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Mak JN, Uzuner C, Espada M, Eathorn A, Reid S, Leonardi M, Armour M, Condous GS. Inter-observer reproducibility of the 2021 AAGL Endometriosis Classification. Aust N Z J Obstet Gynaecol 2024. [PMID: 38896105 DOI: 10.1111/ajo.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/21/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Inter-observer agreement for the American Association of Gynecologic Laparoscopists (AAGL) 2021 Endometriosis Classification staging system has not been described. Its predecessor staging system, the revised American Society for Reproductive Medicine (rASRM), has historically demonstrated poor inter-observer agreement. AIMS We aimed to determine the inter-observer agreement performance of the AAGL 2021 Endometriosis Classification staging system, and compare this with the rASRM staging system. MATERIALS AND METHODS A database of 317 patients with coded surgical data was retrospectively analysed. Three independent observers allocated AAGL surgical stages (1-4), twice. Observers made their own interpretation of how to apply the tool in the first staging allocation. Consensus rules were then developed for a second staging allocation. RESULTS First staging allocation: odds ratio (OR) (and 95% CI) for observer 1 to score higher than observer 2 was 8.08 (5.12-12.76). Observer 1 to score higher than observer 3 was 12.98 (7.99-21.11) and observer 2 to score higher than observer 3 was 1.61 (1.03-2.51). This represents poor agreement. Second staging allocation (after consensus): OR for observer 1 to score higher than observer 2 was 1.14 (0.64-2.03), observer 1 to score higher than observer 3 was 1.81 (0.99-3.28) and observer 2 to score higher than observer 3 was 1.59 (0.87-2.89). This represents good agreement. CONCLUSIONS These findings suggest that in its current format the AAGL 2021 Endometriosis Classification staging system has poor inter-observer agreement, not superior to the rASRM staging system. However, performance improved when additional measures were taken to simplify and clarify areas of ambiguity in interpreting the staging system.
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Affiliation(s)
- Jason Nicholas Mak
- Acute Gynaecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Hospital, Penrith, New South Wales, Australia
| | - Cansu Uzuner
- Acute Gynaecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Hospital, Penrith, New South Wales, Australia
| | - Mercedes Espada
- Department of Obstetrics and Gynaecology, Blue Mountains District ANZAC Memorial Hospital, Katoomba, New South Wales, Australia
- OMNI Ultrasound & Gynaecological Care, Sydney, New South Wales, Australia
| | - Allie Eathorn
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Shannon Reid
- Department of Obstetrics and Gynaecology, Western Sydney University, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Campbelltown Private Hospital, Sydney, New South Wales, Australia
| | - Mathew Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - George Stanley Condous
- Acute Gynaecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Hospital, Penrith, New South Wales, Australia
- OMNI Ultrasound & Gynaecological Care, Sydney, New South Wales, Australia
- Sydney Medical School Nepean, The University of Sydney, Penrith, New South Wales, Australia
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Kim S, Lee BI. The role of cap-assisted endoscopy and its future implications. Clin Endosc 2024; 57:293-301. [PMID: 38807361 PMCID: PMC11133983 DOI: 10.5946/ce.2023.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2024] Open
Abstract
Cap-assisted endoscopy refers to a procedure in which a short tube made of a polymer (mostly transparent) is attached to the distal tip of the endoscope to enhance its diagnostic and therapeutic capabilities. It is reported to be particularly useful in: (1) minimizing blind spots during screening colonoscopy, (2) providing a constant distance from a lesion for clear visualization during magnifying endoscopy, (3) accurately assessing the size of various gastrointestinal lesions, (4) preventing mucosal injury during foreign body removal, (5) securing adequate workspace in the submucosal space during endoscopic submucosal dissection or third space endoscopy, (6) providing an optimal approach angle to a target, and (7) suctioning mucosal and submucosal tissue with negative pressure for resection or approximation. Here, we review various applications of attachable caps in diagnostic and therapeutic endoscopy and their future implications.
