Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.
Division of Gastroenterology, Hepatology and Motility, University of Kansas School of Medicine, Kansas City, Missouri, USA.
J Gastroenterol Hepatol. 2021 Oct;36(10):2728-2734. doi: 10.1111/jgh.15529. Epub 2021 May 6.
Recently, the BLI Adenoma Serrated International Classification (BASIC) system was developed by European experts to differentiate colorectal polyps. Our aim was to validate the BASIC classification system among the US-based endoscopy experts.
Participants utilized a web-based interactive learning system where the group was asked to characterize polyps using the BASIC criteria: polyp surface (presence of mucus, regular/irregular and [pseudo]depressed), pit appearance (featureless, round/non-round with/without dark spots; homogeneous/heterogeneous distribution with/without focal loss), and vessels (present/absent, lacy, peri-cryptal, irregular). The final testing consisted of reviewing BLI images/videos to determine whether the criteria accurately predicted the histology results. Confidence in adenoma identification (rated "1" to "5") and agreement in polyp (adenoma vs non-adenoma) identification and characterization per BASIC criteria were derived. Strength of interobserver agreement with kappa (k) value was reported for adenoma identification.
Ten endoscopy experts from the United States identified conventional adenoma (vs non-adenoma) with 94.4% accuracy, 95.0% sensitivity, 93.8% specificity, 93.8% positive predictive value, and 94.9% negative predictive value using BASIC criteria. Overall strength of interobserver agreement was high: kappa 0.89 (0.82-0.96). Agreement for the individual criteria was as follows: surface mucus (93.8%), regularity (65.6%), type of pit (40.6%), pit visibility (66.9%), pit distribution (57%), vessel visibility (73%), and being lacy (46%) and peri-cryptal (61%). The confidence in diagnosis was rated at high ≥4 in 67% of the cases.
A group of US-based endoscopy experts have validated a simple and easily reproducible BLI classification system to characterize colorectal polyps with >90% accuracy and a high level of interobserver agreement.
最近，欧洲专家制定了 BLI 腺瘤锯齿状国际分类（BASIC）系统，以区分结直肠息肉。我们的目的是验证基于美国的内镜专家对 BASIC 分类系统的适用性。
参与者使用基于网络的互动学习系统，要求他们使用 BASIC 标准来描述息肉：息肉表面（是否存在黏液、规则/不规则和[假性]凹陷）、凹陷外观（无特征、圆形/非圆形伴/不伴暗点；均匀/不均匀分布伴/不伴局灶性缺失）和血管（存在/缺失、花边状、 crypt 周围、不规则）。最终测试包括审查 BLI 图像/视频，以确定标准是否准确预测组织学结果。根据腺瘤识别的置信度（评为“1”至“5”）和基于 BASIC 标准的息肉（腺瘤与非腺瘤）识别和特征描述的一致性得出。报道了腺瘤识别的观察者间一致性的强度，并用κ（k）值表示。
来自美国的 10 名内镜专家使用 BASIC 标准准确识别出传统腺瘤（与非腺瘤相比）的准确率为 94.4%，灵敏度为 95.0%，特异性为 93.8%，阳性预测值为 93.8%，阴性预测值为 94.9%。观察者间总体一致性很强：κ 值为 0.89（0.82-0.96）。各标准的一致性如下：表面黏液（93.8%）、规则性（65.6%）、凹陷类型（40.6%）、凹陷可见性（66.9%）、凹陷分布（57%）、血管可见性（73%）、花边状（46%）和 crypt 周围（61%）。诊断置信度评分≥4 的病例占 67%。
一组基于美国的内镜专家已经验证了一种简单且易于复制的 BLI 分类系统，该系统可准确识别结直肠息肉，准确率超过 90%，且观察者间一致性高。
