scholarly journals Post-polypectomy surveillance interval based on flexible spectral color imaging enhancement (FICE) with magnifying zoom imaging for optical biopsy

2018 ◽  
Vol 06 (08) ◽  
pp. E1051-E1058
Author(s):  
Rodrigo de Rezende Zago ◽  
Pedro Popoutchi ◽  
Lucas Santana Nova da Costa ◽  
Marcelo Averbach
Keyword(s):  
Task Force ◽  
Colorectal Polyps ◽  
Optical Biopsy ◽  
Intraobserver Agreement ◽  
High Confidence ◽  
Color Imaging ◽  
Neoplastic Lesions ◽  
Surveillance Interval ◽  
Pathological Assessment

Abstract Background and study aims Post-polypectomy surveillance interval (SI) is determined based on the number, size, and histology of colorectal polyps. Electronic chromoendoscopy in association with magnifying imaging colonoscopy allows “in vivo” polyp histology prediction. Colorectal polyps ≤ 5 mm can be resected and discarded without pathologic assessment if the endoscopic technology when used with high confidence provides ≥ 90 % agreement between the post-polypectomy SI and the SI based on pathological assessment. The aim of this study was to evaluate the agreement between the post-polypectomy SI based on flexible spectral color imaging enhancement (FICE) chromoendoscopy in association with magnified imaging and the pathology-based SI. Patients and methods Each diagnosed colorectal polyp received a histology prediction (neoplastic or non-neoplastic) based on the FICE capillary-vessel pattern classification. Each prediction was classified as high or low confidence. SI based on the FICE prediction was compared to the pathology-based SI recommendation according to the US Multi-Society Task Force on Colorectal Cancer guideline. Sensitivity, specificity and accuracy of FICE in diagnosing neoplastic lesions were compared with the pathology assessment. Interobserver and intraobserver agreement for FICE-based SI predictions was evaluated using the kappa coefficient. Results A total of 267 polyps had histology prediction assessed with high confidence in 136 patients. Sensitivity of FICE was 98.7 % (95 % CI: 93.5 – 99.3) and specificity was 62.5 % (95 % CI: 43.6 – 78.9). Prediction accuracy was 94.4 % (95 % CI: 88.6 – 96 – 1) in differentiating between neoplastic and non-neoplastic lesions. Therefore, magnifying FICE colonoscopy-based SI recommendation was consistent with pathological assessment in 88.3 % of general cases (95 % CI: 82.1 – 92.6) and in 89.7 % (95 % CI: 83 – 94.5) of the high-confidence evaluation cases. The intraobserver agreement value for FICE-based SI predictions was 0.87 (high-confidence evaluations), and the interobserver agreement values were 0.78 (high- and low-confidence evaluations) and 0.82 (high-confidence evaluations) (95 % CI: 0.79 – 0.95). Conclusions FICE-based SI demonstrated 89.7 % concordance with the pathology-based SI.

scholarly journals A119 THE LOCATION-BASED RESECT AND DISCARD STRATEGY FOR DIMINUTIVE COLORECTAL POLYPS: A PROSPECTIVE CLINICAL STUDY

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 99-101
Author(s):  
M Taghiakbari ◽  
H Pohl ◽  
R Djinbachian ◽  
A N Barkun ◽  
P Marques ◽  
...  
Keyword(s):  
Task Force ◽  
A Priori ◽  
Cost Effective ◽  
Colorectal Polyps ◽  
Prospective Clinical Study ◽  
Colon Polyps ◽  
Optical Diagnosis ◽  
Cost Effective Approach ◽  
Surveillance Interval ◽  
Task Force Guideline

