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Netinatsunton N, Cheewasereechon N, Pattarapuntakul T, Sottisuporn J, Kanjanapradit K, Ovartlarnporn B. Optical diagnosis by near-focus versus normal-focus narrow band imaging colonoscopy in colorectal polyps based on combined NICE and WASP classification: a randomized controlled trial. Clin Endosc 2022; 55:645-654. [PMID: 36071005 PMCID: PMC9539289 DOI: 10.5946/ce.2022.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background/Aims Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Workgroup Serrated Polyps and Polyposis (WASP) classifications were developed for optical diagnosis of neoplastic and sessile serrated polyps, respectively. Near-focus NBI with NICE combined with WASP criteria for optical diagnosis of colonic polyps has not yet been evaluated. We aimed to compare the accuracy of near-focus NBI (group A) with normal-focus NBI (group B) in real-time optical diagnosis of colorectal polyps using combined NICE and WASP criteria.
Methods Among 362 patients, 118 with 227 polyps were recruited. Groups A and B included 62 patients with 130 polyps (three lost polyps) and 56 patients with 106 polyps (six lost polyps), respectively. Optical diagnoses were compared with pathological reports.
Results The accuracy of optical diagnosis of neoplastic polyps in groups A and B was not significantly different (76% vs. 71%, p=0.52). WASP criteria provided all false positive diagnoses of sessile polyps as serrated polyps in 31 (16.2%) patients.
Conclusions Near-focus NBI was not superior to normal-focus NBI in optical diagnostics of neoplastic polyps using NICE criteria. In our study, WASP classification yielded all false positives in the diagnosis of sessile serrated adenomas/polyps. Routine real-life optical diagnosis of polyps is still unadvisable.
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Affiliation(s)
- Nisa Netinatsunton
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Natcha Cheewasereechon
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tanawat Pattarapuntakul
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jaksin Sottisuporn
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kanet Kanjanapradit
- Division of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Bancha Ovartlarnporn
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Houwen BB, Vleugels JL, Pellisé M, Rivero-Sánchez L, Balaguer F, Bisschops R, Tejpar S, Repici A, Ramsoekh D, Jacobs MA, Schreuder RM, Kamiński MF, Rupińska M, Bhandari P, van Oijen MG, Koens L, Bastiaansen BA, Tytgat KM, Fockens P, Dekker E, Hazewinkel Y. Real-time diagnostic accuracy of blue light imaging, linked color imaging and white-light endoscopy for colorectal polyp characterization. Endosc Int Open 2022; 10:E9-E18. [PMID: 35047330 PMCID: PMC8759942 DOI: 10.1055/a-1594-1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Fujifilm has developed a novel ELUXEO 7000 endoscope system that employs light-emitting diodes (LEDs) at four different wavelengths as light sources that enable blue light imaging (BLI), linked color imaging (LCI), and high-definition white-light endoscopy (HD-WLE). The aim of this study was to address the diagnostic accuracy of real-time polyp characterization using BLI, LCI and HD-WLE (ELUXEO 7000 endoscopy system). Patients methods This is a prespecified post-hoc analysis of a prospective study in which 22 experienced endoscopists (> 2,000 colonoscopies) from eight international centers participated. Using a combination of BLI, LCI, and HD-WLE, lesions were endoscopically characterized including a high- or low-confidence statement. Per protocol, digital images were created from all three imaging modalities. Histopathology was the reference standard. Endoscopists were familiar with polyp characterization, but did not take dedicated training for purposes of this study. Results Overall, 341 lesions were detected in 332 patients. Of the lesions, 269 histologically confirmed polyps with an optical diagnosis were included for analysis (165 adenomas, 27 sessile serrated lesions, and 77 hyperplastic polyps). Overall, polyp characterization was performed with high confidence in 82.9 %. The overall accuracy for polyp characterization was 75.1 % (95 % confidence interval [CI] 69.5-80.1 %), compared with an accuracy of 78.0 % (95 % CI 72.0-83.2 %) for high confidence assignments. The accuracy for endoscopic characterization for diminutive polyps was 74.7 % (95 %CI 68.4-80.3 %), compared with an accuracy of 78.2 % (95 % CI 71.4-84.0 %) for high-confidence assignments. Conclusions The diagnostic accuracy of BLI, LCI, and HD-WLE by experienced endoscopist for real-time polyp characterization seems limited (NCT03344289).
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Affiliation(s)
- Britt B.S.L. Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Jasper L.A. Vleugels
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut dʼInvestigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Liseth Rivero-Sánchez
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut dʼInvestigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut dʼInvestigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Sabine Tejpar
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy,Department of Gastroenterology, Humanitas Clinical and Research Center – IRCCS, Rozzano, Italy
| | - D. Ramsoekh
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VU University Medical Centre, VU University Amsterdam, Amsterdam, the Netherlands
| | - M. A.J.M Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VU University Medical Centre, VU University Amsterdam, Amsterdam, the Netherlands
| | - Ramon-Michel Schreuder
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Michal F. Kamiński
- Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Maria Rupińska
- Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - M. G.H. van Oijen
- Department of Medical Oncology, Amsterdam University Medical Center, location Academic Medical Centre, University of Amsterdam, the Netherlands
| | - L. Koens
- Department of Pathology, Amsterdam University Medical Center, location Academic Medical Centre, University of Amsterdam, the Netherlands
| | - Barbara A.J. Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - K. M.A.J. Tytgat
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Radboud University of Nijmegen, Nijmegen, The Netherlands
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Anderson JC, Srivastava A. Colorectal Cancer Screening for the Serrated Pathway. Gastrointest Endosc Clin N Am 2020; 30:457-478. [PMID: 32439082 DOI: 10.1016/j.giec.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Serrated polyps are classified into hyperplastic polyps, sessile serrated adenomas/polyps, and traditional serrated adenomas. Although all serrated polyps share characteristic colonic crypts serrations, distinguishing hyperplastic polyps from sessile serrated adenomas/polyps is challenging. Traditional serrated adenomas are cytologically dysplastic lesions; sessile serrated adenomas/polyps develop cytologic dysplasia as they progress to colorectal cancer. A flat and pale appearance of serrated polyps may make detection difficult. Endoscopic mucosal resection has higher rates of complete resection. Close surveillance is recommended for sessile serrated adenomas/polyps, sessile serrated adenomas/polyp with dysplasia, hyperplastic polyps ≥10 mm, and traditional serrated adenomas.