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Affiliation(s)
- Sol Kim
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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Liang J, Church JM. Estimating the size of colorectal polyps endoscopically: random guess or systematic error? ANZ J Surg 2023; 93:612-616. [PMID: 36300611 DOI: 10.1111/ans.18036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Size of colorectal polyps reflects potential for malignancy and helps define advanced lesions. Studies measuring ability of endoscopists to estimate polyp size show significant variation. The aim of this study was to determine if there is a linear relationship between endoscopic and pathologic polyp size. METHODS Data for adenomas removed completely by snare, in one piece, were retrieved from a prospectively recorded polyp database. Endoscopic estimate of maximum diameter was compared to that on the pathology report by linear regression analysis. RESULTS There were 126 polyps in 126 patients, 85 men and 41 women. Mean age was 63.2 ± 12.9 years. Mean endoscopic polyp size was 12.2 ± 9.3 mm and mean pathology size was 9.3 ± 6.9 mm. Endoscopically, 16 polyps were ≤ 5 mm, 62 were from 6 to 10 mm, 21 were from 11 to 15 mm, and 27 were from 16 to 55 mm. Twenty-nine polyps were right sided, 86 were left and 11 were rectal. Regression of endoscopic size against pathology size yielded a significant r2 of 0.761. Using the regression formula of endoscopic size = 0.7 + 1.175× pathology size an endoscopic estimate of 10 mm (= advanced adenoma) means a pathologic size of 8 mm. For a pathologic size of 10 mm, an endoscopic estimate of 12 mm is needed. A large polyp is ≥20 mm; for this endoscopist a 20 mm polyp is really 16.4 mm. CONCLUSIONS The relationship between endoscopic and directly measured size is linear over all polyp diameters, and likely represents a systematic error.
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Affiliation(s)
- Jennifer Liang
- Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James M Church
- Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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External Validation of the "2021 AAGL Endometriosis Classification": A Retrospective Cohort Study. J Minim Invasive Gynecol 2023; 30:374-381. [PMID: 36621635 DOI: 10.1016/j.jmig.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVE Externally validate the American Association of Gynecologic Laparoscopists (AAGL) staging system against surgical complexity and compare diagnostic accuracy with revised American Society for Reproductive Medicine (rASRM) stage, as was done in original publication. DESIGN Retrospective, diagnostic accuracy study. SETTING Multicenter (Sydney, Australia). PATIENTS A total of 317 patients (January 2016-October 2021) were used in the final analysis. INTERVENTIONS A database of patients with coded surgical data was analyzed. MEASUREMENTS AND MAIN RESULTS Three independent observers assigned an AAGL surgical stage (1-4) as the index test and surgical complexity level (A-D) as the reference standard. Results from the most accurate of the 3 observers were used in the final analysis. The weighted kappa score for the overall performance of AAGL stage and rASRM to predict AAGL level was 0.48 and 0.48, respectively (no difference). This represents weaker agreement with AAGL level than was observed in the reference paper, which reported a weighted kappa of 0.62. Diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) for stage 1 to predict level A was 98.5%, 64.3%, 66.3%, and 98.3%; stage 2 to predict level B 31.2%, 90.5%, 27.0%, and 92.1 %; stage 3 to predict level C 12.3%, 94.1%, 59.3%, and 60.7%; stage 4 to predict level D 95.65%, 88.10%, 38.60%, and 99.62%. Area under the receiver operating characteristic curve for A vs B/C/D (cut point 9) was 0.87, A/B vs C/D (cut point 16) was 0.78, and A/B/C vs D (cut point 22) was 0.94. CONCLUSION There was weak to moderate agreement between AAGL stage and AAGL surgical complexity level. Across all key indicators, the AAGL system did not perform as well in this external validation, nor did it outperform rASRM as it did in the reference paper. Results suggest the system is not generalizable.
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Beukema KR, Simmering JA, Brusse-Keizer M, John S, Quispel R, Mensink PB. Factors influencing endoscopic estimation of colon polyp size in a colon model. Clin Endosc 2022; 55:540-548. [PMID: 35898152 PMCID: PMC9329641 DOI: 10.5946/ce.2022.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/20/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/AIMS Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation. METHODS Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope's tip. Participants were asked to estimate the diameter and volume of each polyp. RESULTS Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62-0.71) for diameter and 0.56 (95% CI, 0.50-0.62) for volume. Polyp size estimated at 3 cm from the colonoscope's tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size. CONCLUSION Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.
