Colorectal surveillance interval assignment based on in vivo prediction of polyp histology: impact of endoscopic quality improvement program.

BACKGROUND

Validated training methods are needed before in vivo optical diagnosis can be used to guide colorectal cancer surveillance interval assignments.

OBJECTIVES

To assess the impact of endoscopist training on accuracy of surveillance intervals based on in vivo optical diagnosis.

DESIGN

Prospective, randomized study.

SETTING

Tertiary referral center.

PATIENTS

A total of 1231 patients with colorectal polyps (before training, n = 577; after training, n = 654).

INTERVENTIONS

Endoscopists were randomized to either participate or not participate in two 1-hour training sessions. Endoscopists' in vivo pathology predictions were recorded for all resected polyps. The accuracy of in vivo prediction-guided surveillance intervals were compared with pathology-guided intervals as the criterion standard. Surveillance interval accuracy before and after training were analyzed.

MAIN OUTCOME MEASUREMENTS

Surveillance interval accuracy based on in vivo polyp predictions with pathology-guided intervals as criterion standard before and after a training intervention.

RESULTS

Optically predicted surveillance intervals for the trained group of endoscopists had an overall accuracy of 84% (242/287) before training and 82% (261/317) after training. There was little evidence to suggest that training had a meaningful impact on the accuracy of optically predicted surveillance intervals (odds ratio 1.20; 95% CI, 0.76-1.89, P = .44).

LIMITATIONS

Limitations include small sample size, lack of endoscopist prediction confidence levels, and optional use of narrow-band imaging.

CONCLUSIONS

Surveillance interval accuracy did not meet published thresholds (>90%) to use in vivo optical diagnosis without pathologic confirmation. Larger studies, focused specifically on the impact of training, are needed to validate methods to improve polyp diagnosis and surveillance predication accuracy.