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Affiliation(s)
- Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, VT, USA; The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA; Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
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Zachariah R, Samarasena J, Luba D, Duh E, Dao T, Requa J, Ninh A, Karnes W. Prediction of Polyp Pathology Using Convolutional Neural Networks Achieves "Resect and Discard" Thresholds. Am J Gastroenterol 2020; 115:138-144. [PMID: 31651444 DOI: 10.14309/ajg.0000000000000429.prediction] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Reliable in situ diagnosis of diminutive (≤5 mm) colorectal polyps could allow for "resect and discard" and "diagnose and leave" strategies, resulting in $1 billion cost savings per year in the United States alone. Current methodologies have failed to consistently meet the Preservation and Incorporation of Valuable endoscopic Innovations (PIVIs) initiative thresholds. Convolutional neural networks (CNNs) have the potential to predict polyp pathology and achieve PIVI thresholds in real time. METHODS We developed a CNN-based optical pathology (OP) model using Tensorflow and pretrained on ImageNet, capable of operating at 77 frames per second. A total of 6,223 images of unique colorectal polyps of known pathology, location, size, and light source (white light or narrow band imaging [NBI]) underwent 5-fold cross-training (80%) and validation (20%). Separate fresh validation was performed on 634 polyp images. Surveillance intervals were calculated, comparing OP with true pathology. RESULTS In the original validation set, the negative predictive value for adenomas was 97% among diminutive rectum/rectosigmoid polyps. Results were independent of use of NBI or white light. Surveillance interval concordance comparing OP and true pathology was 93%. In the fresh validation set, the negative predictive value was 97% among diminutive polyps in the rectum and rectosigmoid and surveillance concordance was 94%. DISCUSSION This study demonstrates the feasibility of in situ diagnosis of colorectal polyps using CNN. Our model exceeds PIVI thresholds for both "resect and discard" and "diagnose and leave" strategies independent of NBI use. Point-of-care adenoma detection rate and surveillance recommendations are potential added benefits.
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Affiliation(s)
- Robin Zachariah
- Department of Gastroenterology and Department of Internal Medicine, University of California Irvine Medical Center, Orange, California, USA
| | - Jason Samarasena
- Department of Gastroenterology and Department of Internal Medicine, University of California Irvine Medical Center, Orange, California, USA
- Docbot, Irvine, California, USA
| | - Daniel Luba
- Monterey Bay GI Consultants Medical Group, Monterey, California, USA
| | - Erica Duh
- Department of Gastroenterology and Department of Internal Medicine, University of California Irvine Medical Center, Orange, California, USA
| | | | | | - Andrew Ninh
- Monterey Bay GI Consultants Medical Group, Monterey, California, USA
| | - William Karnes
- Department of Gastroenterology and Department of Internal Medicine, University of California Irvine Medical Center, Orange, California, USA
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Abstract
OBJECTIVES Reliable in situ diagnosis of diminutive (≤5 mm) colorectal polyps could allow for "resect and discard" and "diagnose and leave" strategies, resulting in $1 billion cost savings per year in the United States alone. Current methodologies have failed to consistently meet the Preservation and Incorporation of Valuable endoscopic Innovations (PIVIs) initiative thresholds. Convolutional neural networks (CNNs) have the potential to predict polyp pathology and achieve PIVI thresholds in real time. METHODS We developed a CNN-based optical pathology (OP) model using Tensorflow and pretrained on ImageNet, capable of operating at 77 frames per second. A total of 6,223 images of unique colorectal polyps of known pathology, location, size, and light source (white light or narrow band imaging [NBI]) underwent 5-fold cross-training (80%) and validation (20%). Separate fresh validation was performed on 634 polyp images. Surveillance intervals were calculated, comparing OP with true pathology. RESULTS In the original validation set, the negative predictive value for adenomas was 97% among diminutive rectum/rectosigmoid polyps. Results were independent of use of NBI or white light. Surveillance interval concordance comparing OP and true pathology was 93%. In the fresh validation set, the negative predictive value was 97% among diminutive polyps in the rectum and rectosigmoid and surveillance concordance was 94%. DISCUSSION This study demonstrates the feasibility of in situ diagnosis of colorectal polyps using CNN. Our model exceeds PIVI thresholds for both "resect and discard" and "diagnose and leave" strategies independent of NBI use. Point-of-care adenoma detection rate and surveillance recommendations are potential added benefits.
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Bae JH, Lee C, Kang HY, Kwak MS, Doo EY, Seo JY, Song JH, Yang SY, Yang JI, Lim SH, Yim JY, Lim JH, Chung GE, Chung SJ, Jin EH, Park B, Kim JS. Improved Real-Time Optical Diagnosis of Colorectal Polyps Following a Comprehensive Training Program. Clin Gastroenterol Hepatol 2019; 17:2479-2488.e4. [PMID: 30772588 DOI: 10.1016/j.cgh.2019.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The optimal training method for endoscopic characterization of colorectal polyps using narrow-band imaging is uncertain, and sessile serrated lesions (SSLs) optical diagnosis data are lacking. We aimed to evaluate a comprehensive training program for real-time optical diagnosis of colorectal polyps, including SSLs. METHODS We performed a single-institution prospective study of 15 endoscopists trained with the Workgroup Serrated Polyps and Polyposis classification system. After the first phase of in vivo optical diagnosis, their performances were evaluated. After re-education for insufficient competency, they began the second phase. The learning curves and performance on 2 preservation and incorporation of valuable endoscopic innovations benchmarks were assessed. RESULTS A total of 7294 polyps, including 486 SSLs, were diagnosed in real-time. The overall accuracy improved from 73.5% in the first phase to 77.1% in the second. The accuracy with high confidence was 79.4% and 85.1% in the first and second phases, respectively. In the first and second phases, the negative predictive values for diminutive neoplastic polyps were 82.1% and 92.5%, respectively, and concordances of the surveillance intervals were 80.7% and 89.7%, respectively. Eight endoscopists achieved the preservation and incorporation of valuable endoscopic innovations benchmarks after the second phase compared with none after the first. In contrast, the high confidence rate decreased from 74.6% to 70.2% as training progressed. CONCLUSION A comprehensive training program for real-time optical diagnosis significantly improved performance and reduced individual variability in less-experienced endoscopists. ClinicalTrials.gov no: NCT02516748.
