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Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study).
Gut 2019; 68(2):271-279Gut

Abstract

OBJECTIVE

This study evaluated the preresection accuracy of optical diagnosis of T1 colorectal cancer (CRC) in large non-pedunculated colorectal polyps (LNPCPs).

DESIGN

In this multicentre prospective study, endoscopists predicted the histology during colonoscopy in consecutive patients with LNPCPs using a standardised procedure for optical assessment. The presence of morphological features assessed with white light, and vascular and surface pattern with narrow-band imaging (NBI) were recorded, together with the optical diagnosis, the confidence level of prediction and the recommended treatment. A risk score chart was developed and validated using a multivariable mixed effects binary logistic least absolute shrinkage and selection (LASSO) model.

RESULTS

Among 343 LNPCPs, 47 cancers were found (36 T1 CRCs and 11 ≥T2 CRCs), of which 11 T1 CRCs were superficial invasive T1 CRCs (23.4% of all malignant polyps). Sensitivity and specificity for optical diagnosis of T1 CRC were 78.7% (95% CI 64.3 to 89.3) and 94.2% (95% CI 90.9 to 96.6), and 63.3% (95% CI 43.9 to 80.1) and 99.0% (95% CI 97.1 to 100.0) for optical diagnosis of endoscopically unresectable lesions (ie, ≥T1 CRC with deep invasion), respectively. A LASSO-derived model using white light and NBI features discriminated T1 CRCs from non-invasive polyps with a cross-validation area under the curve (AUC) of 0.85 (95% CI 0.80 to 0.90). This model was validated in a temporal validation set of 100 LNPCPs (AUC of 0.81; 95% CI 0.66 to 0.96).

CONCLUSION

Our study provides insights in the preresection accuracy of optical diagnosis of T1 CRC. Sensitivity is still limited, so further studies will show how the risk score chart could be improved and finally used for clinical decision making with regard to the type of endoresection to be used and whether to proceed to surgery instead of endoscopy.

TRIAL REGISTRATION NUMBER

NTR5561.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands.Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands.Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands.Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands.Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.Julius Center for Health Sciences and Primary Care, University Medical Center, University Utrecht, Utrecht, The Netherlands.Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29298873

Citation

Backes, Yara, et al. "Multicentre Prospective Evaluation of Real-time Optical Diagnosis of T1 Colorectal Cancer in Large Non-pedunculated Colorectal Polyps Using Narrow Band Imaging (the OPTICAL Study)." Gut, vol. 68, no. 2, 2019, pp. 271-279.
Backes Y, Schwartz MP, Ter Borg F, et al. Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study). Gut. 2019;68(2):271-279.
Backes, Y., Schwartz, M. P., Ter Borg, F., Wolfhagen, F. H. J., Groen, J. N., de Vos Tot Nederveen Cappel, W. H., ... Moons, L. M. G. (2019). Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study). Gut, 68(2), pp. 271-279. doi:10.1136/gutjnl-2017-314723.
Backes Y, et al. Multicentre Prospective Evaluation of Real-time Optical Diagnosis of T1 Colorectal Cancer in Large Non-pedunculated Colorectal Polyps Using Narrow Band Imaging (the OPTICAL Study). Gut. 2019;68(2):271-279. PubMed PMID: 29298873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study). AU - Backes,Yara, AU - Schwartz,Matthijs P, AU - Ter Borg,Frank, AU - Wolfhagen,Frank H J, AU - Groen,John N, AU - de Vos Tot Nederveen Cappel,Wouter H, AU - van Bergeijk,Jeroen, AU - Geesing,Joost M J, AU - Spanier,Bernhard W M, AU - Didden,Paul, AU - Vleggaar,Frank P, AU - Lacle,Miangela M, AU - Elias,Sjoerd G, AU - Moons,Leon M G, AU - ,, Y1 - 2018/01/03/ PY - 2017/06/23/received PY - 2017/11/17/revised PY - 2017/11/18/accepted PY - 2018/1/5/pubmed PY - 2019/1/19/medline PY - 2018/1/5/entrez KW - colonoscopy KW - colorectal adenomas KW - colorectal cancer KW - colorectal carcinoma SP - 271 EP - 279 JF - Gut JO - Gut VL - 68 IS - 2 N2 - OBJECTIVE: This study evaluated the preresection accuracy of optical diagnosis of T1 colorectal cancer (CRC) in large non-pedunculated colorectal polyps (LNPCPs). DESIGN: In this multicentre prospective study, endoscopists predicted the histology during colonoscopy in consecutive patients with LNPCPs using a standardised procedure for optical assessment. The presence of morphological features assessed with white light, and vascular and surface pattern with narrow-band imaging (NBI) were recorded, together with the optical diagnosis, the confidence level of prediction and the recommended treatment. A risk score chart was developed and validated using a multivariable mixed effects binary logistic least absolute shrinkage and selection (LASSO) model. RESULTS: Among 343 LNPCPs, 47 cancers were found (36 T1 CRCs and 11 ≥T2 CRCs), of which 11 T1 CRCs were superficial invasive T1 CRCs (23.4% of all malignant polyps). Sensitivity and specificity for optical diagnosis of T1 CRC were 78.7% (95% CI 64.3 to 89.3) and 94.2% (95% CI 90.9 to 96.6), and 63.3% (95% CI 43.9 to 80.1) and 99.0% (95% CI 97.1 to 100.0) for optical diagnosis of endoscopically unresectable lesions (ie, ≥T1 CRC with deep invasion), respectively. A LASSO-derived model using white light and NBI features discriminated T1 CRCs from non-invasive polyps with a cross-validation area under the curve (AUC) of 0.85 (95% CI 0.80 to 0.90). This model was validated in a temporal validation set of 100 LNPCPs (AUC of 0.81; 95% CI 0.66 to 0.96). CONCLUSION: Our study provides insights in the preresection accuracy of optical diagnosis of T1 CRC. Sensitivity is still limited, so further studies will show how the risk score chart could be improved and finally used for clinical decision making with regard to the type of endoresection to be used and whether to proceed to surgery instead of endoscopy. TRIAL REGISTRATION NUMBER: NTR5561. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/29298873/Multicentre_prospective_evaluation_of_real_time_optical_diagnosis_of_T1_colorectal_cancer_in_large_non_pedunculated_colorectal_polyps_using_narrow_band_imaging__the_OPTICAL_study__ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=29298873 DB - PRIME DP - Unbound Medicine ER -