High-definition endoscopy with digital chromoendoscopy for histologic prediction of distal colorectal polyps

Timo Rath, Gian E Tontini, Andreas Nägel, Michael Vieth, Steffen Zopf, Claudia Günther, Arthur Hoffman, Markus F Neurath, Helmut Neumann, Timo Rath, Gian E Tontini, Andreas Nägel, Michael Vieth, Steffen Zopf, Claudia Günther, Arthur Hoffman, Markus F Neurath, Helmut Neumann

Abstract

Background: Distal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection. Within this study we assessed whether digital chromoendoscopy can accurately predict the histology of distal diminutive colorectal polyps according to the ASGE PIVI statement.

Methods: In this prospective cohort study, 224 consecutive patients undergoing screening or surveillance colonoscopy were included. Real time histology of 121 diminutive distal colorectal polyps was evaluated using high-definition endoscopy with digital chromoendoscopy and the accuracy of predicting histology with digital chromoendoscopy was assessed.

Results: The overall accuracy of digital chromoendoscopy for prediction of adenomatous polyp histology was 90.1 %. Sensitivity, specificity, positive and negative predictive values were 93.3, 88.7, 88.7, and 93.2 %, respectively. In high-confidence predictions, the accuracy increased to 96.3 % while sensitivity, specificity, positive and negative predictive values were calculated as 98.1, 94.4, 94.5, and 98.1 %, respectively. Surveillance intervals with digital chromoendoscopy were correctly predicted with >90 % accuracy.

Conclusions: High-definition endoscopy in combination with digital chromoendoscopy allowed real-time in vivo prediction of distal colorectal polyp histology and is accurate enough to leave distal colorectal polyps in place without resection or to resect and discard them without pathologic assessment. This approach has the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps.

Trial registration: ClinicalTrials NCT02217449.

Figures

Fig. 1
Fig. 1
High definition white light and digital chromoendoscopy of hyperplastic (upper panels) and adenomatous diminutive polyps (lower panels). Each polyp was characterized according to size, shape and surface characteristics including pit pattern and mucosal vascular pattern morphology, with digital chromoendoscopy before resection. The distinction between hyperplastic (upper panels) and adenomatous polyps (lower panels) was made based upon previously published and validated criteria on the appearance of diminutive colonic polyps under digital chromoendoscopy [22]. Left panels: High definition white light; Middle panel: High definition i-scan 1 (default setting); Right panel: High definition i-scan 2 (default setting)