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Affiliation(s)
- Jung Ho Bae
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Changhyun Lee
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Hae Yeon Kang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Min-Sun Kwak
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Eun Young Doo
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ji Yeon Seo
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ji Hyun Song
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Yang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jong In Yang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Seon Hee Lim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jeong Yoon Yim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Hyun Lim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Goh Eun Chung
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Su Jin Chung
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Eun Hyo Jin
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Boram Park
- Department of Public Health Science, Seoul National University, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Castela J, Mão de Ferro S, Rosa I, Lage P, Ferreira S, Pereira Silva J, Cortez Pinto J, Vale Rodrigues R, Moleiro J, Claro I, Esteves S, Dias Pereira A. Real-Time Optical Diagnosis of Colorectal Polyps in the Routine Clinical Practice Using the NICE and WASP Classifications in a Nonacademic Setting. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:314-323. [PMID: 31559322 DOI: 10.1159/000495258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/02/2018] [Indexed: 01/01/2023]
Abstract
Background Narrow-band imaging (NBI) allows "in vivo" classification of colorectal polyps. Objectives We evaluated the optical diagnosis by nonexpert community-based endoscopists in routine clinical practice, the impact of training, and whether the endoscopists could achieve the threshold for the "do not resect" policy. Methods This was an observational study performed in two periods (P1 and P2). Endoscopists had no prior experience in NBI in P1 and applied the technique on a daily basis for 1 year before participation in P2. Lesions were classified by applying the NBI International Colorectal Endoscopic (NICE) and Workgroup serrAted polypS and Polyposis (WASP) classifications, simultaneously. Results A total of 290 polyps were analyzed. The overall accuracy of optical diagnosis was 0.75 (95% CI 0.68-0.81) in P1, with an increase to 0.82 (95% CI 0.73-0.89) in P2 (p = 0.260). The accuracy of the NICE/WASP classifications to differentiate adenomatous from nonadenomatous histology was 0.78 (95% CI 0.72-0.84) in P1 and 0.86 (95% CI 0.77-0.92) in P2 (p = 0.164); assignments made with a high confidence level achieved statistical significance (13% improvement, 95% CI 3-22%; p = 0.022). The negative predictive value for adenomatous histology of diminutive rectosigmoid polyps was 81% (95% CI 64-93%) and 80% (95% CI 59-93%) in P1 and P2, respectively. Conclusions Nonexpert endoscopists achieved moderate accuracy for real-time optical diagnosis of colorectal lesions with the NICE/WASP classifications. The overall performance of the endoscopists improved after sustained use of optical diagnosis, but did not achieve the standards for the implementation of the "do not resect" strategy.
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Affiliation(s)
- Joana Castela
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Susana Mão de Ferro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Pedro Lage
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Sara Ferreira
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - João Pereira Silva
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - João Cortez Pinto
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Rita Vale Rodrigues
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Isabel Claro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Susana Esteves
- Clinical Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - António Dias Pereira
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
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Pu LZCT, Cheong KL, Koay DSC, Yeap SP, Ovenden A, Raju M, Ruszkiewicz A, Chiu PW, Lau JY, Singh R. Randomised controlled trial comparing modified Sano’s and narrow band imaging international colorectal endoscopic classifications for colorectal lesions. World J Gastrointest Endosc 2018; 10:210-218. [PMID: 30283604 PMCID: PMC6162252 DOI: 10.4253/wjge.v10.i9.210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/22/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the utility of modified Sano′s (MS) vs the narrow band imaging international colorectal endoscopic (NICE) classification in differentiating colorectal polyps.
METHODS Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial. Based on the MS or the NICE classifications, patients were randomised for real-time endoscopic diagnosis. This was followed by biopsies, endoscopic or surgical resection. The endoscopic diagnosis was then compared to the final (blinded) histopathology. The primary endpoint was the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of differentiating neoplastic and non-neoplastic polyps (MS II/IIo / IIIa / IIIb vs I or NICE 1 vs 2/3). The secondary endpoints were “endoscopic resectability” (MS II/IIo/IIIa vs I/IIIb or NICE 2 vs 1/3), NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.
RESULTS A total of 348 patients were evaluated. The Sn, Sp, PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were, 98.9%, 85.7%, 98.2% and 90.9% for MS; and 99.1%, 57.7%, 95.4% and 88.2% for NICE, respectively. The area under the receiver operating characteristic curve (AUC) for MS was 0.92 (95%CI: 0.86-0.98); and AUC for NICE was 0.78 (95%CI: 0.69, 0.88). The Sn, Sp, PPV and NPV in predicting “endoscopic resectability” were 98.9%, 86.1%, 97.8% and 92.5% for MS; and 98.6%, 66.7%, 94.7% and 88.9% for NICE, respectively. The AUC for MS was 0.92 (95%CI: 0.87-0.98); and the AUC for NICE was 0.83 (95%CI: 0.75-0.90). The AUC values were statistically different for both comparisons (P = 0.0165 and P = 0.0420, respectively). The accuracy for diagnosis of sessile serrated adenoma/polyp (SSA/P) with high confidence utilizing MS classification was 93.2%. The differentiation of SSA/P from other lesions achieved Sp, Sn, PPV and NPV of 87.2%, 91.5%, 89.6% and 98.6%, respectively. The NPV for predicting adenomas in diminutive rectosigmoid polyps (n = 150) was 96.6% and 95% with MS and NICE respectively. The calculated accuracy of post-polypectomy surveillance for MS group was 98.2% (167 out of 170) and for NICE group was 92.1% (139 out of 151).
CONCLUSION The MS classification outperformed the NICE classification in differentiating neoplastic polyps and predicting endoscopic resectability. Both classifications met ASGE PIVI thresholds.
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Affiliation(s)
- Leonardo Zorrón Cheng Tao Pu
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, SA 5112, Australia
- Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Kuan Loong Cheong
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, SA 5112, Australia
| | | | - Sze Pheh Yeap
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, SA 5112, Australia
| | - Amanda Ovenden
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, SA 5112, Australia
- Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Mahima Raju
- Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Andrew Ruszkiewicz
- Department of Pathology, Lyell McEwin Hospital, Adelaide, SA 5112, Australia
| | - Philip W Chiu
- Department of Surgery, the Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - James Y Lau
- Department of Surgery, the Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, SA 5112, Australia
- Medical School, University of Adelaide, Adelaide, SA 5005, Australia
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Ma MX, Bourke MJ. Sessile Serrated Adenomas: How to Detect, Characterize and Resect. Gut Liver 2018; 11:747-760. [PMID: 28494577 PMCID: PMC5669590 DOI: 10.5009/gnl16523] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/06/2016] [Indexed: 12/13/2022] Open
Abstract
Serrated polyps are important contributors to the burden of colorectal cancers (CRC). These lesions were once considered to have no malignant potential, but currently up to 30% of all CRC are recognized to arise from the serrated neoplasia pathway. The primary premalignant lesions are sessile serrated adenomas/polyps (SSA/Ps), although traditional serrated adenomas are relatively uncommon. Compared to conventional adenomas, SSA/Ps are morphologically subtle with indistinct borders, may be difficult to detect endoscopically, are more prevalent than previously thought, are associated with synchronous and metachronous advanced neoplasia, and have a higher risk of incomplete resection. Although many lesions remain “dormant,” progressive disease is associated with the development of dysplasia and more rapid progression to CRC. As a result, SSA/Ps are strongly implicated in the development of interval cancers. These factors represent unique challenges that require a meticulous approach to their management. In this review, we summarize the contemporary literature on the characterization, detection and resection of SSA/Ps.
