Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Clin Gastroenterol Hepatol. 2021 Nov;19(11):2425-2434.e4. doi: 10.1016/j.cgh.2021.05.017. Epub 2021 May 13.
The ability of optical evaluation to diagnose submucosal invasive cancer (SMIC) prior to endoscopic resection of large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) is critical to inform therapeutic decisions. Prior studies suggest that it is insufficiently accurate to detect SMIC. It is unknown whether lesion morphology influences optical evaluation performance.
LNPCPs ≥20 mm referred for endoscopic resection within a prospective, multicenter, observational cohort were evaluated. Optical evaluation was performed prior to endoscopic resection with the optical prediction of SMIC based on established features (Kudo V pit pattern, depressed morphology, rigidity/fixation, ulceration). Optical evaluation performance outcomes were calculated. Outcomes were reported by dominant morphology: nodular (Paris 0-Is/0-IIa+Is) vs flat (Paris 0-IIa/0-IIb) morphology.
From July 2013 to July 2019, 1583 LNPCPs (median size 35 [interquartile range, 25-50] mm; 855 flat, 728 nodular) were assessed. SMIC was identified in 146 (9.2%; 95% confidence interval [CI], 7.9%-10.8%). Overall sensitivity and specificity were 67.1% (95% CI, 59.2%-74.2%) and 95.1% (95% CI, 93.9%-96.1%), respectively. The overall SMIC miss rate was 3.0% (95% CI, 2.3%-4.0%). Significant differences in sensitivity (90.9% vs 52.7%), specificity (96.3% vs 93.7%), and SMIC miss rate (0.6% vs 5.9%) between flat and nodular LNPCPs were identified (all P < .027). Multiple logistic regression identified size ≥40 mm (odds ratio [OR], 2.0; 95% CI, 1.0-3.8), rectosigmoid location (OR, 2.0; 95% CI, 1.1-3.7), and nodular morphology (OR, 7.2; 95% CI, 2.8-18.9) as predictors of missed SMIC (all P < .039).
Optical evaluation performance is dependent on lesion morphology. In the absence of features suggestive of SMIC, flat lesions can be presumed benign and be managed accordingly.
在对直径≥20mm 的无蒂结直肠大息肉（LNPCP）进行内镜切除前，光学评估诊断黏膜下浸润性癌（SMIC）的能力对治疗决策至关重要。先前的研究表明，其对 SMIC 的检测不够准确。病变形态是否会影响光学评估的性能尚不清楚。
前瞻性、多中心、观察性队列研究中，对直径≥20mm 且需要进行内镜切除的 LNPCP 进行评估。在进行内镜切除前，基于已建立的特征（Kudo V 凹陷模式、凹陷形态、刚性/固定、溃疡）对 SMIC 进行光学预测，进行光学评估。计算光学评估的性能结果。通过主要形态进行结果报告：结节状（巴黎 0-Is/0-IIa+Is）与平坦状（巴黎 0-IIa/0-IIb）形态。
2013 年 7 月至 2019 年 7 月，共评估了 1583 例 LNPCP（中位直径 35[四分位距，25-50]mm；855 例平坦状，728 例结节状）。146 例（9.2%；95%置信区间[CI]，7.9%-10.8%）中发现 SMIC。总体敏感性和特异性分别为 67.1%（95%CI，59.2%-74.2%）和 95.1%（95%CI，93.9%-96.1%）。SMIC 总体漏诊率为 3.0%（95%CI，2.3%-4.0%）。平坦状与结节状 LNPCP 之间的敏感性（90.9% vs 52.7%）、特异性（96.3% vs 93.7%）和 SMIC 漏诊率（0.6% vs 5.9%）存在显著差异（均 P<.027）。多因素逻辑回归确定了≥40mm 大小（比值比[OR]，2.0；95%CI，1.0-3.8）、直肠乙状结肠位置（OR，2.0；95%CI，1.1-3.7）和结节状形态（OR，7.2；95%CI，2.8-18.9）是 SMIC 漏诊的预测因素（均 P<.039）。
光学评估的性能取决于病变形态。在没有提示 SMIC 的特征的情况下，平坦病变可假定为良性，并进行相应的管理。
