Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

Alouisa J P van de Wetering, Lonne W T Meulen, Roel M M Bogie, Quirine E W van der Zander, Ankie Reumkens, Bjorn Winkens, Hao Ran Cheng, Jan-Willem A Straathof, Evelien Dekker, Eric Keulen, C M Bakker, Chantal Hoge, Rogier de Ridder, Ad A M Masclee, Silvia Sanduleanu-Dascalescu, Alouisa J P van de Wetering, Lonne W T Meulen, Roel M M Bogie, Quirine E W van der Zander, Ankie Reumkens, Bjorn Winkens, Hao Ran Cheng, Jan-Willem A Straathof, Evelien Dekker, Eric Keulen, C M Bakker, Chantal Hoge, Rogier de Ridder, Ad A M Masclee, Silvia Sanduleanu-Dascalescu

Abstract

Background and study aims Implementation of optical diagnosis of diminutive polyps may potentially increase the efficacy and cost-effectiveness of colonoscopies. To adopt such strategy in clinical practice, the Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) thresholds provide the basis to be met: ≥ 90 % negative predictive value (NPV) for diagnosis of adenomatous histology and ≥ 90 % agreement on surveillance intervals. We evaluated this within the Dutch Bowel Cancer Screening Program (BCSP). Patients and methods Endoscopic and histological data were collected from participants of the national bowel cancer screening program with an unfavorable fecal immunochemical test referred for colonoscopy between February 2014 and August 2015 at four endoscopy centers. The "resect and discard" scenario was studied, resecting diminutive polyps without histological evaluation. Agreement between optical diagnosis and histological diagnosis was measured for surveillance intervals according to Dutch, European and American post-polypectomy surveillance guideline. Results Fifteen certified endoscopists participated in this study and included 3028 diminutive polyps. In 2,330 patients both optical and histological diagnosis were available. Optical diagnosis of diminutive polyps showed NPV of 84 % (95 % CI 80-87) for adenomatous histology in the rectosigmoid. Applying the 'resect and discard' strategy resulted in 90.6 %, 91.2 %, 90.9 % agreement on surveillance intervals for the Dutch, European and American guideline respectively. Conclusion Our data representing current clinical practice in the Dutch BCSP practice on optical diagnosis of diminutive polyps showed that accuracy of predicting histology remains challenging, and risk of incorrect optical diagnosis is still significant. Therefore, it is too early to safely implement these strategies.

Conflict of interest statement

Competing interests Disclosures: R.M.M. Bogie: received an educational grant from Pentax Medical Europe. E. Dekker: I have endoscopic equipment on loan of FujiFilm, receive a research grant from FujiFilm. I have received a honorarium for consultancy from FujiFilm, Olympus, Tillots, GI Supply and CPP-FAP and a speakersʼ fee from Olympus, Roche and GI Supply. Besides, I am in the supervisory board of eNose. A.A.M. Masclee: 1. Funding grant from Pentax International GMBH. 2. Project funding from Dutch Cancer Society. S. Sanduleanu-Dascalescu: received a research grant from Pentax Europe.

Figures

Fig. 1
Fig. 1
Flowchart of the included patients and polyps.