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Affiliation(s)
- Michael X Ma
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
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Thorlacius H, Takeuchi Y, Kanesaka T, Ljungberg O, Uedo N, Toth E. Serrated polyps - a concealed but prevalent precursor of colorectal cancer. Scand J Gastroenterol 2017; 52:654-661. [PMID: 28277895 DOI: 10.1080/00365521.2017.1298154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Serrated polyps have long been considered to lack malignant potential but accumulating data suggest that these lesions may cause up to one-third of all sporadic colorectal cancer. Serrated polyps are classified into three subtypes, including sessile serrated adenomas/polyps (SSA/Ps), traditional serrated adenomas (TSAs), and hyperplastic polyps (HPs). SSA/P and TSA harbour malignant potential but TSA represents only 1-2%, wheras SSA/P constitute up to 20% of all serrated lesions. HPs are most common (80%) of all serrated polyps but are considered to have a low potential of developing colorectal cancer. Due to their subtle appearence, detection and removal of serrated polyps pose a major challenge to endoscopists. Considering that precancerous serrated polyps are predominately located in the right colon could explain why interval cancers most frequently appear in the proximal colon and why colonoscopy is less protective against colon cancer in the proximal compared to the distal colon. Despite the significant impact on colorectal cancer incidence, the aetiology, incidence, prevalence, and natural history of serrated polyps is incompletely known. To effectively detect, remove, and follow-up serrated polyps, endoscopists and pathologists should be well-informed about serrated polyps. This review highlights colorectal serrated polyps in terms of biology, types, diagnosis, therapy, and follow-up.
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Affiliation(s)
- Henrik Thorlacius
- a Department of Clinical Sciences, Section, of Surgery , Skåne University Hospital, Lund University , Malmö , Sweden
| | - Yoji Takeuchi
- b Department of Gastrointestinal Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Takashi Kanesaka
- b Department of Gastrointestinal Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Otto Ljungberg
- c Department of Clinical Sciences, Section, of Gastroenterology , Skåne University Hospital, Lund University , Malmö , Sweden
| | - Noriya Uedo
- b Department of Gastrointestinal Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Ervin Toth
- d Department of Clinical Sciences, Section, of Pathology , Skåne University Hospital, Lund University , Malmö , Sweden
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Ogawa Y, Kudo SE, Mori Y, Ikehara N, Maeda Y, Wakamura K, Misawa M, Kudo T, Hayashi T, Miyachi H, Katagiri A, Ishida F, Inoue H. Use of endocytoscopy for identification of sessile serrated adenoma/polyps and hyperplastic polyps by quantitative image analysis of the luminal areas. Endosc Int Open 2017; 5:E769-E774. [PMID: 28791327 PMCID: PMC5546899 DOI: 10.1055/s-0043-113562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 05/22/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Recent studies that used magnifying chromoendoscopy and endocytoscopy (EC) to investigate endoscopic features of sessile serrated adenoma/polyps (SSA/Ps) suggested that a dilated crypt opening was an important indicator of SSA/Ps. However, no studies to date have measured the actual extent of dilatation. Hence, we investigated retrospectively the luminal areas using EC to determine a cutoff value for differentiating SSA/Ps from hyperplastic polyps (HPs). PATIENTS AND METHODS A total of 101 lesions, including 25 SSA/Ps, 66 HPs, and 10 normal mucosal samples, assessed by an integrated-type EC were collected. For each lesion, 1 image that showed the widest lumen was selected and the average area of the contiguous 3 lumens were calculated. The cutoff value differentiating SSAPs from HPs was determined by receiver operating curve (ROC) analysis. RESULTS The mean luminal areas of SSA/Ps and HPs were 4152 μm 2 and 2117 μm 2 , respectively. ROC analysis found that a luminal area cutoff of 3068 μm 2 had a sensitivity of 80.0 %, a specificity of 77.3 %, an accuracy of 78.0 %, and an area under the ROC curve of 0.865. Furthermore, a cutoff of ≥ 556 μm 2 was found to accurately distinguish between HPs and normal mucosa (sensitivity 98.5 %, specificity 100 %, accuracy 98.7 %, and AUC 0.998). CONCLUSIONS EC analysis of the luminal area is useful for differentiating between SSAPs and HPs. This approach could be adapted for computer-aided diagnosis of SSA/P.
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Affiliation(s)
- Yushi Ogawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan,Corresponding author Shin-ei Kudo, MD, PhD Digestive Disease CenterShowa University Northern Yokohama Hospital35-1 Chigasaki Chuo, Tsuzuki-kuYokohama City, Kanagawa 224-8503Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Nobunao Ikehara
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Toyoki Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Takemasa Hayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Atsushi Katagiri
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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Herreros de Tejada A, González-Lois C, Santiago J. Serrated lesions and serrated polyposis syndrome. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:516-526. [PMID: 28530106 DOI: 10.17235/reed.2017.4065/2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The serrated pathway has been shown to be an alternative colorectal carcinogenetic route potentially accounting for up to one third of all CRCs. Serrated lesions, particularly SSPs, have been a focus of research during the past few years. They have well-established histological and molecular characteristics that account for their potential carcinogenetic risk through the accumulation BRAF, KRAS and methylator profile (CpG) mutations. Their endoscopic identification and resection represent a challenge because of their specific characteristics, and the need for an adequate specimen for histological diagnosis. Knowledge of these lesions is key, as is the adoption of established criteria for their endoscopic description and histological diagnosis. SPS is the maximum expression of involvement by serrated lesions, is associated with increased risk for CRC, and requires attentive endoscopic follow-up, as well as family screening. While the exact etiopathogenic mechanism remains unknown, current research will likely provide us with appropriate answers in the not too distant future.
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Affiliation(s)
| | - Carmen González-Lois
- Anatomía Patológica, Hospital Universitario Puerta de Hierro Majadahonda, España
| | - José Santiago
- Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, España
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Optical Diagnosis of Sessile Serrated Adenomas/Polyps: A Blind Spot for Endoscopists? J Clin Gastroenterol 2017; 51:391-393. [PMID: 27984398 DOI: 10.1097/mcg.0000000000000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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14
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Abstract
BACKGROUND Optical diagnosis of diminutive (1 to 5 mm) polyps could result in a more cost-effective colonoscopy practice. Previous optical diagnosis studies did not incorporate the differentiation of sessile serrated polyps (SSPs). This study aimed to evaluate the impact of optical diagnosis of diminutive SSPs on the overall performance of endoscopic polyp differentiation in daily colonoscopy practice. METHODS Endoscopy data were prospectively collected between 2011 and 2014 in a colonoscopy center. Each endoscopist reported a real-time optical diagnosis (SSP, adenoma or hyperplastic polyp) for all lesions in a structured colonoscopy reporting system, using narrow band imaging at their discretion. Study outcomes were accuracy of optical diagnosis, surveillance interval agreement and negative predictive value for diminutive rectosigmoid neoplastic histology based on the optical diagnosis of diminutive polyps compared to histopathology. RESULTS Of 2853 removed diminutive polyps, 202 (7.1%) were histologically proven SSPs. Optical diagnosis of diminutive SSPs was accurate in 24.4%. Diminutive SSPs determined 6.9% of postpolypectomy surveillance assignments. Inaccurate optical diagnosis of diminutive SSPs led to lower surveillance interval agreement (78.1% vs. 53.3%, P<0.01) and pooled negative predictive value per polyp (84.3% vs. 50.0%; P<0.01) in patients with diminutive SSPs when compared to patients without diminutive SSPs. Accurate endoscopic identification of diminutive SSPs improved from 0% in 2011 to 47% in 2014 (P=0.02). CONCLUSIONS Endoscopic characterization of diminutive SSPs is difficult, impairing overall performance of optical diagnosis in patients with diminutive SSPs. Future optical diagnosis studies should use validated trainings and classification algorithms that include differentiation of SSPs.
