Exploring the diagnostic performance of optimal diagnosis techniques in detecting recurrence

We read with keen interest the study by Ortiz et al. evaluating the diagnostic utility of linked color imaging (LCI) in detecting recurrence following piecemeal endoscopic mucosal resection (p-EMR) of large nonpedunculated lesions [11]. This study reinforces the diagnostic performance of optical endoscopic techniques, which we find commendable. However, we have some concerns worth addressing.

First, the histologic recurrence rate of 32% is higher compared with previous studies. While the authors attribute this to indistinct lesion margins, the p-EMR technique itself for larger lesions may increase local recurrence risk, necessitating early endoscopic surveillance [22] [33]. Providing the R0 resection rate after p-EMR at baseline could better explain these findings. Moreover, the lack of clarity regarding postoperative endoscopic surveillance timing, coupled with the higher pathologic grades in the included population, could potentially inflate the positive histologic rate. Statistically, with increased disease prevalence, the positive predictive value and negative predictive value may be impacted, affecting the overall diagnostic performance assessment.

Furthermore, optical diagnosis techniques demand specialized training to achieve optimal diagnostic accuracy, which may be challenging in regular endoscopy centers relying on pathologic diagnosis. Artificial intelligence (AI) has demonstrated promising diagnostic performance for gastrointestinal adenomas, polyps, and laterally spreading tumors, and the combination of LCI and AI (LCA) has proven to improve adenoma detection rates for all endoscopists in colon examinations [44]. Therefore, further research evaluating the diagnostic performance of LCA in detecting recurrence after polypectomy may be more clinically applicable and may potentially maximize the value of optical diagnosis for a broader range of endoscopists.

Publication History

Article published online:
30 October 2024

• References

• 1 Ortiz O, Daca-Alvarez M, Rivero-Sánchez L. et al. Linked-color imaging versus high definition white-light endoscopy for evaluation of post-polypectomy scars of nonpedunculated lesions: LCI-Scar study. Endoscopy 2024; 56: 283-290 DOI: 10.1055/a-2204-3236. (PMID: 37931908)
• 2 Thoguluva Chandrasekar V, Aziz M, Patel HK. et al. Efficacy and safety of endoscopic resection of sessile serrated polyps 10 mm or larger: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2020; 18: 2448-2455.e2443 DOI: 10.1016/j.cgh.2019.11.041. (PMID: 31786330)
• 3 Tate DJ, Argenziano ME, Anderson J. et al. Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023; 55: 645-679 DOI: 10.1055/a-2077-0497. (PMID: 37285908)
• 4 Miyaguchi K, Tsuzuki Y, Hirooka N. et al. Linked-color imaging with or without artificial intelligence for adenoma detection: a randomized trial. Endoscopy 2024; 56: 376-383 DOI: 10.1055/a-2239-8145. (PMID: 38191000)