Optical diagnosis expanded to small polyps: post-hoc analysis of diagnostic performance in a prospective multicenter study.
In: Endoscopy, Jg. 51 (2019-03-01), Heft 3, S. 244-252
academicJournal
Zugriff:
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. [ABSTRACT FROM AUTHOR]
Copyright of Endoscopy is the property of Georg Thieme Verlag Stuttgart and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Titel: |
Optical diagnosis expanded to small polyps: post-hoc analysis of diagnostic performance in a prospective multicenter study.
|
---|---|
Autor/in / Beteiligte Person: | Vleugels, Jasper L. A. ; Hazewinkel, Yark ; Dijkgraaf, Marcel G. W. ; Koens, Lianne ; Fockens, Paul ; Dekker, Evelien ; DISCOUNT study group |
Zeitschrift: | Endoscopy, Jg. 51 (2019-03-01), Heft 3, S. 244-252 |
Veröffentlichung: | 2019 |
Medientyp: | academicJournal |
ISSN: | 0013-726X (print) |
DOI: | 10.1055/a-0759-1605 |
Schlagwort: |
|
Sonstiges: |
|