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Ma K, Melson J. Endoscopic Management of Sessile Serrated Polyps of the Colon. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10313676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- Karen Ma
- Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua Melson
- Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
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IJspeert JEG, Bastiaansen BAJ, van Leerdam ME, Meijer GA, van Eeden S, Sanduleanu S, Schoon EJ, Bisseling TM, Spaander MC, van Lelyveld N, Bargeman M, Wang J, Dekker E. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2016; 65:963-70. [PMID: 25753029 DOI: 10.1136/gutjnl-2014-308411] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/18/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Accurate endoscopic differentiation would enable to resect and discard small and diminutive colonic lesions, thereby increasing cost-efficiency. Current classification systems based on narrow band imaging (NBI), however, do not include neoplastic sessile serrated adenomas/polyps (SSA/Ps). We aimed to develop and validate a new classification system for endoscopic differentiation of adenomas, hyperplastic polyps and SSA/Ps <10 mm. DESIGN We developed the Workgroup serrAted polypS and Polyposis (WASP) classification, combining the NBI International Colorectal Endoscopic classification and criteria for differentiation of SSA/Ps in a stepwise approach. Ten consultant gastroenterologists predicted polyp histology, including levels of confidence, based on the endoscopic aspect of 45 polyps, before and after participation in training in the WASP classification. After 6 months, the same endoscopists predicted polyp histology of a new set of 50 polyps, with a ratio of lesions comparable to daily practice. RESULTS The accuracy of optical diagnosis was 0.63 (95% CI 0.54 to 0.71) at baseline, which improved to 0.79 (95% CI 0.72 to 0.86, p<0.001) after training. For polyps diagnosed with high confidence the accuracy was 0.73 (95% CI 0.64 to 0.82), which improved to 0.87 (95% CI 0.80 to 0.95, p<0.01). The accuracy of optical diagnosis after 6 months was 0.76 (95% CI 0.72 to 0.80), increasing to 0.84 (95% CI 0.81 to 0.88) considering high confidence diagnosis. The combined negative predictive value with high confidence of diminutive neoplastic lesions (adenomas and SSA/Ps together) was 0.91 (95% CI 0.83 to 0.96). CONCLUSIONS We developed and validated the first integrative classification method for endoscopic differentiation of small and diminutive adenomas, hyperplastic polyps and SSA/Ps. In a still image evaluation setting, introduction of the WASP classification significantly improved the accuracy of optical diagnosis overall as well as SSA/P in particular, which proved to be sustainable after 6 months.
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Affiliation(s)
- Joep E G IJspeert
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gerrit A Meijer
- Department of Pathology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Susanne van Eeden
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Silvia Sanduleanu
- Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Tanya M Bisseling
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Niels van Lelyveld
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marloes Bargeman
- Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Junfeng Wang
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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Chino A, Osumi H, Kishihara T, Morishige K, Ishikawa H, Tamegai Y, Igarashi M. Advantages of magnifying narrow-band imaging for diagnosing colorectal cancer coexisting with sessile serrated adenoma/polyp. Dig Endosc 2016; 28 Suppl 1:53-9. [PMID: 26864801 DOI: 10.1111/den.12631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/31/2016] [Accepted: 02/04/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM In the present study, we investigated the advantages of narrow-band imaging (NBI) for efficient diagnosis of sessile serrated adenoma/polyp (SSA/P). The main objective of this study was to analyze the characteristic features of cancer coexisting with serrated lesion by carrying out NBI. METHODS We evaluated 264 non-malignant serrated lesions by using three modalities (conventional white light colonoscopy, magnifying chromoendoscopy, and magnifying NBI). Of the evaluated cancer cases with serrated lesions, 37 fulfilled the inclusion criteria. RESULTS In diagnosing non-malignant SSA/P, an expanded crypt opening (ECO) under magnifying NBI is a useful sign. One hundred and twenty-five lesions (87%) of observed ECO were, at the same time, detected to have type II open pit pattern, which is known to be a valuable indicator when using magnifying chromoendoscopy. ECO had high sensitivity of 80% for identifying SSA/P, with 62% specificity and 83% positive predictive value (PPV). In detecting the cancer with SSA/P, irregular vessels under magnifying NBI were frequently observed with 100% sensitivity and 99% specificity, 86% PPV and 100% negative predictive value. CONCLUSIONS A focus on irregular vessels in serrated lesions might be useful for identification of cancer with SSA/P. This is an advantage of carrying out magnifying NBI in addition to being used simultaneously with other modalities by switching, and observations can be made by using wash-in water alone. We can carry out advanced examinations for selected lesions with irregular vessels. To confirm cancerous demarcation and invasion depth, a combination of all three aforementioned modalities should be done.
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Affiliation(s)
- Akiko Chino
- Division of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroki Osumi
- Division of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Teruhito Kishihara
- Division of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kenjiro Morishige
- Division of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hirotaka Ishikawa
- Division of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiro Tamegai
- Division of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiro Igarashi
- Division of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Mori Y, Kudo SE, Ogawa Y, Wakamura K, Kudo T, Misawa M, Hayashi T, Katagiri A, Miyachi H, Inoue H, Oka S, Matsuda T. Diagnosis of sessile serrated adenomas/polyps using endocytoscopy (with videos). Dig Endosc 2016; 28 Suppl 1:43-8. [PMID: 26748690 DOI: 10.1111/den.12601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 12/25/2015] [Accepted: 12/30/2015] [Indexed: 02/02/2023]
Abstract
Sessile serrated adenomas/polyps (SSA/P) are considered to be precursors of colorectal cancers. They therefore need to be distinguished from hyperplastic polyps, and should be treated similarly to adenomas. Various endoscopic classifications for discriminating SSA/P have recently been proposed and validated, including the 'Type II-O' pit pattern in magnifying chromoendoscopy and the 'varicose microvascular vessel' in narrow-band imaging. However, there is currently no diagnostic consensus on the endoscopic appearance of SSA/P. Endocytoscopy (EC) is an emerging modality with diagnostic potential for SSA/P. EC is a type of a contact light microscopy, which allows in vivo visualization of cells and nuclei facilitating precise, real-time pathological prediction. SSA/P show oval gland lumens with small round nuclei in EC, indirectly reflecting the pathological features. EC has shown a sensitivity of 83.3% and a specificity of 97.8% for the diagnosis of SSA/P. EC is also a promising tool for the diagnosis of SSA/P with cytological dysplasia because of its ability to detect morphological changes in nuclei, which is the most important factor determining the presence of dysplasia in the lesion. However, clinical data validating the usefulness of EC are lacking, and further studies are required.
