PM, Reitsma JB, Bruns DE. et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ 2015; 351: h5527
    Search in Google Scholar
  • 22 IJspeert JE, Bastiaansen BA, van Leerdam ME. et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2016; 65: 963-970
    CrossrefPubMedSearch in Google Scholar
  • 23 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599-607.e591
    CrossrefPubMedSearch in Google Scholar
  • 24 Hamilton SR, Aaltonen LA. , eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. Lyon: IARC Press; 2000
    Search in Google Scholar
  • 25 Paggi S, Rondonotti E, Amato A. et al. Resect and discard strategy in clinical practice: a prospective cohort study. Endoscopy 2012; 44: 899-904
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Vleugels JLA, Greuter MJE, Hazewinkel Y. et al. Implementation of an optical diagnosis strategy saves costs and does not impair clinical outcomes of a fecal immunochemical test-based colorectal cancer screening program. Endosc Int Open 2017; 5: E1197-E1207
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Rex DK, Patel NJ, Vemulapalli KC. A survey of patient acceptance of resect and discard for diminutive polyps. Gastrointest Endosc 2015; 82: 376-380 e371
    CrossrefPubMedSearch in Google Scholar
  • 28 Ladabaum U, Fioritto A, Mitani A. et al. Real-time optical biopsy of colon polyps with narrow band imaging in community practice does not yet meet key thresholds for clinical decisions. Gastroenterology 2013; 144: 81-91
    CrossrefPubMedSearch in Google Scholar
  • 29 Schachschal G, Mayr M, Treszl A. et al. Endoscopic versus histological characterisation of polyps during screening colonoscopy. Gut 2014; 63: 458-465
    CrossrefPubMedSearch in Google Scholar
  • 30 Rees CJ, Rajasekhar PT, Wilson A. et al. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut 2017; 66: 887-895
    CrossrefPubMedSearch in Google Scholar
  • 31 Kudo S, Hirota S, Nakajima T. et al. Colorectal tumours and pit pattern. J Clin Pathol 1994; 47: 880-885
    CrossrefPubMedSearch in Google Scholar
  • 32 Hayashi N, Tanaka S, Hewett DG. et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78: 625-632
    CrossrefPubMedSearch in Google Scholar
  • 33 Backes Y, Moss A, Reitsma JB. et al. Narrow band imaging, magnifying chromoendoscopy, and gross morphological features for the optical diagnosis of t1 colorectal cancer and deep submucosal invasion: a systematic review and meta-analysis. Am J Gastroenterol 2017; 112: 54-64
    CrossrefPubMedSearch in Google Scholar
  • 34 van der Vlugt M, van Doorn SC, Wang J. et al. Optical diagnosis of malignant colorectal polyps: is it feasible?. Endoscopy Int Open 2016; 4: E778-E783
    PubMedSearch in Google Scholar
  • 35 Backes Y, Schwartz MP, Ter Borg F. et al. Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study). Gut 2018;
    CrossrefPubMedSearch in Google Scholar