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Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy.
Gastroenterology 2016; 150(2):406-18G

Abstract

BACKGROUND & AIMS

Narrow-band imaging (NBI) allows real-time histologic classification of colorectal polyps. We investigated whether endoscopists without prior training in NBI can achieve the following thresholds recommended by the American Society for Gastrointestinal Endoscopy: for diminutive colorectal polyps characterized with high confidence, a ≥90% negative predictive value for adenomas in the rectosigmoid and a ≥90% agreement in surveillance intervals.

METHODS

Twenty-six endoscopists from 2 tertiary care centers underwent standardized training in NBI interpretation. Endoscopists made real-time predictions of diminutive colorectal polyp histology and surveillance interval predictions based on NBI. Their performance was evaluated by comparing predicted with actual findings from histologic analysis. Multilevel logistic regression was used to assess predictors of performance. Cumulative summation analysis was used to characterize learning curves.

RESULTS

The endoscopists performed 1451 colonoscopies and made 3012 diminutive polyp predictions (74.3% high confidence) using NBI. They made 898 immediate post-procedure surveillance interval predictions. An additional 505 surveillance intervals were determined with histology input. The overall negative predictive value for high-confidence characterizations in the rectosigmoid was 94.7% (95% confidence interval: 92.6%-96.8%) and the surveillance interval agreement was 91.2% (95% confidence interval: 89.7%-92.7%). Overall, 97.0% of surveillance interval predictions would have brought patients back on time or early. High-confidence characterization was the strongest predictor of accuracy (odds ratio = 3.42; 95% confidence interval: 2.72-4.29; P < .001). Performance improved over time, however, according to cumulative summation analysis, only 7 participants (26.9%) identified adenomas with sufficient sensitivity such that further auditing is not required.

CONCLUSIONS

With standardized training, gastroenterologists without prior expertise in NBI were able to meet the negative predictive value and surveillance interval thresholds set forth by the American Society for Gastrointestinal Endoscopy. The majority of disagreement in surveillance interval brought patients back early. Performance improves with time, but most endoscopists will require ongoing auditing of performance. ClinicalTrials.gov ID NCT02441998.

Authors+Show Affiliations

Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado. Electronic address: Swati.Patel@ucdenver.edu.Department of Medicine, Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan.Department of Medicine, Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan.Gastroenterology of the Rockies, Boulder, Colorado.Department of Medicine, Division of Gastroenterology & Hepatology, University of Kansas Medical Center, Kansas City, Kansas.Department of Medicine, Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan.Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.Department of Medicine, Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan.Department of Medicine, Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan.Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University, Chicago, Illinois.Department of Medicine, Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan.Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.Department of Medicine, Division of Gastroenterology & Hepatology, University of Kansas Medical Center, Kansas City, Kansas.Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26522260

Citation

Patel, Swati G., et al. "Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy." Gastroenterology, vol. 150, no. 2, 2016, pp. 406-18.
Patel SG, Schoenfeld P, Kim HM, et al. Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy. Gastroenterology. 2016;150(2):406-18.
Patel, S. G., Schoenfeld, P., Kim, H. M., Ward, E. K., Bansal, A., Kim, Y., ... Wani, S. (2016). Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy. Gastroenterology, 150(2), pp. 406-18. doi:10.1053/j.gastro.2015.10.042.
Patel SG, et al. Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy. Gastroenterology. 2016;150(2):406-18. PubMed PMID: 26522260.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy. AU - Patel,Swati G, AU - Schoenfeld,Philip, AU - Kim,Hyungjin Myra, AU - Ward,Emily K, AU - Bansal,Ajay, AU - Kim,Yeonil, AU - Hosford,Lindsay, AU - Myers,Aimee, AU - Foster,Stephanie, AU - Craft,Jenna, AU - Shopinski,Samuel, AU - Wilson,Robert H, AU - Ahnen,Dennis J, AU - Rastogi,Amit, AU - Wani,Sachin, Y1 - 2015/10/30/ PY - 2015/06/29/received PY - 2015/10/01/revised PY - 2015/10/21/accepted PY - 2015/11/3/entrez PY - 2015/11/3/pubmed PY - 2016/6/4/medline KW - Advanced Endoscopic Imaging KW - Colon Polyps KW - Colorectal Cancer KW - Colorectal Neoplasia SP - 406 EP - 18 JF - Gastroenterology JO - Gastroenterology VL - 150 IS - 2 N2 - BACKGROUND & AIMS: Narrow-band imaging (NBI) allows real-time histologic classification of colorectal polyps. We investigated whether endoscopists without prior training in NBI can achieve the following thresholds recommended by the American Society for Gastrointestinal Endoscopy: for diminutive colorectal polyps characterized with high confidence, a ≥90% negative predictive value for adenomas in the rectosigmoid and a ≥90% agreement in surveillance intervals. METHODS: Twenty-six endoscopists from 2 tertiary care centers underwent standardized training in NBI interpretation. Endoscopists made real-time predictions of diminutive colorectal polyp histology and surveillance interval predictions based on NBI. Their performance was evaluated by comparing predicted with actual findings from histologic analysis. Multilevel logistic regression was used to assess predictors of performance. Cumulative summation analysis was used to characterize learning curves. RESULTS: The endoscopists performed 1451 colonoscopies and made 3012 diminutive polyp predictions (74.3% high confidence) using NBI. They made 898 immediate post-procedure surveillance interval predictions. An additional 505 surveillance intervals were determined with histology input. The overall negative predictive value for high-confidence characterizations in the rectosigmoid was 94.7% (95% confidence interval: 92.6%-96.8%) and the surveillance interval agreement was 91.2% (95% confidence interval: 89.7%-92.7%). Overall, 97.0% of surveillance interval predictions would have brought patients back on time or early. High-confidence characterization was the strongest predictor of accuracy (odds ratio = 3.42; 95% confidence interval: 2.72-4.29; P < .001). Performance improved over time, however, according to cumulative summation analysis, only 7 participants (26.9%) identified adenomas with sufficient sensitivity such that further auditing is not required. CONCLUSIONS: With standardized training, gastroenterologists without prior expertise in NBI were able to meet the negative predictive value and surveillance interval thresholds set forth by the American Society for Gastrointestinal Endoscopy. The majority of disagreement in surveillance interval brought patients back early. Performance improves with time, but most endoscopists will require ongoing auditing of performance. ClinicalTrials.gov ID NCT02441998. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/26522260/Real_Time_Characterization_of_Diminutive_Colorectal_Polyp_Histology_Using_Narrow_Band_Imaging:_Implications_for_the_Resect_and_Discard_Strategy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(15)01575-9 DB - PRIME DP - Unbound Medicine ER -