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Affiliation(s)
- Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama
| | - Yushi Ogawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama
| | - Toyoki Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama
| | - Takemasa Hayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama
| | - Atsushi Katagiri
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University Koto-Toyosu Hospital
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima
| | - Takahisa Matsuda
- Cancer Screening Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
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Parikh ND, Gibson J, Nagar A, Ahmed AA, Aslanian HR. Confocal laser endomicroscopy features of sessile serrated adenomas/polyps. United European Gastroenterol J 2015; 4:599-603. [PMID: 27536371 DOI: 10.1177/2050640615621819] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 11/15/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND AIMS Sessile serrated adenomas/polyps (SSA/Ps) are difficult to differentiate from non-neoplastic tissue on white-light endoscopy. Confocal laser endomicroscopy (CLE) provides subcellular imaging and real-time "optical biopsy". The aim of this study was to prospectively describe CLE features of SSA/Ps. PATIENTS AND METHODS Consecutive patients with SSA/Ps were prospectively evaluated with probe-based CLE imaging. CLE images and polyp histology were independently reviewed by three endoscopists and an expert gastrointestinal (GI) pathologist. Distinguishing CLE features of SSA/Ps were identified in conjunction with pathologic correlation. RESULTS In total, 260 CLE images were generated from nine SSA/Ps evaluated in seven patients. Four consensus CLE features of SSA/P were identified: (1) a mucus cap with a bright, cloud-like appearance; (2) thin, branching crypts; (3) increased number of goblet cells and microvesicular mucin-containing cells; and (4) architectural disarray, with dystrophic goblet cells and lack of regular circular crypts. CONCLUSION This is a novel description of characteristic CLE features of SSA/Ps. The four features we identified are easy to detect and may allow for CLE to serve as a diagnostic modality.
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Affiliation(s)
- Neil D Parikh
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Joanna Gibson
- Department of Pathology, Yale University School of Medicine, New Haven CT, USA
| | - Anil Nagar
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ali A Ahmed
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Harry R Aslanian
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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20
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Rath T, Tontini GE, Nägel A, Vieth M, Zopf S, Günther C, Hoffman A, Neurath MF, Neumann H. High-definition endoscopy with digital chromoendoscopy for histologic prediction of distal colorectal polyps. BMC Gastroenterol 2015; 15:145. [PMID: 26493200 PMCID: PMC4619024 DOI: 10.1186/s12876-015-0374-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/13/2015] [Indexed: 12/23/2022] Open
Abstract
Background Distal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection. Within this study we assessed whether digital chromoendoscopy can accurately predict the histology of distal diminutive colorectal polyps according to the ASGE PIVI statement. Methods In this prospective cohort study, 224 consecutive patients undergoing screening or surveillance colonoscopy were included. Real time histology of 121 diminutive distal colorectal polyps was evaluated using high-definition endoscopy with digital chromoendoscopy and the accuracy of predicting histology with digital chromoendoscopy was assessed. Results The overall accuracy of digital chromoendoscopy for prediction of adenomatous polyp histology was 90.1 %. Sensitivity, specificity, positive and negative predictive values were 93.3, 88.7, 88.7, and 93.2 %, respectively. In high-confidence predictions, the accuracy increased to 96.3 % while sensitivity, specificity, positive and negative predictive values were calculated as 98.1, 94.4, 94.5, and 98.1 %, respectively. Surveillance intervals with digital chromoendoscopy were correctly predicted with >90 % accuracy. Conclusions High-definition endoscopy in combination with digital chromoendoscopy allowed real-time in vivo prediction of distal colorectal polyp histology and is accurate enough to leave distal colorectal polyps in place without resection or to resect and discard them without pathologic assessment. This approach has the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps. Trial registration ClinicalTrials NCT02217449.
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Affiliation(s)
- Timo Rath
- Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Gian E Tontini
- Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Andreas Nägel
- Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Steffen Zopf
- Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Claudia Günther
- Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Arthur Hoffman
- Department of Medicine II, HSK Wiesbaden, Wiesbaden, Germany
| | - Markus F Neurath
- Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Helmut Neumann
- Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
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Kaltenbach T, Rastogi A, Rouse RV, McQuaid KR, Sato T, Bansal A, Kosek JC, Soetikno R. Real-time optical diagnosis for diminutive colorectal polyps using narrow-band imaging: the VALID randomised clinical trial. Gut 2015; 64:1569-77. [PMID: 25387891 DOI: 10.1136/gutjnl-2014-307742] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 09/09/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diminutive (≤ 5 mm) colorectal polyps are common, and overwhelmingly benign. Routinely, after polypectomy, they are examined pathologically to determine the surveillance intervals. Advances in equipment and techniques, such as narrow-band imaging (NBI) colonoscopy, now permit reliable real-time optical diagnosis. METHODS We conducted a randomised single-masked study involving three institutions to determine whether optical diagnosis of diminutive colorectal polyps meets clinical practice standards and reduces the need for histopathology. We randomly assigned eligible patients undergoing routine high-definition colonoscopy to optical diagnosis using near focus versus standard view, using computer-generated block sequence. By validated criteria, we rendered an optical diagnosis and a confidence level (high vs low) for all polyps, using NBI. Our primary endpoint was the number of accurate high-confidence optical diagnoses compared with central blinded pathology in the two groups. We analysed data using intention to treat. FINDINGS We enrolled 558 subjects, and randomly assigned 281 to near focus and 277 to standard view optical diagnosis. We detected 1309 predominantly diminutive (74.5%) and neoplastic (60.0%) polyps. Endoscopists were significantly more likely, OR 2.2 (95% CI 1.6 to 3.0, p<0.0001), to make a high-confidence optical diagnosis with near focus (85.1%) than standard (72.6%) view. High-confidence diagnoses had 96.4% and 92.0% negative predictive value, respectively. Of all polyps, 75.3% (95% CI71.3% to 78.9%) had a high-confidence accurate prediction using near focus, compared with 63.1% (95% CI 58.5% to 67.6%) using standard view. Optical versus histopathological diagnosis showed excellent agreement between the surveillance intervals, 93.5% in near focus and 92.2% in standard view. The median diagnosis time was 14 s. CONCLUSIONS Real-time optical diagnosis using NBI colonoscopy may replace the pathology diagnosis for the majority of diminutive colorectal polyps. Using colonoscopy with near focus view increases the confidence level of the optical diagnosis. Optical diagnosis would be a paradigm shift in clinical practice of colonoscopy for colorectal cancer screening. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT01288833.
