What size cutoff level should be used to implement optical polyp diagnosis?

Abstract

Background The risk of advanced pathology increases with polyp size, as does the potential for mismanagement when optical diagnosis is used. This study aimed to evaluate the proportion of patients who would be assigned inadequate surveillance intervals when different size cutoffs are adopted for use of optical diagnosis.

Methods In a post hoc analysis of three prospective studies, the use of optical diagnosis was evaluated for three polyp size groups: 1–3, 1–5, and 1–10 mm. The primary outcome was the proportion of patients in whom advanced adenomas were found and optical diagnosis resulted in delayed surveillance. Secondary outcomes included agreements between surveillance intervals based on high confidence optical diagnosis and pathology outcomes, reduction in histopathological examinations, and proportion of patients who could receive an immediate surveillance recommendation.

Results We included 3374 patients (7291 polyps ≤ 10 mm) undergoing complete colonoscopies (median age 66.0 years, 75.2 % male, 29.6 % for screening). The percentage of patients with advanced adenomas and either 2- or 7-year delayed surveillance intervals (n = 79) was 3.8 %, 15.2 %, and 25.3 % for size cutoffs of 1–3, 1–5, and 1–10 mm polyps, respectively (P < 0.001). Surveillance interval agreements between pathology and optical diagnosis for the three groups were 97.2 %, 95.5 %, and 94.2 %, respectively. Total reductions in pathology examinations for the three groups were 33.5 %, 62.3 %, and 78.2 %, respectively.

Conclusion A 3-mm cutoff for clinical implementation of optical diagnosis resulted in a very low risk of delayed management of advanced neoplasia while showing high surveillance interval agreement with pathology and a one-third reduction in overall requirement for pathology examinations.

Publikationsverlauf

Eingereicht: 05. Juli 2021

Angenommen nach Revision: 06. April 2022

Artikel online veröffentlicht:
03. Juni 2022

• References

• 1 Gupta N, Bansal A, Rao D. et al. Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc 2012; 75: 1022-1030
• 2 Lieberman D, Moravec M, Holub J. et al. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology 2008; 135: 1100-1105
• 3 Kessler WR, Imperiale TF, Klein RW. et al. A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps. Endoscopy 2011; 43: 683-691
• 4 Fan C, Younis A, Bookhout CE. et al. Management of serrated polyps of the colon. Curr Treat Options Gastroenterol 2018; 16: 182-202
• 5 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158: 1131-1153
• 6 Chandran S, Parker F, Lontos S. et al. Can we ease the financial burden of colonoscopy? Using real-time endoscopic assessment of polyp histology to predict surveillance intervals. Intern Med J 2015; 45: 1293-1299
• 7 Hassan C, Antonelli G, Dumonceau J-M. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020. Endoscopy 2020; 52: 687-700
• 8 Rutter MD, East J, Rees CJ. et al. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut 2020; 69: 201-223
• 9 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
• 10 Bisschops R, East JE, Hassan C. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 1155-1179
• 11 Vleugels JLA, Hazewinkel Y, Dijkgraaf MGW. et al. Optical diagnosis expanded to small polyps: post-hoc analysis of diagnostic performance in a prospective multicenter study. Endoscopy 2019; 51: 244-252
• 12 Shahidi N, Rex DK, Kaltenbach T. et al. Use of endoscopic impression, artificial intelligence, and pathologist interpretation to resolve discrepancies between endoscopy and pathology analyses of diminutive colorectal polyps. Gastroenterology 2020; 158: 783-785
• 13 Alaoui A, Oumedjbeur K, Djinbachian R. et al. A79 Clinical validation of the simple classification for optical diagnosis of diminutive and small colorectal polyps. J Can Assoc Gastroenterol 2020; 3: 93-94
• 14 Djinbachian R, Pohl H, Marques P. et al. Sa2010 Optical diagnosis of small colorectal polyps using Optivista and iScan image enhanced endoscopy: a randomized controlled trial. Gastrointest Endosc 2020; 91: AB240
• 15 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
• 16 Von Renteln D, Leduc R, Bouchard S. et al. A78 Comparison of the NICE, Sano, and WASP classifications for optical diagnosis of small colorectal polyps. J Can Assoc Gastroenterol 2020; 3: 92-93
• 17 Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 2009; 136: 1174-1181
• 18 The Paris endoscopic classification of superficial neoplastic lesions. esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-43
• 19 Rex DK, Ahnen DJ, Baron JA. et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329
• 20 Jass JR, Sobin LH, Morson BC. Histological typing of intestinal tumours. 2nd ed. Berlin, New York: Springer-Verlag; 1989
• 21 Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. Hoboken, NJ: John Wiley & Sons; 2013
• 22 Landis JR, Koch GGJB. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
• 23 Bonithon-Kopp C, Piard F, Fenger C. et al. Colorectal adenoma characteristics as predictors of recurrence. Dis Colon Rectum 2004; 47: 323-333
• 24 Saini SD, Kim HM, Schoenfeld P. Incidence of advanced adenomas at surveillance colonoscopy in patients with a personal history of colon adenomas: a meta-analysis and systematic review. Gastrointest Endosc 2006; 64: 614-626
• 25 Ponugoti P, Rastogi A, Kaltenbach T. et al. Disagreement between high confidence endoscopic adenoma prediction and histopathological diagnosis in colonic lesions ≤3 mm in size. Endoscopy 2019; 51: 221-226
• 26 Schachschal G, Sehner S, Choschzick M. et al. Impact of reassessment of colonic hyperplastic polyps by expert GI pathologists. Int J Colorectal Dis 2016; 31: 675-683
• 27 Singh H, Bay D, Ip S. et al. Pathological reassessment of hyperplastic colon polyps in a city-wide pathology practice: implications for polyp surveillance recommendations. Gastrointest Endosc 2012; 76: 1003-1008
• 28 Anderson JC, Lisovsky M, Greene MA. et al. Factors associated with classification of hyperplastic polyps as sessile serrated adenomas/polyps on morphologic review. J Clin Gastroenterol 2018; 52: 524-529
• 29 Baldin RKS, Anselmi JúniorRA, Azevedo M. et al. Interobserver variability in histological diagnosis of serrated colorectal polyps. J Coloproct (Rio J) 2015; 35: 193-197
• 30 Byrne MF, Chapados N, Soudan F. et al. Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model. Gut 2019; 68: 94-100
• 31 van der Sommen F, de Groof J, Struyvenberg M. et al. Machine learning in GI endoscopy: practical guidance in how to interpret a novel field. Gut 2020; 69: 2035-2045
• 32 Anderson BW, Smyrk TC, Anderson KS. et al. Endoscopic overestimation of colorectal polyp size. Gastrointest Endosc 2016; 83: 201-208
• 33 Atalaia-Martins C, Marcos P, Leal C. et al. Variation between pathological measurement and endoscopically estimated size of colonic polyps. GE Port J Gastroenterol 2019; 26: 163-168
• 34 Yoshida N, Hisabe T, Hirose R. et al. Improvement in the visibility of colorectal polyps by using blue laser imaging (with video). Gastrointest Endosc 2015; 82: 542-549
• 35 Sola-Vera J, Cuesta R, Uceda F. et al. Accuracy for optical diagnosis of colorectal polyps in clinical practice. Rev Esp Enferm Dig 2015; 107: 255-261