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Affiliation(s)
- Koen Robert Beukema
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jaimy A Simmering
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands.,Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Marjolein Brusse-Keizer
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Sneha John
- Department of Gastroenterology, Gold Coast University Hospital, Southport, Australia
| | - Rutger Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Peter B Mensink
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
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Redondo-Cerezo E, Heredia-Carrasco C, Alegría-Motte C, Caballero-Mateos A, Vadillo-Calles F, Ortega-Suazo EJ, Martos-Ruiz V, Ariza-Fernández JL, López-González E, Martínez-Cara JG, Valverde-Lopez F, de Hierro ML, Sánchez-Capilla D, López-Hidalgo JL, Jimenez-Rosales R. Accuracy in optical diagnosis for polyps between 5 and 15 mm and its implications on surveillance. A prospective, multicenter study. (POPS study). Surg Endosc 2022; 36:5356-5365. [PMID: 34988735 DOI: 10.1007/s00464-021-08917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Polyps histology and diameter up to 1 cm determine whether a patient needs a colonoscopy after 3 years or less, or far ahead. Endoscopists' and pathologists' size estimations can be imprecise. Our aim was to assess endoscopist ability to correctly recommend surveillance colonoscopies for patients with polyps around the 10 mm threshold, based on its endoscopic sizing and optical diagnosis by NBI. METHODS NBI-assisted diagnosis and endoscopist estimation of polyp size were compared with reference standard, considering this as the post resection polyp measurements by the nurse assistant and the pathologic results, in a prospective, multicenter, real life study, that recruited adults undergoing colonoscopy in five hospitals. By comparing the endoscopic and pathologist size estimation, with polyps' measurement after resection, and optical and histological diagnoses in patients with polyps between 5 and 15 mm, sensitivity was assessed at the patient level by means of two characteristics: the presence of adenoma, and the surveillance interval. Surveillance intervals were established by the endoscopist, based on optical diagnosis, and by another gastroenterologist, grounded on the pathologic report. Determinants of accuracy were explored at the polyp level. RESULTS 532 polyps were resected in 451 patients. Size estimation was more precise for the endoscopist. Endoscopist sensitivity for the presence of adenoma or carcinoma was 98.7%. Considering the presence of high-grade dysplasia or cancer, sensitivity was 82.6% for the endoscopic optical diagnosis. Sensitivity for a correct 3-year surveillance interval was 91.5%, specificity 82.3%, with a PPV of 93.2% and NPV of 78.5% for the endoscopist. 6.51% of patients would have had their follow-up colonoscopy delayed, whereas 22 (4.8%) would have it been performed earlier, had endoscopist recommendations been followed. CONCLUSION Our study observes that NBI optical diagnosis can be recommended in routine practice to establish surveillance intervals for polyps between 5 and 15 mm. CLINICAL TRIALS REGISTRATION NUMBER NCT04232176.
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Affiliation(s)
- Eduardo Redondo-Cerezo
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain.
| | - Clara Heredia-Carrasco
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | | | | | | | - Eva Julissa Ortega-Suazo
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | | | | | | | - Juan Gabriel Martínez-Cara
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | - Francisco Valverde-Lopez
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | - Mercedes López de Hierro
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | - Damián Sánchez-Capilla
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | | | - Rita Jimenez-Rosales
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
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Han SK, Kim H, Kim JW, Kim HS, Kim SY, Park HJ. Usefulness of a Colonoscopy Cap with an External Grid for the Measurement of Small-Sized Colorectal Polyps: A Prospective Randomized Trial. J Clin Med 2021; 10:jcm10112365. [PMID: 34072225 PMCID: PMC8197876 DOI: 10.3390/jcm10112365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
Accurate measurement of polyp size during colonoscopy is crucial. The usefulness of cap-assisted colonoscopy and external grid application on monitor (gCAP) was evaluated for polyp size measurement in this 3-year, single-center, single-blind, randomized trial. Using the endoscopic forceps width as reference, the discrepancy percent (DP), error rate (ER), and measurement time were compared between gCAP and visual estimation (VE) after randomization. ER was calculated within a 20% and 33% limit. From the 111 patients, 280 polyps were measured. The mean polyp sizes were 4.0 ± 1.7 mm and 4.2 ± 1.8 mm with gCAP and VE, respectively (p = 0.368). Compared with that by the forceps method, DP was significantly lower in the gCAP group than in the VE group. Moreover, ER was significantly lower in the gCAP group within its preset limit. The measurement time was 4 s longer in the gCAP group than in the VE group (8.2 ± 4.8 s vs. 4.2 ± 1.5 s; p < 0.001). However, the forceps method lasted 28 s longer than the others. On subgroup analysis by size, gCAP was more accurate for polyp size ≥ 5 mm. The gCAP method was more accurate for polyp size measurement than VE, especially for polyps ≥ 5 mm, and was more convenient than the forceps method.
