van de Wetering Alouisa J P, Meulen Lonne W T, Bogie Roel M M, van der Zander Quirine E W, Reumkens Ankie, Winkens Bjorn, Cheng Hao Ran, Straathof Jan-Willem A, Dekker Evelien, Keulen Eric, Bakker C M, Hoge Chantal, de Ridder Rogier, Masclee Ad A M, Sanduleanu-Dascalescu Silvia
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
Endosc Int Open. 2020 Mar;8(3):E257-E265. doi: 10.1055/a-1072-4853. Epub 2020 Feb 21.
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). 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. 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. 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.
微小息肉光学诊断的实施可能会提高结肠镜检查的有效性和成本效益。要在临床实践中采用这种策略，有价值的内镜创新保留与整合（PIVI）阈值提供了需要满足的基础：腺瘤组织学诊断的阴性预测值（NPV）≥90%，以及监测间隔的一致性≥90%。我们在荷兰结直肠癌筛查计划（BCSP）中对此进行了评估。从2014年2月至2015年8月期间在四个内镜中心因粪便免疫化学检测结果不佳而被转诊进行结肠镜检查的全国结直肠癌筛查计划参与者中收集了内镜和组织学数据。研究了“切除并丢弃”方案，即切除微小息肉而不进行组织学评估。根据荷兰、欧洲和美国的息肉切除术后监测指南，测量了光学诊断和组织学诊断在监测间隔方面的一致性。15名认证内镜医师参与了这项研究，共纳入3028个微小息肉。在2330例患者中，光学诊断和组织学诊断均可用。乙状结肠直肠微小息肉的光学诊断显示腺瘤组织学的NPV为84%（95%CI 80-87）。应用“切除并丢弃”策略，荷兰、欧洲和美国指南在监测间隔方面的一致性分别为90.6%、91.2%、90.9%。我们的数据代表了荷兰BCSP实践中目前对微小息肉进行光学诊断的临床情况，表明预测组织学的准确性仍然具有挑战性，光学诊断错误的风险仍然很大。因此，安全实施这些策略还为时过早。