Abstract Background Replacing histopathology evaluation of diminutive polyps with optical polyp diagnosis is considered a cost-effective approach. However, the widespread use of optical diagnosis is limited due to concerns about making incorrect optical diagnoses and the requirements of training, credentialing and auditing of performance. Aims This prospective study aimed to evaluate a simplified resect and discard strategy that is not operator dependent. Methods The study evaluated a resect and discard strategy that uses anatomical polyp location to classify colon polyps into non-neoplastic or low-risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and optical diagnosis, respectively. The primary outcome was ≥90% agreement with pathology in surveillance interval assignment. Results Overall, 1117 patients undergoing complete colonoscopy were included and 482 (43.1%) had at least one diminutive polyp. Surveillance interval agreement between the location-based resect and discard strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0% (95% CI = 0.96 - 0.98), surpassing the ≥90% benchmark. Optical diagnoses using NICE and Sano classifications reached 89.1% and 90.01% agreement, respectively (p <0.0001), and were inferior to the location-based strategy. The location-based resect and discard strategy allowed a 69.7% (95% CI = 0.67 - 0.72) reduction in pathology examinations compared with 55.3% (95% CI = 0.52 - 0.58) (NICE and Sano) and 41.9% (95% CI = 0.39 - 0.45) (WASP) with optical diagnosis. Conclusions The location-based resect and discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥90% quality benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided. Funding Agencies None

scholarly journals Predictive rules for optical diagnosis of < 10-mm colorectal polyps based on a dedicated software

Endoscopy ◽  
2019 ◽  
Vol 52 (01) ◽  
pp. 52-60 ◽  
Author(s):  
Cesare Hassan ◽  
Raf Bisschops ◽  
Pradeep Bhandari ◽  
Emmanuel Coron ◽  
Helmut Neumann ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Colorectal Polyp ◽  
Colorectal Polyps ◽  
Hyperplastic Polyps ◽  
High Confidence ◽  
Still Images ◽  
The Individual ◽  
Video Library ◽  
Leave One Out

Abstract Background The BASIC classification for predicting in vivo colorectal polyp histology incorporates both surface and pit/vessel descriptor domains. This study aimed to define new BASIC classes for adenomatous and hyperplastic polyps. Methods A video library (102 still images/videos of < 10-mm polyps using white-light [WLI] and blue-light imaging [BLI]) was reviewed by seven expert endoscopists. Polyps were rated according to the individual descriptors of the three BASIC domains (surface/pit/vessel). A model to predict polyp histology (adenomatous or hyperplastic) was developed using multivariable logistic regression and subsequent “leave-one-out” cross-validation. New BASIC rules were then defined by Delphi agreement. The overall accuracy of these rules when used by experts was evaluated according to the level of confidence and light type. Results The strength of prediction for adenomatous histology from 2175 observations assessed by area under the curve (AUC; 95 % confidence interval) was poor-to-fair for the surface descriptors (0.50 [0.33 – 0.69] for mucus; 0.68 [0.57 – 0.79] for irregular surface), but stronger for pits (0.87 [0.80 – 0.96] for featureless/round/not round) and vessels (0.80 [0.65 – 0.87] for not present/lacy/pericryptal). By combining the domains, a good-to-excellent prediction was shown (AUC 0.89 [0.81 – 0.96]). After the definition of new BASIC rules for adenomatous and hyperplastic polyps, accuracy for high confidence BLI predictions was 90.3 % (86.3 % – 93.2 %), which was superior to high confidence WLI (83.7 % [77.3 % – 87.7 %]) and low confidence BLI predictions (77.7 % [61.1 % – 88.6 %]). Conclusions Based on the strength of prediction, the new BASIC classes for adenomatous and hyperplastic histology show favorable results for accuracy and confidence levels.

