Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

Abstract

w.vandewetering@maastrichtuniversity.nl ABSTR AC T Background and study aims Implementation of optical diagnosis of diminutive polyps may potentially increase the efficacy and cost-effectiveness of colonoscopies. To adopt such strategy in clinical practice, the Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) thresholds provide the basis to be met: ≥ 90 % negative predictive value (NPV) for diagnosis of adenomatous histology and ≥ 90 % agreement on surveillance intervals. We evaluated this within the Dutch Bowel Cancer Screening Program (BCSP). Patients and methods Endoscopic and histological datawere collected from participants of the national bowel cancer screening program with an unfavorable fecal immunochemical test referred for colonoscopy between February 2014 and August 2015 at four endoscopy centers. The "resect and discard" scenario was studied, resecting diminutive polyps without histological evaluation. Agreement between optical diagnosis and histological diagnosis was measured for surveillance intervals according to Dutch, European and American post-polypectomy surveillance guideline.Results Fifteen certified endoscopists participated in this study and included 3028 diminutive polyps. In 2,330 patients both optical and histological diagnosis were available. Optical diagnosis of diminutive polyps showed NPV of 84 % (95 % CI 80-87) for adenomatous histology in the rectosigmoid. Applying the 'resect and discard' strategy resulted in 90.6 %, 91.2 %, 90.9 % agreement on surveillance intervals for the Dutch, European and American guideline respectively.Conclusion Our data representing current clinical practice in the Dutch BCSP practice on optical diagnosis of diminutive polyps showed that accuracy of predicting histology remains challenging, and risk of incorrect optical diagnosis is still significant. Therefore, it is too early to safely implement these strategies.

Optical diagnosis of colorectal polyp images using a newly developed computer-aided diagnosis system (CADx) compared with intuitive optical diagnosis

“…Winkens 5 , P. Aepli 6 , B. Hayee 7 , A.B. Pischel 8 , M. Stefanovic 9 , S. Subramaniam 10 , P. Bhandari 10…”

“…This study has several strengths. First, both experts and novices performed the optical diagnosis of CRPs, while previous studies mainly focused on highly selected groups of experts [3][4][5]. Adding novices increased the generalizability of this study.…”

“…Although CRPs contain valuable visual clues about their histology, current optical diagnostic procedures are limited in their predictive power and are subject to a considerable interobserver variability. Recent studies have also shown that while the PIVI criteria are met in highly selected groups of expert endoscopists [3], the same is not true in community endoscopy practices [4,5].…”

Utility of the narrow-band imaging international colorectal endoscopic classification for optical diagnosis of colorectal polyp histology in clinical practice: a retrospective study

“…Developed in 1999, NBI has been reported to provide valuable information regarding the histology of polyps detected during colonoscopy [ 4 ]. Since then, many studies have reported the efficacy of NBI-assisted optical diagnosis of colorectal polyp histology [ 5 – 7 ]. Moreover, NBI-assisted optical diagnosis may enable immediate determination of the appropriate surveillance interval with reduction in the risk of adverse events and health care expenditure [ 8 – 10 ].…”