References

    1. Kahi CJ, Anderson JC, Waxman I, Kessler WR, Imperiale TF, Li X, Rex DK. High-definition chromocolonoscopy vs. high-definition white light colonoscopy for average-risk colorectal cancer screening. Am J Gastroenterol. 2010;105(6):1301–1307. doi: 10.1038/ajg.2010.51.
    1. Rex DK, Helbig CC. High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging. Gastroenterology. 2007;133(1):42–47. doi: 10.1053/j.gastro.2007.04.029.
    1. Gupta N, Bansal A, Rao D, Early DS, Jonnalagadda S, Wani SB, Edmundowicz SA, Sharma P, Rastogi A. Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc. 2012;75(5):1022–1030. doi: 10.1016/j.gie.2012.01.020.
    1. O’Brien MJ, Winawer SJ, Zauber AG, Gottlieb LS, Sternberg SS, Diaz B, Dickersin GR, Ewing S, Geller S, Kasimian D, et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990;98(2):371–379. doi: 10.1016/0016-5085(90)90827-N.
    1. Butterly LF, Chase MP, Pohl H, Fiarman GS. Prevalence of clinically important histology in small adenomas. Clin Gastroenterol Hepatol. 2006;4(3):343–348. doi: 10.1016/j.cgh.2005.12.021.
    1. Lieberman D, Moravec M, Holub J, Michaels L, Eisen G. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology. 2008;135(4):1100–1105. doi: 10.1053/j.gastro.2008.06.083.
    1. Kessler WR, Imperiale TF, Klein RW, Wielage RC, Rex DK. A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps. Endoscopy. 2011;43(8):683–691. doi: 10.1055/s-0030-1256381.
    1. Rex DK, Kahi C, O’Brien M, Levin TR, Pohl H, Rastogi A, Burgart L, Imperiale T, Ladabaum U, Cohen J, et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc. 2011;73(3):419–422. doi: 10.1016/j.gie.2011.01.023.
    1. Galloro G. High technology imaging in digestive endoscopy. World J Gastrointest Endosc. 2012;4(2):22–27. doi: 10.4253/wjge.v4.i2.22.
    1. Neumann H, Fujishiro M, Wilcox CM, Monkemuller K. Present and future perspectives of virtual chromoendoscopy with i-scan and optical enhancement technology. Dig Endosc. 2014;26(Suppl 1):43–51. doi: 10.1111/den.12190.
    1. Neumann H, Neurath MF, Mudter J. New endoscopic approaches in IBD. World J Gastroenterol. 2011;17(1):63–68. doi: 10.3748/wjg.v17.i1.63.
    1. Tontini GE, Vecchi M, Neurath MF, Neumann H. Review article: newer optical and digital chromoendoscopy techniques vs. dye-based chromoendoscopy for diagnosis and surveillance in inflammatory bowel disease. Aliment Pharmacol Ther. 2013;38(10):1198–1208. doi: 10.1111/apt.12508.
    1. Hewett DG, Huffman ME, Rex DK. Leaving distal colorectal hyperplastic polyps in place can be achieved with high accuracy by using narrow-band imaging: an observational study. Gastrointest Endosc. 2012;76(2):374–380. doi: 10.1016/j.gie.2012.04.446.
    1. Rastogi A, Keighley J, Singh V, Callahan P, Bansal A, Wani S, Sharma P. High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study. Am J Gastroenterol. 2009;104(10):2422–2430. doi: 10.1038/ajg.2009.403.
    1. Repici A, Hassan C, Radaelli F, Occhipinti P, De Angelis C, Romeo F, Paggi S, Saettone S, Cisaro F, Spaander M, et al. Accuracy of narrow-band imaging in predicting colonoscopy surveillance intervals and histology of distal diminutive polyps: results from a multicenter, prospective trial. Gastrointest Endosc. 2013;78(1):106–114. doi: 10.1016/j.gie.2013.01.035.
    1. Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology. 2009;136(4):1174–1181. doi: 10.1053/j.gastro.2008.12.009.
    1. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003, 58(6 Suppl):S3-43.
    1. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, de Vet HC. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD Initiative. Ann Intern Med. 2003;138(1):40–44. doi: 10.7326/0003-4819-138-1-200301070-00010.
    1. Atkin WS, Valori R, Kuipers EJ, Hoff G, Senore C, Segnan N, Jover R, Schmiegel W, Lambert R, Pox C. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Colonoscopic surveillance following adenoma removal. Endoscopy. 2012;44(Suppl 3):SE151–163.
    1. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143(3):844–857. doi: 10.1053/j.gastro.2012.06.001.
    1. Basford PJ, Longcroft-Wheaton G, Higgins B, Bhandari P. High-definition endoscopy with i-Scan for evaluation of small colon polyps: the HiSCOPE study. Gastrointest Endosc. 2014;79(1):111–118. doi: 10.1016/j.gie.2013.06.013.
    1. Lee CK, Lee SH, Hwangbo Y. Narrow-band imaging versus I-Scan for the real-time histological prediction of diminutive colonic polyps: a prospective comparative study by using the simple unified endoscopic classification. Gastrointest Endosc. 2011;74(3):603–609. doi: 10.1016/j.gie.2011.04.049.
    1. Rastogi A, Early DS, Gupta N, Bansal A, Singh V, Ansstas M, Jonnalagadda SS, Hovis CE, Gaddam S, Wani SB, et al. Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology. Gastrointest Endosc. 2011;74(3):593–602. doi: 10.1016/j.gie.2011.04.050.
