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Abstract
Diminutive and small colorectal polyps are common findings during colonoscopies, and rarely contain dysplastic elements and progress to colorectal cancer. With improving technology and the advent of artificial intelligence, detection rates of small or diminutive polyps and adenomas are rising, resulting in increasing costs associated with colonoscopy. Incomplete resection rates are an outcome of interest because it correlates with interval colorectal cancer. More effort is warranted to standardize training programs and sensitize endoscopists to the importance of personal performance as a quality metric of colonoscopy. This article reviews indications, methods, and recent developments in polypectomy for small and diminutive polyps.
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Affiliation(s)
- Melissa Zarandi-Nowroozi
- Department of Medicine, Division of Gastroenterology, Montreal University Hospital (CHUM) and Montreal University Hospital Research Center (CRCHUM), 900 Rue Saint-Denis, Montréal, QC H2X 0A9, Canada
| | - Roupen Djinbachian
- Department of Medicine, Division of Gastroenterology, Montreal University Hospital (CHUM) and Montreal University Hospital Research Center (CRCHUM), 900 Rue Saint-Denis, Montréal, QC H2X 0A9, Canada
| | - Daniel von Renteln
- Department of Medicine, Division of Gastroenterology, Montreal University Hospital (CHUM) and Montreal University Hospital Research Center (CRCHUM), 900 Rue Saint-Denis, Montréal, QC H2X 0A9, Canada.
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Parsa N, Rex DK, Byrne MF. Colorectal polyp characterization with standard endoscopy: Will Artificial Intelligence succeed where human eyes failed? Best Pract Res Clin Gastroenterol 2021; 52-53:101736. [PMID: 34172255 DOI: 10.1016/j.bpg.2021.101736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Abstract
The American Society for Gastrointestinal Endoscopy (ASGE) has proposed the "resect-and-discard" and "diagnose-and-leave" strategies for diminutive colorectal polyps to reduce the costs of unnecessary polyp resection and pathology evaluation. However, the diagnostic thresholds set by these guidelines are not always met in community practice. To overcome this sub-optimal performance, artificial intelligence (AI) has been applied to the field of endoscopy. The incorporation of deep learning algorithms with AI models resulted in highly accurate systems that match the expert endoscopists' optical biopsy and exceed the ASGE recommended thresholds. Recent studies have demonstrated that the integration of AI in clinical practice results in significant improvement in endoscopists' diagnostic accuracy while reducing the time to make a diagnosis. Yet, several points need to be addressed before AI models can be successfully implemented in clinical practice. In this review, we summarize the recent literature on the application of AI for characterization of colorectal polyps, and review the current limitation and future directions for this field.
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Affiliation(s)
- Nasim Parsa
- University of Missouri, Department of Medicine, Division of Gastroenterology and Hepatology, Columbia, MO, United States
| | - Douglas K Rex
- Indiana University School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, IN, United States
| | - Michael F Byrne
- University of British Columbia, Department of Medicine, Division of Gastroenterology and Hepatology Vancouver, British Columbia, Canada; Satisfai Health and AI4GI Joint Venture, Vancouver, British Columbia, Canada.
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Abstract
PURPOSE OF REVIEW Optical diagnosis of diminutive colorectal polyps has been recently proposed as an alternative to histopathologic diagnosis. Recent developments in imaging techniques, new classification systems, and the use of artificial intelligence have allowed for increased viability of optical diagnosis. This review provides an up-to-date overview of optical diagnosis recommendations, classifications, outcomes, and recent developments. RECENT FINDINGS There are currently seven major classification systems and three major society recommendations for quality benchmarks for optical diagnosis of diminutive polyps. The NICE classification has been extensively studied and meets quality benchmarks for most imaging techniques but does not allow for the diagnosis of sessile serrated polyps (SSPs). The SIMPLE classification has met quality benchmarks for NBI and i-Scan and allows for the diagnosis of SSPs. Other classification systems need to be further studied to validate effectiveness. Computer-assisted diagnosis of colorectal polyps is a very promising recent development with first studies showing that society-recommended quality benchmarks for real-time colonoscopies on patients are being met. Limitations include a non-negligible percentage of failure to diagnose, low specificity, and low number of real-time diagnostic studies. More research needs to be performed to further understand the value of artificial intelligence for optical polyp diagnosis. Optical diagnosis of diminutive colorectal polyps is currently a viable strategy for experienced endoscopists using validated classifications and imaging-enhanced endoscopy. Artificial intelligence-based diagnosis could make optical diagnosis widely applicable but is currently in its early developmental stage.
