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Endoscopy 2022; 54(12): 1182-1190
DOI: 10.1055/a-1843-9535
Original article

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

Mahsa Taghiakbari
1   University of Montreal, Montreal, Quebec, Canada
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
,
Heiko Pohl
3   Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States
4   VA Medical Center, Whiter River Junction, Vermont, United States
,
Roupen Djinbachian 
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
5   Division of Internal Medicine, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
,
Joseph C. Anderson
3   Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States
4   VA Medical Center, Whiter River Junction, Vermont, United States
,
Danny Metellus
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
5   Division of Internal Medicine, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
,
Alan N. Barkun
6   Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
,
Mickael Bouin
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
7   Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
,
Daniel von Renteln 
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
7   Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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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.

Tables 1 s–7 s, Fig. 1 s



Publication History

Received: 05 July 2021

Accepted after revision: 06 April 2022

Article published online:
03 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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