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Affiliation(s)
- Seul-Ki Han
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Hyunil Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Jin-woo Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Hyun-Soo Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Su-Young Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Hong-Jun Park
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Wonju 24626, Korea
- Correspondence: ; Tel.: +82-33-741-0526; Fax: +82-33-741-0951
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Elwir S, Shaukat A, Shaw M, Hughes J, Colton J. Variability in, and factors associated with, sizing of polyps by endoscopists at a large community practice. Endosc Int Open 2017; 5:E742-E745. [PMID: 28791323 PMCID: PMC5546891 DOI: 10.1055/s-0043-112246] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/02/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND AIMS Accurate sizing of polyps at time of colonoscopy is critical for determining surveillance intervals. Endoscopists routinely over- or underestimate the size of polyps at colonoscopy. We evaluated the variability in sizing of polyps among multiple endoscopists, and the effect of patient and physician related factors on polyp size estimation in a large community-based practice. METHODS Adult patients who underwent a colonoscopy with polypectomy at five endoscopy centers in Minneapolis/St. Paul by one of 52 endoscopists in 2013 were included in this study. Association of patient, physician, and procedure related factors on polyp sizing was assessed. RESULTS In the study time frame, 38 624 colonoscopies were performed at five ambulatory endoscopy centers. Of these, 16 336 had one or more polyp removed with size information available, and were included in this analysis. There was significant inter-physician variation for estimating polyp sizes larger than 5 mm (intraclass correlation coefficient [ICC] 0.13). Older patient age (OR 1.08, 95 %CI 1.06 - 1.11), and male physician gender (OR 1.92, 95 %CI 1.26 - 2.94) were associated with increased odds of physicians sizing polyps as larger in size. Surveillance procedures had a higher odds of larger polyp sizing compared to screening (OR 0.91, 95 %CI 0.86 - 0.97) and diagnostic procedures (OR 0.86, 95 %CI 0.78 - 0.94). CONCLUSION In a large community setting, variation of polyp sizing estimates exists between physicians. Male physicians were more likely to size polyps as larger in size. Older patients and patients undergoing surveillance procedures were more likely to have polyps that were sized as larger in size.
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Affiliation(s)
- Saleh Elwir
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA,Corresponding author Saleh Elwir, MD Division of Gastroenterology, Hepatology and NutritionUniversity of Minnesota406 Harvard St. SEMMC 36MinneapolisMN 55455USA+1-612-625-5620
| | - Aasma Shaukat
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA,Division of Gastroenterology and Hepatology, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
| | - Michael Shaw
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - John Hughes
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, Colorado, USA
| | - Joshua Colton
- Minnesota Gastroenterology, PA, St. Paul, Minnesota, USA
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Rees CJ, Rajasekhar PT, Wilson A, Close H, Rutter MD, Saunders BP, East JE, Maier R, Moorghen M, Muhammad U, Hancock H, Jayaprakash A, MacDonald C, Ramadas A, Dhar A, Mason JM. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut 2017; 66:887-895. [PMID: 27196576 PMCID: PMC5531217 DOI: 10.1136/gutjnl-2015-310584] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accurate optical characterisation and removal of small adenomas (<10 mm) at colonoscopy would allow hyperplastic polyps to be left in situ and surveillance intervals to be determined without the need for histopathology. Although accurate in specialist practice the performance of narrow band imaging (NBI), colonoscopy in routine clinical practice is poorly understood. METHODS NBI-assisted optical diagnosis was compared with reference standard histopathological findings in a prospective, blinded study, which recruited adults undergoing routine colonoscopy in six general hospitals in the UK. Participating colonoscopists (N=28) were trained using the NBI International Colorectal Endoscopic (NICE) classification (relating to colour, vessel structure and surface pattern). By comparing the optical and histological findings in patients with only small polyps, test sensitivity was determined at the patient level using two thresholds: presence of adenoma and need for surveillance. Accuracy of identifying adenomatous polyps <10 mm was compared at the polyp level using hierarchical models, allowing determinants of accuracy to be explored. FINDINGS Of 1688 patients recruited, 722 (42.8%) had polyps <10 mm with 567 (78.5%) having only polyps <10 mm. Test sensitivity (presence of adenoma, N=499 patients) by NBI optical diagnosis was 83.4% (95% CI 79.6% to 86.9%), significantly less than the 95% sensitivity (p<0.001) this study was powered to detect. Test sensitivity (need for surveillance) was 73.0% (95% CI 66.5% to 79.9%). Analysed at the polyp level, test sensitivity (presence of adenoma, N=1620 polyps) was 76.1% (95% CI 72.8% to 79.1%). In fully adjusted analyses, test sensitivity was 99.4% (95% CI 98.2% to 99.8%) if two or more NICE adenoma characteristics were identified. Neither colonoscopist expertise, confidence in diagnosis nor use of high definition colonoscopy independently improved test accuracy. INTERPRETATION This large multicentre study demonstrates that NBI optical diagnosis cannot currently be recommended for application in routine clinical practice. Further work is required to evaluate whether variation in test accuracy is related to polyp characteristics or colonoscopist training. TRIAL REGISTRATION NUMBER The study was registered with clinicaltrials.gov (NCT01603927).
