Rath Timo, Tontini Gian E, Vieth Michael, Nägel Andreas, Neurath Markus F, Neumann Helmut
Department of Medicine I, Division of Gastroenterology, Pneumology and Endocrinology, University Hospital Erlangen, Germany.
Institute of Pathology, Klinikum Bayreuth, Germany.
Endoscopy. 2016 Jun;48(6):557-62. doi: 10.1055/s-0042-102251. Epub 2016 Mar 23.
In order to reduce time, costs, and risks associated with resection of diminutive colorectal polyps, the American Society for Gastrointestinal Endoscopy (ASGE) recently proposed performance thresholds that new technologies should meet for the accurate real-time assessment of histology of colorectal polyps. In this study, we prospectively assessed whether laser-induced fluorescence spectroscopy (LIFS), using the new WavSTAT4 optical biopsy system, can meet the ASGE criteria.
27 patients undergoing screening or surveillance colonoscopy were included. The histology of 137 diminutive colorectal polyps was predicted in real time using LIFS and findings were compared with the results of conventional histopathological examination. The accuracy of predicting polyp histology with WavSTAT4 was assessed according to the ASGE criteria.
The overall accuracy of LIFS using WavSTAT4 for predicting polyp histology was 84.7 % with sensitivity, specificity, and negative predictive value (NPV) of 81.8 %, 85.2 %, and 96.1 %. When only distal colorectal diminutive polyps were considered, the NPV for excluding adenomatous histology increased to 100 % (accuracy 82.4 %, sensitivity 100 %, specificity 80.6 %). On-site, LIFS correctly predicted the recommended surveillance intervals with an accuracy of 88.9 % (24/27 patients) when compared with histology-based United States guideline recommendations; in the 3 patients for whom LIFS- and histopathology-based recommended surveillance intervals differed, LIFS predicted shorter surveillance intervals.
From the data of this pilot study, LIFS using the WavSTAT4 system appears accurate enough to allow distal colorectal polyps to be left in place and nearly reaches the threshold to "resect and discard" them without pathologic assessment. WavSTAT4 therefore has the potential to reduce costs and risks associated with the removal of diminutive colorectal polyps.
为了减少与微小结直肠息肉切除相关的时间、成本和风险，美国胃肠内镜学会（ASGE）最近提出了新技术在准确实时评估结直肠息肉组织学方面应达到的性能阈值。在本研究中，我们前瞻性地评估了使用新型WavSTAT4光学活检系统的激光诱导荧光光谱法（LIFS）是否能满足ASGE标准。
纳入27例接受筛查或监测结肠镜检查的患者。使用LIFS实时预测137个微小结直肠息肉的组织学，并将结果与传统组织病理学检查结果进行比较。根据ASGE标准评估WavSTAT4预测息肉组织学的准确性。
使用WavSTAT4的LIFS预测息肉组织学的总体准确率为84.7%，敏感性、特异性和阴性预测值（NPV）分别为81.8%、85.2%和96.1%。仅考虑远端结直肠微小息肉时，排除腺瘤性组织学的NPV增至100%（准确率82.4%，敏感性100%，特异性80.6%）。在现场，与基于组织学的美国指南建议相比，LIFS正确预测推荐监测间隔的准确率为88.9%（24/27例患者）；在LIFS和基于组织病理学的推荐监测间隔不同的3例患者中，LIFS预测的监测间隔更短。
从这项初步研究的数据来看，使用WavSTAT4系统的LIFS似乎足够准确，可使远端结直肠息肉留在原位，并且几乎达到了无需病理评估就“切除并丢弃”它们的阈值。因此，WavSTAT4有潜力降低与切除微小结直肠息肉相关的成本和风险。