Evaluation of the polyp-based resect and discard strategy: a retrospective study

Endoscopy ◽  
2021 ◽  
Author(s):  
Antoine Duong ◽  
Heiko Pohl ◽  
Roupen Djinbachian ◽  
Annie Deshêtres ◽  
Alan N. Barkun ◽  
...  
Keyword(s):  
Multiple Testing ◽  
Primary Outcome ◽  
Task Force ◽  
Colorectal Polyps ◽  
Surveillance Interval ◽  
Almost All ◽  
A Prospective Study ◽  
Post Hoc ◽  
Standard Colonoscopy

Abstract Background Standard colonoscopy practice requires removal and histological characterization of almost all detected small (< 10 mm) and diminutive (≤ 5 mm) colorectal polyps. This study aimed to test a simplified polyp-based resect and discard (PBRD) strategy that assigns surveillance intervals based only on size and number of small/diminutive polyps, without the need for pathology examination. Methods A post hoc analysis was performed on patients enrolled in a prospective study. The primary outcome was surveillance interval agreement of the PBRD strategy with pathology-based management according to 2020 US Multi-Society Task Force guidelines. Chart analysis also evaluated clinician adherence to pathology-based recommendations. One-sided testing was performed with a null-hypothesis of 90 % agreement with pathology-based surveillance intervals and a two-sided 96.7 % confidence interval (CI) using correction for multiple testing. Results 452 patients were included in the study. Surveillance intervals assigned using the PBRD strategy were correct in 97.8 % (96.7 %CI 96.3–99.3 %) of patients compared with pathology-based management. The PBRD strategy reduced pathology examinations by 58.7 % while providing 87.8 % of patients with immediate surveillance interval recommendations on the day of colonoscopy, compared with 47.1 % when using pathology-based management. Chart analysis of surveillance interval assignments showed 63.3 % adherence to pathology-based guidelines. Conclusion The PBRD strategy surpassed the 90 % agreement with the pathology-based standard for determining surveillance interval, reduced the need for pathology examinations, and increased the proportion of patients receiving immediate surveillance interval recommendations. The PBRD strategy does not require expertise in optical diagnosis and may replace histological characterization of small and diminutive colorectal polyps.

The location-based resect and discard strategy for diminutive colorectal polyps: a prospective clinical study

Endoscopy ◽  
2021 ◽  
Author(s):  
Mahsa Taghiakbari ◽  
Heiko Pohl ◽  
Roupen Djinbachian ◽  
Alan Barkun ◽  
Paola Marques ◽  
...  
Keyword(s):  
Task Force ◽  
A Priori ◽  
Colonic Polyps ◽  
Colorectal Polyps ◽  
Prospective Clinical Study ◽  
Optical Diagnosis ◽  
Clinical Implementation ◽  
Surveillance Interval ◽  
Task Force Guideline ◽  
Very High

Abstract Background Clinical implementation of the resect-and-discard strategy has been difficult because optical diagnosis is highly operator dependent. This prospective study aimed to evaluate a resect-and-discard strategy that is not operator dependent. Methods The study evaluated a resect-and-discard strategy that uses the anatomical polyp location to classify colonic polyps into non-neoplastic or low risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and on optical diagnosis. The primary outcome was ≥ 90 % agreement with pathology in surveillance interval assignment. Results 1117 patients undergoing complete colonoscopy were included and 482 (43.1 %) had at least one diminutive polyp. Surveillance interval agreement between the location-based strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0 % (95 % confidence interval [CI] 0.96–0.98), surpassing the ≥ 90 % benchmark. Optical diagnoses using the NICE and Sano classifications reached 89.1 % and 90.01 % agreement, respectively (P < 0.001), and were inferior to the location-based strategy. The location-based resect-and-discard strategy allowed a 69.7 % (95 %CI 0.67–0.72) reduction in pathology examinations compared with 55.3 % (95 %CI 0.52–0.58; NICE and Sano) and 41.9 % (95 %CI 0.39–0.45; WASP) with optical diagnosis. Conclusion The location-based resect-and-discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥ 90 % benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided.

scholarly journals 1700 nm optical coherence microscopy enables minimally invasive, label-free, in vivo optical biopsy deep in the mouse brain

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jun Zhu ◽  
Hercules Rezende Freitas ◽  
Izumi Maezawa ◽  
Lee-way Jin ◽  
Vivek J. Srinivasan
Keyword(s):  
Minimally Invasive ◽  
Mouse Brain ◽  
Numerical Aperture ◽  
Optical Biopsy ◽  
Optical Coherence ◽  
Label Free ◽  
Optical Coherence Microscopy ◽  
Minimal Invasiveness ◽  
Cortical Regions