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Affiliation(s)
- Tonya Kaltenbach
- Veterans Affairs Palo Alto, GI Endoscopy Unit and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amit Rastogi
- Veterans Affairs Kansas City, Gastroenterology Section and Department of Medicine, Division of Gastroenterology, University of Kansas, Kansas City, Missouri, USA
| | - Robert V Rouse
- Veterans Affairs Palo Alto, Pathology and Laboratory Medicine Service and Department of Pathology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kenneth R McQuaid
- Veterans Affairs San Francisco, Gastrointestinal Diagnostic Unit and Division of Gastroenterology, University California San Francisco, San Francisco, California, USA
| | - Tohru Sato
- Veterans Affairs Palo Alto, GI Endoscopy Unit and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ajay Bansal
- Veterans Affairs Kansas City, Gastroenterology Section and Department of Medicine, Division of Gastroenterology, University of Kansas, Kansas City, Missouri, USA
| | - Jon C Kosek
- Veterans Affairs Palo Alto, Pathology and Laboratory Medicine Service and Department of Pathology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Roy Soetikno
- Veterans Affairs Palo Alto, GI Endoscopy Unit and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
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Vleugels JLA, IJspeert JEG, Dekker E. Serrated lesions of the colon and rectum: the role of advanced endoscopic imaging. Best Pract Res Clin Gastroenterol 2015; 29:675-86. [PMID: 26381311 DOI: 10.1016/j.bpg.2015.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/20/2015] [Indexed: 02/06/2023]
Abstract
Conventional adenomas were traditionally thought to be the only precursors to colorectal cancer (CRC). Nowadays, also serrated polyps are acknowledged as precursor lesions for CRC, responsible for up to 30% of all CRCs and probably a larger percentage of interval CRCs after colonoscopy. In recent years, much research is being done to unravel the serrated neoplasia pathway. Endoscopic detection of serrated polyps is still a challenge for gastroenterologists, which is illustrated by large variations in detection rates of serrated polyps in the proximal colon. Clinical practice is further inhibited by poor optical differentiation of SSA/Ps from conventional adenomas and HPs and difficult delineation of those lesions, resulting in incomplete resection. The main focus of this review is to highlight recent advancements in endoscopic imaging techniques with regards to detection, differentiation and resection of serrated polyps.
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Affiliation(s)
- J L A Vleugels
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - J E G IJspeert
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - E Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Yamada M, Sakamoto T, Otake Y, Nakajima T, Kuchiba A, Taniguchi H, Sekine S, Kushima R, Ramberan H, Parra-Blanco A, Fujii T, Matsuda T, Saito Y. Investigating endoscopic features of sessile serrated adenomas/polyps by using narrow-band imaging with optical magnification. Gastrointest Endosc 2015; 82:108-17. [PMID: 25840928 DOI: 10.1016/j.gie.2014.12.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/07/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND A sessile serrated adenoma/polyp (SSA/P) is a common type of colorectal polyp that possesses malignant potential. Although narrow-band imaging (NBI) can easily differentiate neoplastic lesions from hyperplastic polyps (HPs), SSA/Ps can be a challenge to distinguish from HPs. OBJECTIVE To investigate specific endoscopic features of SSA/Ps by using NBI with optical magnification. DESIGN Retrospective study. SETTING Single high-volume referral center. PATIENTS A total of 289 patients with histopathologically proven SSA/Ps or HPs obtained from colonoscopic polypectomy. INTERVENTION Endoscopic images obtained by using NBI with optical magnification of 242 lesions (124 HPs, 118 SSA/Ps) removed between January 2010 and December 2012 were independently evaluated by 2 experienced endoscopists. Three external experienced endoscopists systematically validated the diagnostic accuracies by using 40 lesions (21 HPs and 19 SSA/Ps) removed between January and March 2013. MAIN OUTCOME MEASUREMENTS Specific endoscopic features of SSA/Ps by using 5 potential characteristics: dilated and branching vessels (DBVs), irregular dark spots, a regular network pattern, a disorganized network pattern, and a dense pattern. RESULTS Multivariate analysis demonstrated that DBV had a 2.3-fold odds ratio (95% confidence interval, 0.96-5.69) among SSA/Ps compared with HPs (sensitivity, 56%; specificity, 75%; accuracy, 65%). Interobserver and intraobserver agreement indicated almost perfect agreement for DBVs in both the evaluation and validation studies. When DBVs, proximal location, and tumor size (≥10 mm) were combined, the positive predictive value was 92% and the area under the curve was 0.783 in the receiver-operating characteristics by using the validation group. LIMITATIONS Retrospective study. CONCLUSIONS The current study suggests that a DBV is a potentially unique endoscopic feature of a colorectal SSA/P.
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Affiliation(s)
- Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yosuke Otake
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Nakajima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Aya Kuchiba
- Department of Biostatistics, National Cancer Center, Tokyo, Japan
| | - Hirokazu Taniguchi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Sekine
- Molecular Pathology Division, National Cancer Center Research Institute, Tokyo, Japan
| | - Ryoji Kushima
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Hemchand Ramberan
- Department of Gastroenterology, University of Tennessee College of Medicine, Erlanger Hospital, Chattanooga, TN, USA
| | - Adolfo Parra-Blanco
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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IJspeert JEG, Medema JP, Dekker E. Colorectal neoplasia pathways: state of the art. Gastrointest Endosc Clin N Am 2015; 25:169-82. [PMID: 25839680 DOI: 10.1016/j.giec.2014.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colorectal cancer (CRC) is a heterogeneous disease and each CRC possesses a unique molecular tumor profile. The main pathways of oncogenesis are the chromosomal instability, microsatellite instability and serrated neoplasia pathway. Sessile serrated adenomas/polyps (SSA/Ps) may be the precursor lesions of CRC arising via the serrated neoplasia pathway. This has led to a paradigm shift because all SSA/Ps should be detected and resected during colonoscopy. The ability to accurately detect and resect only those polyps with a malignant potential could result in safer and cost-effective practice. Optimization of the endoscopic classification systems is however needed to implement targeted prevention methods.
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Affiliation(s)
- Joep Evert Godfried IJspeert
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, Room C2-231, Amsterdam 1105 AZ The Netherlands
| | - Jan Paul Medema
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental Molecular Medicine, Academic Medical Center (AMC), Meibergdreef 9, Room G2-131, Amsterdam 1105 AZ, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, Room C2-115, Amsterdam 1105 AZ, The Netherlands.