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Affiliation(s)
- Colin J Rees
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK,School of Medicine, Pharmacy and Health, Durham University, Durham, UK,Northern Region Endoscopy Group, UK
| | - Praveen T Rajasekhar
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK,Northern Region Endoscopy Group, UK
| | - Ana Wilson
- St Mark's Hospital and Academic Institute, London North West Healthcare NHS Trust, Imperial College London, London, UK
| | - Helen Close
- Durham Clinical Trials Unit, School of Medicine Pharmacy & Health, Durham University, Stockton-on-Tees, UK
| | - Matthew D Rutter
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK,Northern Region Endoscopy Group, UK,Department of Gastroenterology, North Tees & Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - Brian P Saunders
- St Mark's Hospital and Academic Institute, London North West Healthcare NHS Trust, Imperial College London, London, UK
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Rebecca Maier
- Durham Clinical Trials Unit, School of Medicine Pharmacy & Health, Durham University, Stockton-on-Tees, UK
| | - Morgan Moorghen
- St Mark's Hospital and Academic Institute, London North West Healthcare NHS Trust, Imperial College London, London, UK
| | - Usman Muhammad
- Durham Clinical Trials Unit, School of Medicine Pharmacy & Health, Durham University, Stockton-on-Tees, UK
| | - Helen Hancock
- Durham Clinical Trials Unit, School of Medicine Pharmacy & Health, Durham University, Stockton-on-Tees, UK
| | - Anthoor Jayaprakash
- Department of Gastroenterology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Chris MacDonald
- Department of Gastroenterology, North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Arvind Ramadas
- Department of Gastroenterology, South Tees Hospitals NHS Foundation Trust, Middlesborough, UK
| | - Anjan Dhar
- Department of Gastroenterology, County Durham & Darlington NHS Foundation Trust, Darlington, UK
| | - James M Mason
- Warwick Medical School, University of Warwick, Coventry, UK
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Integrated Multipoint-Laser Endoscopic Airway Measurements by Transoral Approach. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6838697. [PMID: 27022612 PMCID: PMC4770123 DOI: 10.1155/2016/6838697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/14/2016] [Accepted: 01/17/2016] [Indexed: 11/30/2022]
Abstract
Objectives. Optical and technical characteristics usually do not allow objective endoscopic distance measurements. So far no standardized method for endoscopic distance measurement is available. The aim of this study was to evaluate the feasibility and accuracy of transoral airway measurements with a multipoint-laser endoscope. Methods. The semirigid endoscope includes a multipoint laser measurement system that projects 49 laser points (wavelength 639 nm, power < 5 mW) into the optical axis of the endoscopic view. Distances, areas, and depths can be measured in real-time. Transoral endoscopic airway measurements were performed on nine human cadavers, which were correlated with CT measurements. Results. The preliminary experiment showed an optimum distance between the endoscope tip and the object of 5 to 6 cm. There was a mean measurement error of 3.26% ± 2.53%. A Spearman correlation coefficient of 0.95 (p = 0.01) was calculated for the laryngeal measurements and of 0.93 (p < 0.01) for the tracheal measurements compared to the CT. Using the Bland-Altman-Plot, the 95% limits of agreement for the laryngeal measurements were satisfactory: −0.76 and 0.93. Conclusions. Integrated multipoint-laser endoscopic measurement is a promising technical supplement, with potential use in diagnostic endoscopy and transoral endoscopic surgery in daily practice.
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