Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study

Abstract

Background/Aims: Endoscopic diagnosis of dysplasia or colitic cancer in patients with ulcerative colitis (UC) is more challenging than that of colorectal neoplasia in non-colitic patients. We aimed to evaluate the accuracy of the endoscopic diagnosis of "nonpedunculated" dysplasia or colitic cancer in UC patients. Methods: Ten endoscopists from four countries were surveyed using photographs of 61 histologically confirmed dysplastic or non-dysplastic lesions retrieved from the UC registry database of Asan Medical Center. The participants provided their assessment based on the given photographs and their intention to perform biopsy. Results:The overall diagnostic performance of the 10 participants is summarized as follows: sensitivity of 88.2% (95% confidence interval [CI], 84.3% to 91.5%), specificity of 34.8% (95% CI, 29.1% to 40.8%), positive predictive value of 63.0% (95% CI, 60.8% to 65.2%), negative predictive value of 70.2% (95% CI, 62.7% to 76.6%), and accuracy of 64.6% (95% CI, 60.7% to 68.4%). The interobserver agreement on the intention to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, including ulceration, distinctness of the borders, and pit patterns, only neoplastic pit patterns were significantly predictive of dysplasia (odds ratio, 3.710; 95% CI, 2.001 to 6.881). The diagnostic sensitivity and specificity of neoplastic pit patterns were 68.2% (95% CI, 63.0% to 73.2%) and 63.3% (95% CI, 57.3% to 69.1%), respectively. Conclusions: Diagnostic per-formance based on the endoscopist's intention to perform a biopsy for nonpedunculated potentially dysplastic lesions in UC patients was suboptimal according to this survey-based study. (Gut Liver,

Kuijieyuan Decoction Improved Intestinal Barrier Injury of Ulcerative Colitis by Affecting TLR4-Dependent PI3K/AKT/NF-κB Oxidative and Inflammatory Signaling and Gut Microbiota

“…Ulcerative colitis (UC) is a chronic inflammatory disease of the colon caused by unbalanced immune responses to host intestinal microbiota and main threatens to public health ( Roselli and Finamore, 2019 ). Although much progress has been made in diagnosis ( Yang et al., 2019 ; Vadstrup et al., 2020 ) and therapy ( Karjalainen et al., 2020 ; Kunovszki et al., 2020 ) for UC in recent years, an effective therapeutic drug is still difficult to be available. Gut microbiota disturbance ( Noor et al., 2010 ) and intestinal barrier injury ( Chen et al., 2019 ) is often associated with a UC risk.…”

Use of advanced endoscopic technology for optical characterization of neoplasia in patients with ulcerative colitis: Systematic review

“…To eliminate technical barriers to magnifying endoscopes and effectively introduce the pit pattern into clinical practice, the usefulness of pit pattern evaluation in non magnified settings has been assessed. Three studies examined the feasibility of using the pit pattern without magnification to differentiate neoplastic from non‐neoplastic lesions 24,26,39 . These studies showed that with the non magnification setting, the sensitivity was lower than, and specificity was comparable to, that of the magnification setting: the sensitivity ranged from 68% to 77%, and the specificity ranged from 63% to 90%.…”

“…Improvement of the interobserver agreement rates is also important for widespread use of diagnostics. The interobserver agreement regarding the intention to perform biopsy (Fleiss' kappa of 0.17) 39 and the overall interobserver agreement for any pit pattern (Fleiss' kappa of 0.28) 26 are reportedly poor to fair.…”

“…Three studies examined the feasibility of using the pit pattern without magnification to differentiate neoplastic from nonneoplastic lesions. 24,26,39 These studies showed that with the non magnification setting, the sensitivity was lower than, and specificity was comparable to, that of the magnification setting: the sensitivity ranged from 68% to 77%, and the specificity ranged from 63% to 90%.…”

Role of Interventional IBD in Management of Ulcerative Colitis(UC)-Associated Neoplasia and Post-Operative Pouch Complications in UC: A Systematic Review

“…However, targeted biopsy may be cost-effective and time-saving [20]. An inter-observer agreement study has shown poor agreement on intention to biopsy among endoscopists in non-pedunculated potentially dysplastic lesions in UC [21]. Apart from IEE, EUS-guided assessment of depth of invasion can help in treatment selection [22].…”