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Moussata D, Boschetti G, Chauvenet M, Stroeymeyt K, Nancey S, Berger F, Lecomte T, Flourié B. Endoscopic and histologic characteristics of serrated lesions. World J Gastroenterol 2015; 21:2896-904. [PMID: 25780286 PMCID: PMC4356908 DOI: 10.3748/wjg.v21.i10.2896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/25/2014] [Accepted: 10/14/2014] [Indexed: 02/07/2023] Open
Abstract
In recent years, a second pathway for colonic carcinogenesis, distinct from the adenomatous pathway, has been explored. This is referred to as serrated pathway and includes three types of polyp, characterised by a serrated appearance of the crypts: hyperplastic polyps (HP), sessile serrated adenomas (SSA) or lesions, and traditional serrated adenomas. Each lesion has its own genetic, as well as macroscopic and microscopic morphological features. Because of their flat aspect, their detection is easier with chromoendoscopy (carmin indigo or narrow-band imaging). However, as we show in this review, the distinction between SSA and HP is quite difficult. It is now recommended to resect in one piece as it is possible the serrated polyps with a control in a delay depending on the presence or not of dysplasia. These different types of lesion are described in detail in the present review in general population, in polyposis and in inflammatory bowel diseases patients. This review highlights the need to improve characterization and understanding of this way of colorectal cancerogenesis.
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Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2015; 81:741-7. [PMID: 25708763 DOI: 10.1016/j.gie.2014.11.048] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/18/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal technique for removal of diminutive or small colorectal polyps is debatable. OBJECTIVE To compare the complete resection rates of cold snare polypectomy (CSP) and cold forceps polypectomy (CFP) for the removal of adenomatous polyps ≤7 mm. DESIGN Prospective randomized controlled study. SETTING A university hospital. PATIENTS A total of 139 patients who were found to have ≥1 colorectal adenomatous polyps ≤7 mm. INTERVENTIONS Polyps were randomized to be treated with either CSP or CFP. After the initial polypectomy, additional EMR was performed at the polypectomy site to assess the presence of residual polyp tissue. MAIN OUTCOME MEASUREMENTS Absence of residual polyp tissue in the EMR specimen of the polypectomy site was defined as complete resection. RESULTS Among a total of 145 polyps, 128 (88.3%) were adenomatous polyps. The overall complete resection rate for adenomatous polyps was significantly higher in the CSP group compared with the CFP group (57/59, 96.6% vs 57/69, 82.6%; P = .011). Although the complete resection rates for adenomatous polyps ≤4 mm were not different (27/27, 100% vs 31/32, 96.9%; P = 1.000), the complete resection rates for adenomatous polyps sized 5 to 7 mm was significantly higher in the CSP group compared with the CFP group (30/32, 93.8% vs 26/37, 70.3%; P = .013). LIMITATIONS Single-center study. CONCLUSION CSP is recommended for the complete resection of colorectal adenomatous polyps ≤7 mm. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01665898.).
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Bordaçahar B, Barret M, Terris B, Dhooge M, Dreanic J, Prat F, Coriat R, Chaussade S. Sessile serrated adenoma: from identification to resection. Dig Liver Dis 2015; 47:95-102. [PMID: 25445408 DOI: 10.1016/j.dld.2014.09.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/13/2014] [Indexed: 02/07/2023]
Abstract
Until the past two decades, almost all colorectal polyps were divided into two main groups: hyperplastic polyps and adenomas. Sessile serrated adenomas presented endoscopic, pathological and molecular profiles distinct from others polyps. Previously under-diagnosed, physicians now identified sessile serrated adenomas. The serrated neoplastic pathway is accounting for up to one-third of all sporadic colorectal cancers and sessile serrated adenomas have been identified as the main precursor lesions in serrated carcinogenesis. By analogy with the adenoma-adenocarcinoma sequence, the sessile serrated adenomas-adenocarcinoma sequence, has been identified. The development of endoscopic resection techniques permits the consideration of a non-surgical approach as the first option regardless of the size of the lesion. Sessile serrated adenoma warrants the watchfulness of physicians and requires an optimal quality of the colonoscopy procedure, a thorough evaluation of the lesion, an adequate endoscopic resection and follow-up colonoscopies in accordance with sessile serrated adenomas guidelines. We herein present a review on sessile serrated adenomas focusing on their pathological specificities, epidemiology, treatment modalities and follow-up.
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Affiliation(s)
- Benoît Bordaçahar
- Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Benoît Terris
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Pathology, Cochin Teaching Hospital, AP-HP, Paris, France
| | - Marion Dhooge
- Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Johann Dreanic
- Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Frédéric Prat
- Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Romain Coriat
- Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
| | - Stanislas Chaussade
- Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
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28
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Yamashina T, Takeuchi Y, Uedo N, Aoi K, Matsuura N, Nagai K, Matsui F, Ito T, Fujii M, Yamamoto S, Hanaoka N, Higashino K, Ishihara R, Tomita Y, Iishi H. Diagnostic features of sessile serrated adenoma/polyps on magnifying narrow band imaging: a prospective study of diagnostic accuracy. J Gastroenterol Hepatol 2015; 30:117-23. [PMID: 25088839 DOI: 10.1111/jgh.12688] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The narrow band imaging classification system (NBI International Colorectal Endoscopic [NICE] classification) classifies colorectal polyps very accurately. However, sessile serrated adenoma/polyps (SSA/Ps) pathologically resembles hyperplastic polyp and has a possibility to be left in situ on NICE classification. The aim of this study was to establish and evaluate new simple diagnostic features for SSA/Ps using magnifying narrow band imaging (M-NBI). METHODS We performed a single-arm observational study of diagnostic accuracy in two stages, as follows: seeking stage, development of simple diagnostic features for SSA/P and definition of diagnostic criteria based on retrospective assessments of M-NBI; and validation stage, prospective validation and evaluation of the new diagnostic criteria. RESULTS In the seeking stage, we identified brownish, oval, expanded crypt openings and thick-branched vessels on the surfaces of SSA/Ps. We named these "expanded crypt openings" (ECOs) and "thick and branched vessels" (TBVs), respectively. In the validation stage, we enrolled 796 polyps in 261 patients, and classified 126 polyps as NICE type 1; all these lesions were endoscopically removed and assessed histopathologically. The sensitivity, specificity, and accuracy of ECOs for SSA/Ps were 84.3%, 81.1%, and 82.4%, whereas those of TBVs were 45.1%, 68.9%, and 59.2%, respectively. M-NBI provided a sensitivity of 98% and specificity of 59.5% for discrimination of SSA/Ps from other lesions classified as NICE type 1. CONCLUSIONS Identification of ECOs, supplemented with TBVs, has high sensitivity for the diagnosis of SSA/P. These findings may facilitate the use of endoscopic optical diagnosis in clinical practice.
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Affiliation(s)
- Takeshi Yamashina
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Response:. Gastrointest Endosc 2014; 79:1031-2. [PMID: 24856847 DOI: 10.1016/j.gie.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 02/08/2023]
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30
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Singh A, Konda VJ, Siddiqui UD. The not so NICE classification. Gastrointest Endosc 2014; 79:1030-1. [PMID: 24856845 DOI: 10.1016/j.gie.2014.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, University of Chicago, Chicago, Illinois, USA
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31
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Affiliation(s)
- Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
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32
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Ladabaum U. Endoscopic optical biopsy: when we look, what can we see? Lancet Oncol 2013; 14:1253-4. [PMID: 24239211 DOI: 10.1016/s1470-2045(13)70545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
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