Accuracy in optical diagnosis for polyps between 5 and 15 mm and its implications on surveillance. A prospective, multicenter study. (POPS study)
Por:
Redondo-Cerezo, E, Heredia-Carrasco, C, Alegria-Motte, C, Caballero-Mateos, A, Vadillo-Calles, F, Ortega-Suazo, E, Martos-Ruiz, V, Ariza-Fernandez, J, Lopez-Gonzalez, E, Martinez-Cara, J, Valverde-Lopez, F, de Hierro, M, Sanchez-Capilla, D, Lopez-Hidalgo, J and Jimenez-Rosales, R
Publicada:
1 jul 2022
Ahead of Print:
1 ene 2022
Categoría:
Surgery
Resumen:
Background and aims Polyps histology and diameter up to 1 cm determine whether a patient needs a colonoscopy after 3 years or less, or far ahead. Endoscopists' and pathologists' size estimations can be imprecise. Our aim was to assess endoscopist ability to correctly recommend surveillance colonoscopies for patients with polyps around the 10 mm threshold, based on its endoscopic sizing and optical diagnosis by NBI. Methods NBI-assisted diagnosis and endoscopist estimation of polyp size were compared with reference standard, considering this as the post resection polyp measurements by the nurse assistant and the pathologic results, in a prospective, multicenter, real life study, that recruited adults undergoing colonoscopy in five hospitals. By comparing the endoscopic and pathologist size estimation, with polyps' measurement after resection, and optical and histological diagnoses in patients with polyps between 5 and 15 mm, sensitivity was assessed at the patient level by means of two characteristics: the presence of adenoma, and the surveillance interval. Surveillance intervals were established by the endoscopist, based on optical diagnosis, and by another gastroenterologist, grounded on the pathologic report. Determinants of accuracy were explored at the polyp level. Results 532 polyps were resected in 451 patients. Size estimation was more precise for the endoscopist. Endoscopist sensitivity for the presence of adenoma or carcinoma was 98.7%. Considering the presence of high-grade dysplasia or cancer, sensitivity was 82.6% for the endoscopic optical diagnosis. Sensitivity for a correct 3-year surveillance interval was 91.5%, specificity 82.3%, with a PPV of 93.2% and NPV of 78.5% for the endoscopist. 6.51% of patients would have had their follow-up colonoscopy delayed, whereas 22 (4.8%) would have it been performed earlier, had endoscopist recommendations been followed. Conclusion Our study observes that NBI optical diagnosis can be recommended in routine practice to establish surveillance intervals for polyps between 5 and 15 mm. Clinical Trials Registration Number: NCT04232176
Filiaciones:
Redondo-Cerezo, E:
Virgen Nieves Univ Hosp, Dept Gastroenterol & Hepatol, Endoscopy Unit, Ave Fuerzas Armadas 2, Granada 18014, Spain
Heredia-Carrasco, C:
Virgen Nieves Univ Hosp, Dept Gastroenterol & Hepatol, Endoscopy Unit, Ave Fuerzas Armadas 2, Granada 18014, Spain
Alegria-Motte, C:
Hosp Comarcal Santa Ana, Internal Med Serv, Motril, Spain
Caballero-Mateos, A:
Hosp Comarcal Santa Ana, Internal Med Serv, Motril, Spain
Vadillo-Calles, F:
Hosp Comarcal Virgen Puerto, Internal Med Serv, Plasencia, Spain
Ortega-Suazo, E:
Virgen Nieves Univ Hosp, Dept Gastroenterol & Hepatol, Endoscopy Unit, Ave Fuerzas Armadas 2, Granada 18014, Spain
Martos-Ruiz, V:
Hosp Comarcal Santa Ana, Internal Med Serv, Motril, Spain
Ariza-Fernandez, J:
Hosp Comarcal Poniente, Gastroenterol Serv, El Ejido, Spain
:
Hosp Comarcal Vega Baja, Internal Med Serv, Orihuela, Spain
Martinez-Cara, J:
Virgen Nieves Univ Hosp, Dept Gastroenterol & Hepatol, Endoscopy Unit, Ave Fuerzas Armadas 2, Granada 18014, Spain
Valverde-Lopez, F:
Virgen Nieves Univ Hosp, Dept Gastroenterol & Hepatol, Endoscopy Unit, Ave Fuerzas Armadas 2, Granada 18014, Spain
de Hierro, M:
Virgen Nieves Univ Hosp, Dept Gastroenterol & Hepatol, Endoscopy Unit, Ave Fuerzas Armadas 2, Granada 18014, Spain
Sanchez-Capilla, D:
Virgen Nieves Univ Hosp, Dept Gastroenterol & Hepatol, Endoscopy Unit, Ave Fuerzas Armadas 2, Granada 18014, Spain
Lopez-Hidalgo, J:
Virgen Nieves Univ Hosp, Pathol Dept, Granada, Spain
Jimenez-Rosales, R:
Virgen Nieves Univ Hosp, Dept Gastroenterol & Hepatol, Endoscopy Unit, Ave Fuerzas Armadas 2, Granada 18014, Spain
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