AbstractIn vivo, minimally invasive microscopy in deep cortical and sub-cortical regions of the mouse brain has been challenging. To address this challenge, we present an in vivo high numerical aperture optical coherence microscopy (OCM) approach that fully utilizes the water absorption window around 1700 nm, where ballistic attenuation in the brain is minimized. Key issues, including detector noise, excess light source noise, chromatic dispersion, and the resolution-speckle tradeoff, are analyzed and optimized. Imaging through a thinned-skull preparation that preserves intracranial space, we present volumetric imaging of cytoarchitecture and myeloarchitecture across the entire depth of the mouse neocortex, and some sub-cortical regions. In an Alzheimer’s disease model, we report that findings in superficial and deep cortical layers diverge, highlighting the importance of deep optical biopsy. Compared to other microscopic techniques, our 1700 nm OCM approach achieves a unique combination of intrinsic contrast, minimal invasiveness, and high resolution for deep brain imaging.

P.03.10 LINKED COLOR IMAGING (LCI) REDUCES THE MISS RATE OF NEOPLASTIC LESIONS IN THE RIGHT COLON: A RANDOMIZED TANDEM COLONOSCOPY STUDY

2018 ◽  
Vol 50 (2) ◽  
pp. e147
Author(s):  
G. Mogavero ◽  
S. Paggi ◽  
A. Amato ◽  
A. Andrealli ◽  
G. Imperiali ◽  
...  
Keyword(s):  
Right Colon ◽  
Color Imaging ◽  
Neoplastic Lesions ◽  
Linked Color Imaging ◽  
The Right

scholarly journals A118 POLYP SIZE CUT-OFF LEVEL TO IMPLEMENT OPTICAL POLYP DIAGNOSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 98-99
Author(s):  
M Taghiakbari ◽  
R Djinbachian ◽  
D von Renteln
Keyword(s):  
Colorectal Polyps ◽  
Optical Diagnosis ◽  
Clinical Implementation ◽  
Polyp Size ◽  
Funding Agencies ◽  
Size Groups ◽  
Surveillance Interval ◽  
High Reduction ◽  
Advanced Adenomas ◽  
Post Hoc

Abstract Background Optical polyp diagnosis can be used for real-time pathology prediction of colorectal polyps ≤10 mm. However, the risk of misdiagnosing a polyp with advanced pathology potentially increases with increasing polyp size. Aims This study aimed to evaluate different size cut-offs for using optical polyp diagnosis and the associated risk of patients undergoing inadequate follow-up or surveillance. Methods In a post-hoc analysis of two prospective studies, the performance of optical diagnosis was evaluated in three polyp size groups: 1–3 mm, 1–5 mm, and 1–10 mm. The primary outcome was the proportion of patients with advanced adenomas and delayed or inappropriate surveillance. Secondary outcomes included percentage of polyps with advanced pathology, agreement between surveillance intervals based on high-confidence optical diagnosis and pathology outcomes, reduction in histopathological examinations, and proportion of patients who could receive an immediate surveillance interval recommendation. Results We included 1525 patients with complete colonoscopies (mean age 62.9 years, 50.2% male). The percentage of patients with advanced adenomas and delayed or inappropriate surveillance was 0.7%, 1.7%, and 1.8% when using optical diagnosis for patients with polyps of 1–3, 1–5, and 1–10 mm, respectively. The percentage of polyps with advanced pathology was 0.5%, 1.4%, and 1.9%, respectively. Surveillance interval agreement between pathology and optical diagnosis was 99%, 98%, and 97.8%, respectively. Total reduction in pathology examinations was 33.9%, 53.5%, and 69.0%, respectively. Conclusions A 3-mm cut-off for clinical implementation of optical polyp diagnosis yielded high surveillance interval agreement with pathology and a high reduction in pathology examinations while minimizing the risk of inappropriate management for polyps with advanced pathology. Funding Agencies None

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