Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Gut. 2016 Jun;65(6):963-70. doi: 10.1136/gutjnl-2014-308411. Epub 2015 Mar 9.
Accurate endoscopic differentiation would enable to resect and discard small and diminutive colonic lesions, thereby increasing cost-efficiency. Current classification systems based on narrow band imaging (NBI), however, do not include neoplastic sessile serrated adenomas/polyps (SSA/Ps). We aimed to develop and validate a new classification system for endoscopic differentiation of adenomas, hyperplastic polyps and SSA/Ps <10 mm.
We developed the Workgroup serrAted polypS and Polyposis (WASP) classification, combining the NBI International Colorectal Endoscopic classification and criteria for differentiation of SSA/Ps in a stepwise approach. Ten consultant gastroenterologists predicted polyp histology, including levels of confidence, based on the endoscopic aspect of 45 polyps, before and after participation in training in the WASP classification. After 6 months, the same endoscopists predicted polyp histology of a new set of 50 polyps, with a ratio of lesions comparable to daily practice.
The accuracy of optical diagnosis was 0.63 (95% CI 0.54 to 0.71) at baseline, which improved to 0.79 (95% CI 0.72 to 0.86, p<0.001) after training. For polyps diagnosed with high confidence the accuracy was 0.73 (95% CI 0.64 to 0.82), which improved to 0.87 (95% CI 0.80 to 0.95, p<0.01). The accuracy of optical diagnosis after 6 months was 0.76 (95% CI 0.72 to 0.80), increasing to 0.84 (95% CI 0.81 to 0.88) considering high confidence diagnosis. The combined negative predictive value with high confidence of diminutive neoplastic lesions (adenomas and SSA/Ps together) was 0.91 (95% CI 0.83 to 0.96).
We developed and validated the first integrative classification method for endoscopic differentiation of small and diminutive adenomas, hyperplastic polyps and SSA/Ps. In a still image evaluation setting, introduction of the WASP classification significantly improved the accuracy of optical diagnosis overall as well as SSA/P in particular, which proved to be sustainable after 6 months.
准确的内镜下鉴别有助于切除和丢弃小而微小的结肠病变，从而提高成本效益。然而，目前基于窄带成像（NBI）的分类系统并不包括肿瘤性无蒂锯齿状腺瘤/息肉（SSA/Ps）。我们旨在开发和验证一种新的分类系统，用于内镜下鉴别直径<10mm 的腺瘤、增生性息肉和 SSA/Ps。
我们开发了工作组锯齿状息肉和息肉病（WASP）分类，结合了 NBI 国际结直肠内镜分类和区分 SSA/Ps 的标准，采用逐步方法。十名顾问胃肠病学家根据 45 个息肉的内镜特征，在参加 WASP 分类培训之前和之后，预测息肉的组织学，包括置信水平。6 个月后，同一名内镜医生预测了一组 50 个新息肉的组织学，病变比例与日常实践相当。
光学诊断的准确性在基线时为 0.63（95%CI 0.54 至 0.71），培训后提高至 0.79（95%CI 0.72 至 0.86，p<0.001）。对于诊断为高度置信的息肉，准确性为 0.73（95%CI 0.64 至 0.82），提高至 0.87（95%CI 0.80 至 0.95，p<0.01）。6 个月后的光学诊断准确性为 0.76（95%CI 0.72 至 0.80），考虑到高度置信诊断，增加至 0.84（95%CI 0.81 至 0.88）。高度置信的微小肿瘤性病变（腺瘤和 SSA/Ps 联合）的阴性预测值为 0.91（95%CI 0.83 至 0.96）。
我们开发并验证了用于内镜下鉴别小而微小的腺瘤、增生性息肉和 SSA/Ps 的第一个综合分类方法。在静态图像评估环境中，引入 WASP 分类显著提高了整体光学诊断的准确性，特别是 SSA/P 的准确性，并且在 6 个月后仍然可持续。
