Abstract
Background and aimsDye-less chromoendoscopy is an emerging technology for colorectal polyp characterization. Herein, we investigated whether the newly introduced I-scan optical enhancement (OE) can accurately predict polyp histology in vivo in real-time.MethodsIn this prospective three-phased study, 84 patients with 230 diminutive colorectal polyps were included. During the first two study phases, five endoscopists assessed whether analysis of polyp colour, surface and vascular pattern under i-scan OE can differentiate in vivo between adenomatous and hyperplastic polyps. Finally, junior and experienced endoscopists (JE, EE, each n = 4) not involved in the prior study phases made a post hoc diagnosis of polyp histology using a static i-scan OE image database. Histopathology was used as a gold-standard in all study phases.ResultsThe overall accuracy of i-scan OE for histology prediction was 90% with a sensitivity, specificity, positive (PPV) and negative prediction value (NPV) of 91%, 90%, 86% and 94%, respectively. In high confidence predictions, the diagnostic accuracy increased to 93% with sensitivity, specificity, PPV and NPV of 94%, 91%, 89% and 96%. Colonoscopy surveillance intervals were predicted correctly in ≥ 90% of patients. In the post hoc analysis EE predicted polyp histology under i-scan OE with an overall accuracy of 91%. After a single training session, JE achieved a comparable diagnostic performance for predicting polyp histology with i-scan OE.ConclusionThe histology of diminutive colorectal polyps can be accurately predicted with i-scan OE in vivo in real-time. Furthermore, polyp differentiation with i-scan OE appears to require only a short learning curve.
Highlights
Colorectal cancer is one of the most common malignant disease prevalent in the population and has a high morbidity and mortality [1]
During the first two study phases, five endoscopists assessed whether analysis of polyp colour, surface and vascular pattern under i-scan optical enhancement (OE) can differentiate in vivo between adenomatous and hyperplastic polyps
The histology of diminutive colorectal polyps can be accurately predicted with i-scan OE in vivo in real-time
Summary
Colorectal cancer is one of the most common malignant disease prevalent in the population and has a high morbidity and mortality [1]. Since white light endoscopy cannot accurately differentiate between adenomatous and hyperplastic diminutive polyps [14, 15], it is standard to date to remove all polyps for subsequent histopathological analyses This redundant removal of all polyps is cost-, risk- and time-intensive and the annual up-front cost-savings in the US of forgoing pathology of diminutive polyps has been estimated to exceed 1 billion dollars per year [16]. Based on these considerations, the American Society of Gastrointestinal Endoscopy (ASGE) has proposed the so called PIVI (Preservation and Incorporation of Valuable endoscopic Innovations) statement [17] in which diagnostic thresholds are defined that new endoscopic techniques should meet in order to allow for valid and accurate in vivo prediction of polyp histology. We investigated whether the newly introduced I-scan optical enhancement (OE) can accurately predict polyp histology in vivo in real-time
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