Polyp Morphology: An Interobserver Evaluation for the Paris Classification Among International Experts

Doorn, Sascha C. van; Hazewinkel, Yark; East, James E.; Leerdam, Monique E. van; Rastogi, Amit; Pellisé, María; Sanduleanu‐Dascalescu, Silvia; Bastiaansen, Barbara A.; Fockens, Paul; Dekker, Evelien

doi:10.1038/ajg.2014.326

Cited by 99 publications

(81 citation statements)

References 38 publications

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“…28 It is important to recognize that previous studies in other gastrointestinal conditions that validated specific optical criteria suggestive of malignancy such as Barrett's esophagus, early gastric cancer, and colorectal polyps required at least moderate interobserver agreements between individual endoscopists. [29][30][31] Furthermore, in our present study, papillary projections was the only cholangioscopic feature that achieved substantial interobserver agreement highlighting that if this finding is observed using any cholangioscopy system, then a biliary neoplasm is likely.…”

Section: Discussionsupporting

confidence: 69%

The interobserver agreement of optical features used to differentiate benign from neoplastic biliary lesions assessed at balloon‐assisted cholangioscopy

Behary

Keegan

Craig

2019

J of Gastro and Hepatol

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Background and Aim Balloon‐assisted cholangioscopy allows mucosal assessment of the biliary tree with pediatric endoscopes. No validated optical criteria exist to differentiate benign from neoplastic biliary lesions. We aimed to identify, validate, and revalidate optical features differentiating benign from neoplastic biliary lesions. Furthermore, we aimed to determine whether cholangioscopic appearance allows endoscopists to accurately differentiate benign from neoplastic biliary lesions. Methods Baseline: from 44 de‐identified balloon‐assisted cholangioscopy videos, a blinded investigator analyzed potential optical features distinguishing benign from neoplastic biliary lesions. Validation: during the initial “teaching phase,” 20 endoscopists viewed video clips of 11 optical features identified in the baseline study. At the subsequent “test phase,” 20 further video clips were assessed by the endoscopists blinded to clinical details and questionnaires completed for the presence or absence of optical features, favored diagnosis and diagnostic confidence. Revalidation: The six identified optical features from the validation study with at least moderate agreement were revalidated the same way 12 months later assessing 20 new lesions. Results Baseline: 11 optical features were found to differentiate benign from neoplastic biliary lesions. Validation and revalidation: six optical features demonstrated at least moderate interobserver agreement (irregular margin, dark mucosa, adherent mucous, papillary projections, tubular, or branched/disorganized surface structures). Endoscopists correctly diagnosed lesions as benign in 89% and neoplastic in 83%. When highly confident, endoscopists correctly diagnosed 96% of benign and 87% neoplastic lesions. Conclusions Six features were validated and revalidated to differentiate benign from neoplastic biliary lesions. When highly confident with a diagnosis, endoscopists usually differentiate benign from neoplastic biliary lesions.

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Section: Discussionsupporting

confidence: 69%

The interobserver agreement of optical features used to differentiate benign from neoplastic biliary lesions assessed at balloon‐assisted cholangioscopy

Behary

Keegan

Craig

2019

J of Gastro and Hepatol

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“…Recent findings suggest that interobserver variability makes the Paris classification unreliable in community gastroenterology practice and that further systems may need to be developed …”

Section: Techniquementioning

confidence: 99%

“…Recent findings suggest that interobserver variability makes the Paris classification unreliable in community gastroenterology practice and that further systems may need to be developed. 188 Image enhanced endoscopy. The histological type of most polyps can be determined with some accuracy by examination of morphology and pit pattern.…”

Section: Retroflexionmentioning

confidence: 99%

Improving the utility of colonoscopy: Recent advances in practice

Corte

Leong

2015

J of Gastro and Hepatol

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Colonoscopy is a frequently performed diagnostic and therapeutic test and the primary screening tool in several nationalized bowel cancer screening programs. There has been a considerable focus on maximizing the utility of colonoscopy. This has occurred in four key areas: Optimizing patient selection to reduce unnecessary or low yield colonoscopy has offered cost-benefit improvements in population screening. Improving quality assurance, through the development of widely accepted quality metrics for use in individual practice and the research setting, has offered measurable improvements in colonoscopic yield. Significant improvements have been demonstrated in colonoscopic technique, from the administration of preparation to the techniques employed during withdrawal of the colonoscope. Improved techniques to avoid post-procedural complications have also been developed-further maximizing the utility of colonoscopy. The aim of this review is to summarize the recent evidence-based advances in colonoscopic practice that contribute to the optimal practice of colonoscopy.

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“…In research studies, characterisation is usually done with the Paris classification for gastrointestinal polyps, and the National Health Service bowel cancer screening programme has recently adopted this for clinical use 8. However, there are doubts about its reproducibility, especially for diminutive polyps where interobserver kappa values were 0.27 (fair) even among experts 9. Invasive potential can be estimated based on morphology.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic approach to polyp recognition

Lahiff

East

2017

Frontline Gastroenterol

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Identification and complete resection of colorectal polyps provide a significant mortality benefit from colorectal cancer. With improvements in colonoscopic techniques and advanced endoscopic imaging techniques, polyp detection has taken on greater complexity since the establishment of bowel cancer screening programmes internationally. All endoscopists operating within symptomatic and screening populations should be aware of endoscopic features associated with advanced neoplasia. Chromoendoscopy and advanced imaging techniques, such as narrow spectrum technologies (narrow band imaging, flexible spectral imaging colour enhancement (FICE) and i-Scan digital contrast (iSCAN)), have specific classification systems to support accurate lesion characterisation. This review summarises the evidence in relation to polyp detection, recognition and characterisation as well as the identification of features of invasion. Future areas of interest include optimal management of large polyps, incorporation of a 'detect, resect and discard' strategy for small and diminutive polyps, expected wider use of computer decision support tools (artificial intelligence and deep learning) and the use of fluorescently labelled molecular probes to improve detection and assessment of neoplasia.

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Polyp Morphology: An Interobserver Evaluation for the Paris Classification Among International Experts

Cited by 99 publications

References 38 publications

The interobserver agreement of optical features used to differentiate benign from neoplastic biliary lesions assessed at balloon‐assisted cholangioscopy

The interobserver agreement of optical features used to differentiate benign from neoplastic biliary lesions assessed at balloon‐assisted cholangioscopy

Improving the utility of colonoscopy: Recent advances in practice

Endoscopic approach to polyp recognition

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