Endoscopic versus histological characterisation of polyps during screening colonoscopy
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Endoscopic versus histological characterisation of polyps during screening colonoscopy. / Schachschal, Guido; Mayr, Michael; Treszl, Andras; Balzer, Klaus; Wegscheider, Karl; Aschenbeck, Jens; Aminalai, Alireza; Drossel, Rolf; Schröder, Andreas; Scheel, Mathias; Bothe, Carl-Hermann; Bruhn, Jens-Peter; Burmeister, Wolfgang; Stange, Gabriela; Bähr, Christina; Kießlich, Ralf; Rösch, Thomas.
In: GUT, Vol. 63, No. 3, 01.03.2014, p. 458-65.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Endoscopic versus histological characterisation of polyps during screening colonoscopy
AU - Schachschal, Guido
AU - Mayr, Michael
AU - Treszl, Andras
AU - Balzer, Klaus
AU - Wegscheider, Karl
AU - Aschenbeck, Jens
AU - Aminalai, Alireza
AU - Drossel, Rolf
AU - Schröder, Andreas
AU - Scheel, Mathias
AU - Bothe, Carl-Hermann
AU - Bruhn, Jens-Peter
AU - Burmeister, Wolfgang
AU - Stange, Gabriela
AU - Bähr, Christina
AU - Kießlich, Ralf
AU - Rösch, Thomas
PY - 2014/3/1
Y1 - 2014/3/1
N2 - BACKGROUND: As screening colonoscopy becomes more widespread, the costs for histopathological assessment of resected polyps are rising correspondingly. Reference centres have published highly accurate results for endoscopic polyp classification. Therefore, it has been proposed that, for smaller polyps, the differential diagnosis that guides follow-up recommendations could be based on endoscopy alone.OBJECTIVE: The aim was to prospectively assess whether the high accuracy for endoscopic polyp diagnosis as reported by reference centres can be reproduced in routine screening colonoscopy.DESIGN: Ten experienced private practice endoscopists had initial training in pit patterns. Then they assessed all polyps detected during 1069 screening colonoscopies. Patients (46% men; mean age 63 years) were randomly assigned to colonoscopy with conventional or latest generation HDTV instruments. The main outcome measure was diagnostic accuracy of in vivo polyp assessment (adenomatous vs hyperplastic). Secondary outcome measures were differences between endoscopes and reliability of image-based follow-up recommendations; a blinded post hoc analysis of polyp photographs was also performed.RESULTS: 675 polyps were assessed (461 adenomatous, 214 hyperplastic). Accuracy, sensitivity and specificity of in vivo diagnoses were 76.6%, 78.1% and 73.4%; size of adenomas and endoscope withdrawal time significantly influenced accuracy. Image-based recommendations for post-polypectomy surveillance were correct in only 69.5% of cases. Post hoc analysis of polyp photographs did not improve accuracy.CONCLUSIONS: In everyday practice, endoscopic classification of polyp type is not accurate enough to abandon histopathological assessment and use of latest generation colonoscopes does not improve this. Image-based surveillance recommendations after polypectomy would consequently not meet guideline requirements.TRIALREGNO: NCT01297712.
AB - BACKGROUND: As screening colonoscopy becomes more widespread, the costs for histopathological assessment of resected polyps are rising correspondingly. Reference centres have published highly accurate results for endoscopic polyp classification. Therefore, it has been proposed that, for smaller polyps, the differential diagnosis that guides follow-up recommendations could be based on endoscopy alone.OBJECTIVE: The aim was to prospectively assess whether the high accuracy for endoscopic polyp diagnosis as reported by reference centres can be reproduced in routine screening colonoscopy.DESIGN: Ten experienced private practice endoscopists had initial training in pit patterns. Then they assessed all polyps detected during 1069 screening colonoscopies. Patients (46% men; mean age 63 years) were randomly assigned to colonoscopy with conventional or latest generation HDTV instruments. The main outcome measure was diagnostic accuracy of in vivo polyp assessment (adenomatous vs hyperplastic). Secondary outcome measures were differences between endoscopes and reliability of image-based follow-up recommendations; a blinded post hoc analysis of polyp photographs was also performed.RESULTS: 675 polyps were assessed (461 adenomatous, 214 hyperplastic). Accuracy, sensitivity and specificity of in vivo diagnoses were 76.6%, 78.1% and 73.4%; size of adenomas and endoscope withdrawal time significantly influenced accuracy. Image-based recommendations for post-polypectomy surveillance were correct in only 69.5% of cases. Post hoc analysis of polyp photographs did not improve accuracy.CONCLUSIONS: In everyday practice, endoscopic classification of polyp type is not accurate enough to abandon histopathological assessment and use of latest generation colonoscopes does not improve this. Image-based surveillance recommendations after polypectomy would consequently not meet guideline requirements.TRIALREGNO: NCT01297712.
KW - Adenomatous Polyps
KW - Aged
KW - Colonic Neoplasms
KW - Colonic Polyps
KW - Colonoscopes
KW - Colonoscopy
KW - Diagnosis, Differential
KW - Early Detection of Cancer
KW - Female
KW - Humans
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Sensitivity and Specificity
KW - Single-Blind Method
U2 - 10.1136/gutjnl-2013-304562
DO - 10.1136/gutjnl-2013-304562
M3 - SCORING: Journal article
C2 - 23812324
VL - 63
SP - 458
EP - 465
JO - GUT
JF - GUT
SN - 0017-5749
IS - 3
ER -