    1. Rogart JN, Jain D, Siddiqui UD, Oren T, Lim J, Jamidar P, Aslanian H. Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. Gastrointest Endosc. 2008;68(6):1136–1145. doi: 10.1016/j.gie.2008.04.035.
    1. Sikka S, Ringold DA, Jonnalagadda S, Banerjee B. Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopes without optical magnification. Endoscopy. 2008;40(10):818–822. doi: 10.1055/s-2008-1077437.
    1. Gupta N, Bansal A, Rao D, Early DS, Jonnalagadda S, Edmundowicz SA, Sharma P, Rastogi A. Accuracy of in vivo optical diagnosis of colon polyp histology by narrow-band imaging in predicting colonoscopy surveillance intervals. Gastrointest Endosc. 2012;75(3):494–502. doi: 10.1016/j.gie.2011.08.002.
    1. Hoffman A, Sar F, Goetz M, Tresch A, Mudter J, Biesterfeld S, Galle PR, Neurath MF, Kiesslich R. High definition colonoscopy combined with i-Scan is superior in the detection of colorectal neoplasias compared with standard video colonoscopy: a prospective randomized controlled trial. Endoscopy. 2010;42(10):827–833. doi: 10.1055/s-0030-1255713.
    1. Hazewinkel Y, East JE, Dekker E. Response. Gastrointest Endosc. 2014;79(1):184. doi: 10.1016/j.gie.2013.09.007.
    1. Hazewinkel Y, Lopez-Ceron M, East JE, Rastogi A, Pellise M, Nakajima T, van Eeden S, Tytgat KM, Fockens P, Dekker E. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc. 2013;77(6):916–924. doi: 10.1016/j.gie.2012.12.018.
    1. Iacucci M, Xianyong G, Love J, Eustace G, Ghosh S. Novel irregular vascular pattern features of serrated adenoma detected by high-definition iScan endoscopic technique. Gastrointest Endosc. 2014;79(1):182–184. doi: 10.1016/j.gie.2013.08.016.
    1. Kumar S, Fioritto A, Mitani A, Desai M, Gunaratnam N, Ladabaum U. Optical biopsy of sessile serrated adenomas: do these lesions resemble hyperplastic polyps under narrow-band imaging? Gastrointest Endosc. 2013;78(6):902–909. doi: 10.1016/j.gie.2013.06.004.
    1. O’Brien MJ, Yang S, Clebanoff JL, Mulcahy E, Farraye FA, Amorosino M, Swan N. Hyperplastic (serrated) polyps of the colorectum: relationship of CpG island methylator phenotype and K-ras mutation to location and histologic subtype. Am J Surg Pathol. 2004;28(4):423–434. doi: 10.1097/00000478-200404000-00001.
    1. O’Brien MJ, Yang S, Mack C, Xu H, Huang CS, Mulcahy E, Amorosino M, Farraye FA. Comparison of microsatellite instability, CpG island methylation phenotype, BRAF and KRAS status in serrated polyps and traditional adenomas indicates separate pathways to distinct colorectal carcinoma end points. Am J Surg Pathol. 2006;30(12):1491–1501. doi: 10.1097/01.pas.0000213313.36306.85.
    1. Rosenberg DW, Yang S, Pleau DC, Greenspan EJ, Stevens RG, Rajan TV, Heinen CD, Levine J, Zhou Y, O’Brien MJ. Mutations in BRAF and KRAS differentially distinguish serrated versus non-serrated hyperplastic aberrant crypt foci in humans. Cancer Res. 2007;67(8):3551–3554. doi: 10.1158/0008-5472.CAN-07-0343.
    1. Ignjatovic A, Thomas-Gibson S, East JE, Haycock A, Bassett P, Bhandari P, Man R, Suzuki N, Saunders BP. Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps. Gastrointest Endosc. 2011;73(1):128–133. doi: 10.1016/j.gie.2010.09.021.
    1. Raghavendra M, Hewett DG, Rex DK. Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes. Gastrointest Endosc. 2010;72(3):572–576. doi: 10.1016/j.gie.2010.03.1124.
    1. Rastogi A, Pondugula K, Bansal A, Wani S, Keighley J, Sugar J, Callahan P, Sharma P. Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. Gastrointest Endosc. 2009;69(3 Pt 2):716–722. doi: 10.1016/j.gie.2008.09.058.
    1. Bouwens MW, de Ridder R, Masclee AA, Driessen A, Riedl RG, Winkens B, Sanduleanu S. Optical diagnosis of colorectal polyps using high-definition i-scan: an educational experience. World J Gastroenterol. 2013;19(27):4334–4343. doi: 10.3748/wjg.v19.i27.4334.
    1. Neumann H, Vieth M, Fry LC, Gunther C, Atreya R, Neurath MF, Monkemuller K. Learning curve of virtual chromoendoscopy for the prediction of hyperplastic and adenomatous colorectal lesions: a prospective 2-center study. Gastrointest Endosc. 2013;78(1):115–120. doi: 10.1016/j.gie.2013.02.001.
    1. Testoni PA, Notaristefano C, Di Leo M, Vailati C, Mazzoleni G, Viale E. High-definition with i-Scan gives comparable accuracy for detecting colonic lesions by non-expert and expert endoscopists. Dig Liver Dis. 2013;45(6):481–486. doi: 10.1016/j.dld.2012.12.014.
    1. Gomez V, Racho RG, Heckman MG, Diehl NN, Wallace MB. High-Definition White-Light (HDWL) colonoscopy and higher adenoma detection rate and the potential for paradoxical over surveillance. Dig Dis Sci. 2014;59(11):2749–2756. doi: 10.1007/s10620-014-3253-9.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe