ID: 3521113 HIGH CONFIDENCE OPTICAL DIAGNOSIS OF SMALL POLYPS AT COLONOSCOPY VERSUS HISTOPATHOLOGY: MOVING TOWARDS A NEW GOLD STANDARD?

Abstract Background The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1 – 5 mm). Methods A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80 % agreement was reached after a maximum of three voting rounds. Recommendation 1 In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 90 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm in the rectosigmoid. Histopathology is used as the gold standard.Level of agreement 95 %. Recommendation 2 In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 80 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm. Histopathology is used as the gold standard.Level of agreement 100 %. Conclusion The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps.

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The addition of high magnifying endoscopy improves rates of high confidence optical diagnosis of colorectal polyps

Endoscopy International Open ◽

10.1055/s-0034-1391362 ◽

2015 ◽

Vol 03 (02) ◽

pp. E140-E145 ◽

Cited By ~ 15

Author(s):

Mineo Iwatate ◽

Yasushi Sano ◽

Santa Hattori ◽

Wataru Sano ◽

Noriaki Hasuike ◽

...

Keyword(s):

Colorectal Polyps ◽

Magnifying Endoscopy ◽

Optical Diagnosis ◽

High Confidence

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From Annotator Agreement to Noise Models

Computational Linguistics ◽

10.1162/coli.2009.35.4.35402 ◽

2009 ◽

Vol 35 (4) ◽

pp. 495-503 ◽

Cited By ~ 19

Author(s):

Beata Beigman Klebanov ◽

Eyal Beigman

Keyword(s):

Gold Standard ◽

Noise Level ◽

Reliable Data ◽

Mathematical Framework ◽

High Confidence ◽

Data Set ◽

Noise Models

This article discusses the transition from annotated data to a gold standard, that is, a subset that is sufficiently noise-free with high confidence. Unless appropriately reinterpreted, agreement coefficients do not indicate the quality of the data set as a benchmarking resource: High overall agreement is neither sufficient nor necessary to distill some amount of highly reliable data from the annotated material. A mathematical framework is developed that allows estimation of the noise level of the agreed subset of annotated data, which helps promote cautious benchmarking.

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Endoscopic scar assessment after colorectal endoscopic mucosal resection scars: when is biopsy necessary (EMR Scar Assessment Project for Endoscope (ESCAPE) trial)

Gut ◽

10.1136/gutjnl-2018-316574 ◽

2019 ◽

Vol 68 (9) ◽

pp. 1633-1641 ◽

Cited By ~ 11

Author(s):

Pujan Kandel ◽

Eelco Christiaan Brand ◽

Joe Pelt ◽

Colleen T Ball ◽

Wei-Chung Chen ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Predictive Value ◽

Narrow Band Imaging ◽

Colorectal Neoplasia ◽

Optical Diagnosis ◽

High Definition ◽

High Confidence ◽

Escape Trial ◽

Mucosal Resection ◽

Scar Assessment

ObjectiveIt is unclear whether endoscopic assessment of scars after colorectal endoscopic mucosal resection (EMR) has to include biopsies, even if endoscopy is negative. Vice versa, endoscopic diagnosis of recurrent adenoma may not require biopsy before endoscopic reinterventions. We prospectively analysed various endoscopic modalities in the diagnosis of recurrence following EMR.DesignWe conducted a prospective study of patients undergoing colonoscopy after EMR of large (≥20 mm) colorectal neoplasia. Endoscopists predicted recurrence and confidence level with four imaging modes: high-definition white light (WL) and narrow-band imaging (NBI) with and without near focus (NF). Separately, 26 experienced endoscopists assessed offline images.ResultsTwo hundred and thirty patients with 255 EMR scars were included. The prevalence of recurrent adenoma was 24%. Diagnostic values were high for all modes (negative predictive value (NPV) ≥97%, positive predictive value (PPV) ≥81%, sensitivity ≥90%, specificity ≥93% and accuracy ≥93%). In high-confidence cases, NBI with NF had NPV of 100% (95% CI 98% to 100%) and sensitivity of 100% (95% CI 93% to 100%). Use of clips at initial EMR increased diagnostic inaccuracy (adjusted OR=1.68(95% CI 1.01 to 2.75)). In offline assessment, specificity was high for all imaging modes (mean: ≥93% (range: 55%–100%)), while sensitivity was significantly higher for NBI-NF (82%(72%–93%)%)) compared with WL (69%(38%–86%); p<0.001), WL-NF (68%(55%–83%); p<0.001) and NBI (71%(59%–90%); p<0.001).ConclusionOur study demonstrates very high sensitivity and accuracy for all four imaging modalities, especially NBI with NF, for diagnosis of recurrent neoplasia after EMR. Our data strongly suggest that in cases of high confidence negative optical diagnosis based on NBI-NF, no biopsy is needed to confirm absence of recurrence during colorectal EMR follow-up. A high confidence positive optical diagnosis can lead to immediate resection of any suspicious area. In all cases of low confidence, biopsy is still required.Trial registration numberNCT02668198.

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Disagreement between high confidence endoscopic adenoma prediction and histopathological diagnosis in colonic lesions ≤ 3 mm in size

Endoscopy ◽

10.1055/a-0831-2348 ◽

2019 ◽

Vol 51 (03) ◽

pp. 221-226 ◽

Cited By ~ 8

Author(s):

Prasanna Ponugoti ◽

Amit Rastogi ◽

Tonya Kaltenbach ◽

Margaret MacPhail ◽

Andrew Sullivan ◽

...

Keyword(s):

Gold Standard ◽

Normal Tissue ◽

Normal Mucosa ◽

Poor Quality ◽

Colorectal Polyps ◽

Histopathological Diagnosis ◽

High Confidence ◽

Endoscopic Appearance ◽

Specimen Handling ◽

Tissue Specimens

Abstract Background Diminutive colorectal polyps resected during colonoscopy are sometimes histologically interpreted as normal tissue. The aim of this observational study was to explore whether errors in specimen handling or processing account in part for polyps ≤ 3 mm in size being interpreted as normal tissue by pathology when they were considered high confidence adenomas by an experienced endoscopist at colonoscopy. Methods One endoscopist photographed 900 consecutive colorectal lesions that were ≤ 3 mm in size and considered endoscopically to be high confidence conventional adenomas. The photographs were reviewed blindly to eliminate poor quality images. The remaining 644 endoscopy images were reviewed by two external experts who predicted the histology while blinded to the pathology results. Results Of 644 consecutive lesions ≤ 3 mm in size considered high confidence conventional adenomas by a single experienced colonoscopist, 15.4 % were reported as normal mucosa by pathology. The prevalence of reports of normal mucosa in polyps removed by cold snare and cold forceps were 15.2 % and 16.0 %, respectively. When endoscopy photographs were reviewed by two blinded outside experts, the lesions found pathologically to be adenomas and normal mucosa were interpreted as high confidence adenomas by endoscopic appearance in 96.9 % and 93.9 %, respectively, by Expert 1 (P = 0.15), and in 99.6 % and 100 %, respectively, by Expert 2 (P = 0.51). Conclusion Retrieval and/or processing of tissue specimens of tiny colorectal polyps resulted in some lesions being diagnosed as normal tissue by pathology despite being considered endoscopically to be high confidence adenomas. These findings suggest that pathology interpretation is not a gold standard for lesion management when this phenomenon is observed.

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Implementation of an optical diagnosis strategy saves costs and does not impair clinical outcomes of a fecal immunochemical test-based colorectal cancer screening program

Endoscopy International Open ◽

10.1055/s-0043-113565 ◽

2017 ◽

Vol 05 (12) ◽

pp. E1197-E1207 ◽

Cited By ~ 6

Author(s):

Jasper Vleugels ◽

Marjolein Greuter ◽

Yark Hazewinkel ◽

Veerle Coupé ◽

Evelien Dekker

Keyword(s):

Colorectal Cancer ◽

Program Effectiveness ◽

Screening Program ◽

Fecal Immunochemical Test ◽

Base Case ◽

Hyperplastic Polyps ◽

Optical Diagnosis ◽

High Confidence ◽

Life Years ◽

Immunochemical Test

Abstract Background and study aims In an optical diagnosis strategy, diminutive polyps that are endoscopically characterized with high confidence are removed without histopathological analysis and distal hyperplastic polyps are left in situ. We evaluated the effectiveness and costs of optical diagnosis. Methods Using the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model, we simulated biennial fecal immunochemical test (FIT) screening in individuals aged 55 – 75 years. In this program, we compared an optical diagnosis strategy with current histopathology assessment of all diminutive polyps. Base-case assumptions included 76 % high-confidence predictions and sensitivities of 88 %, 91 %, and 88 % for endoscopically characterizing adenomas, sessile serrated polyps, and hyperplastic polyps, respectively. Outcomes were colorectal cancer burden, number of colonoscopies, life-years, and costs. Results Both the histopathology strategy and the optical diagnosis strategy resulted in 21 life-days gained per simulated individual compared with no screening. For optical diagnosis, €6 per individual was saved compared with the current histopathology strategy. These cost savings were related to a 31 % reduction in colonoscopies in which histopathology was needed for diminutive polyps. Projecting these results onto the Netherlands (17 million inhabitants), assuming a fully implemented FIT-based screening program, resulted in an annual undiscounted cost saving of € 1.7 – 2.2 million for optical diagnosis. Conclusion Implementation of optical diagnosis in a FIT-based screening program saves costs without decreasing program effectiveness when compared with current histopathology analysis of all diminutive polyps. Further work is required to evaluate how endoscopists participating in a screening program should be trained, audited, and monitored to achieve adequate competence in optical diagnosis.

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