References

    1. Edwards B K, Ward E, Kohler B A et al.Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–573.
    1. Lieberman D A, Rex D K, Winawer S J et al.Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844–857.
    1. European Colorectal Cancer Screening Guidelines Working Group . von Karsa L, Patnick J et al.European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy. 2013;45:51–59.
    1. Shaukat A, Mongin S J, Geisser M S et al.Long-term mortality after screening for colorectal cancer. N Engl J Med. 2013;369:1106–1114.
    1. Toes-Zoutendijk E, van Leerdam M E, Dekker E et al.Real-time monitoring of results during first year of dutch colorectal cancer screening program and optimization by altering fecal immunochemical test cut-off levels. Gastroenterology. 2017;152:767–775 e762.
    1. Hassan C, Pickhardt P J, Rex D K. A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol. 2010;8:865–869, 869 e861-863.
    1. ASGE Technology Committee . Abu Dayyeh B K, Thosani N et al.ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc. 2015;81:502 e501–502 e516.
    1. Rex D K, Kahi C, OʼBrien M 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;73:419–422.
    1. le Clercq C M, Bouwens M W, Rondagh E J et al.Postcolonoscopy colorectal cancers are preventable: a population-based study. Gut. 2014;63:957–963.
    1. Rondagh E J, Bouwens M W, Riedl R G et al.Endoscopic appearance of proximal colorectal neoplasms and potential implications for colonoscopy in cancer prevention. Gastrointest Endosc. 2012;75:1218–1225.
    1. (RIVM) RvVeM . Protocol voor de toelating en auditing van coloscopiecentra en endoscopisten – Bevolkingsonderzoek Darmkanker. 2012.
    1. Bronzwaer M ES, Depla A, van Lelyveld N et al.Quality assurance of colonoscopy within the Dutch national colorectal cancer screening program. Gastrointest Endosc. 2019;89:1–13.
    1. Calderwood A H, Schroy P C, 3rd, Lieberman D A et al.Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness. Gastrointest Endosc. 2014;80:269–276.
    1. Schlemper R J, Riddell R H, Kato Y et al.The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–255.
    1. NVMDL (Dutch Association of Gastroenterology) – Dutch Guideline Colonoscopy Surveillance 2013
    1. Hassan C, Quintero E, Dumonceau J M et -polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2013;45:842–851.
    1. Lieberman D, Moravec M, Holub J et al.Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology. 2008;135:1100–1105.
    1. Von Renteln D, Bouin M, Barkun A N. Current standards and new developments of colorectal polyp management and resection techniques. Expert Rev Gastroenterol Hepatol. 2017;11:835–842.
    1. Vleugels J LA, Hassan C, Senore C et al.Diminutive polyps with advanced histologic features do not increase risk for metachronous advanced colon neoplasia. Gastroenterology. 2019;156:623–634 e623.
    1. Vleugels J LA, Dijkgraaf M GW, Hazewinkel al.Effects of training and feedback on accuracy of predicting rectosigmoid neoplastic lesions and selection of surveillance intervals by endoscopists performing optical diagnosis of diminutive polyps Gastroenterology 20181541682–1693.
    1. Ignjatovic A, East J E, Suzuki N et al.Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol. 2009;10:1171–1178.
    1. Ladabaum U, Fioritto A, Mitani A et al.Real-time optical biopsy of colon polyps with narrow band imaging in community practice does not yet meet key thresholds for clinical decisions. Gastroenterology. 2013;144:81–91.
    1. Rees C J, Rajasekhar P T, Wilson A et al.Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut. 2017;66:887–895.
    1. Klare P, Haller B, Wormbt S et al.Narrow-band imaging vs. high definition white light for optical diagnosis of small colorectal polyps: a randomized multicenter trial. Endoscopy. 2016;48:909–915.
    1. Basford P J, Longcroft-Wheaton G, Higgins B et al.High-definition endoscopy with i-Scan for evaluation of small colon polyps: the HiSCOPE study. Gastrointestinal endoscopy. 2014;79:111–118.
    1. Kuiper T, Marsman W A, Jansen J M et al.Accuracy for optical diagnosis of small colorectal polyps in nonacademic settings. Clin Gastroenterol Hepatol. 2012;10:1016–1020; quiz e1079.
    1. Repici A, Ciscato C, Correale L et al.Narrow-band Imaging International Colorectal Endoscopic Classification to predict polyp histology: REDEFINE study (with videos) Gastrointest Endosc. 2016;84:479–486 e473.
    1. JE I J, Bastiaansen B A, van Leerdam M E et al.Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut. 2016;65:963–970.
    1. Schachschal G, Mayr M, Treszl A et al.Endoscopic versus histological characterisation of polyps during screening colonoscopy. Gut. 2014;63:458–465.
    1. Vleugels J LA, Greuter M JE, Hazewinkel Y et al.Implementation of an optical diagnosis strategy saves costs and does not impair clinical outcomes of a fecal immunochemical test-based colorectal cancer screening program. Endosc Int Open. 2017;5:E1197–E1207.
    1. Kaltenbach T, Rex D K, Wilson A et al.Implementation of optical diagnosis for colorectal polyps: standardization of studies is needed. Clin Gastroenterol Hepatol. 2015;13:6–10 e11.
    1. Kaminski M F, Hassan C, Bisschops R et al.Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2014;46:435–449.
    1. Atkinson N S, East J E. Optical biopsy and sessile serrated polyps: Is DISCARD dead? Long live DISCARD-lite! Gastrointest Endosc. 2015;82:118–121.
    1. von Renteln D, Kaltenbach T, Rastogi A et al.Simplifying resect and discard strategies for real-time assessment of diminutive colorectal polyps. Clin Gastroenterol Hepatol. 2018;16:706–714.
    1. Mori Y, Kudo S E, Misawa M et al.Real-time use of artificial intelligence in identification of diminutive polyps during colonoscopy: a prospective study. Ann Intern Med. 2018;169:357–366.
    1. Byrne M F, Chapados N, Soudan F et al.Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model. Gut. 2017 doi: 10.1136/gutjnl-2017-314547.
    1. Chen P J, Lin M C, Lai M J et al.Accurate Classification of diminutive colorectal polyps using computer-aided analysis. Gastroenterology. 2018;154:568–575.
    1. Vinsard D G, Mori Y, Misawa M et al.Quality assurance of computer-aided detection and diagnosis in colonoscopy. Gastrointest Endosc. 2019;90:55–63.

Source: PubMed

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