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Affiliation(s)
- Roupen Djinbachian
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Anne-Julie Dubé
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Daniel von Renteln
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada. .,Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada.
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Abstract
Although advancements in endoscopic imaging of colorectal mucosa have outstripped the pace of research in the field, the potential clinical applications of these novel technologies are promising. Chief among these is the ability to diagnose colorectal polyps in vivo. This feature appears most applicable to diminuitive polyps, which have very little malignant potential yet represent over 70% of resected polyps. In an ideal application, the capability to predict diminutive hyperplastic polyp histology in vivo precludes the need for excision whereas dimunitive adenomas do require excision, but not necessarily histopathologic analysis if the diagnosis is made in vivo with adequate confidence. However, the vast array of new advanced imaging modalities and polyp classification tools have been difficult to reconcile. We aim to highlight the current status of real-time colorectal polyp diagnosis and identify the barriers that remain to its widespread implementation.
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Affiliation(s)
- James E Allen
- Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, USA
| | - Prateek Sharma
- Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, USA.
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Abstract
The prevalence of cancer in small and diminutive polyps is relevant to "resect and discard" and CT colonography reporting recommendations. We evaluated a prospectively collected colonoscopy polyp database to identify polyps <10mm and those with cancer or advanced histology (high-grade dysplasia or villous elements). Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10mm in size. A total of 4790 lesions were excluded as they were not conventional adenomas or serrated class lesions. There were 23,524 conventional adenomas <10mm of which 22,952 were tubular adenomas. There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤5mm in size and 0.8% of adenomas 6-9mm in size. Of all conventional adenomas, 2.1% of those ≤5mm in size and 5.6% of those 6-9mm in size were advanced. Among 36,107 polyps ≤5mm in size and 6523 polyps 6-9mm in size, there were no cancers. These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps.
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Affiliation(s)
- Prasanna L Ponugoti
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Oscar W Cummings
- Division of Surgical Pathology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States.
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Takeuchi Y, Hanafusa M, Kanzaki H, Ohta T, Hanaoka N, Yamamoto S, Higashino K, Tomita Y, Uedo N, Ishihara R, Iishi H. An alternative option for " resect and discard" strategy, using magnifying narrow-band imaging: a prospective "proof-of-principle" study. J Gastroenterol 2015; 50:1017-26. [PMID: 25689934 DOI: 10.1007/s00535-015-1048-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 01/27/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The "resect and discard" strategy is beneficial for cost savings on screening and surveillance colonoscopy, but it has the risk to discard lesions with advanced histology or small invasive cancer (small advanced lesion; SALs). The aim of this study was to prove the principle of new "resect and discard" strategy with consideration for SALs using magnifying narrow-band imaging (M-NBI). METHODS Patients undergoing colonoscopy at a tertiary center were involved in this prospective trial. For each detected polyp <10 mm, optical diagnosis (OD) and virtual management ("leave in situ", "discard" or "send for pathology") were independently made using non-magnifying NBI (N-NBI) and M-NBI, and next surveillance interval were predicted. Histological and optical diagnosis results of all polyps were compared. RESULTS While the management could be decided in 82% of polyps smaller than 10 mm, 24/31 (77%) SALs including two small invasive cancers were not discarded based on OD using M-NBI. The sensitivity [90% confidence interval (CI)] of M-NBI for SALs was 0.77 (0.61-0.89). The risk for discarding SALs using N-NBI was significantly higher than that using M-NBI (53 vs. 23%, p = 0.02). The diagnostic accuracy (95% CI) of M-NBI in distinguishing neoplastic from non-neoplastic lesions [0.88 (0.86-0.90)] was significantly better than that of N-NBI [0.84 (0.82-0.87)] (p = 0.005). CONCLUSIONS The results of our study indicated that our "resect and discard" strategy using M-NBI could work to reduce the risk for discarding SALs including small invasive cancer (UMIN-CTR, UMIN000003740).
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Affiliation(s)
- Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Masao Hanafusa
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Hiromitsu Kanzaki
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Takashi Ohta
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Noboru Hanaoka
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Yasuhiko Tomita
- Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, 537-8511, Japan.
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Hiroyasu Iishi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
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Hattori S, Iwatate M, Sano W, Hasuike N, Kosaka H, Ikumoto T, Kotaka M, Ichiyanagi A, Ebisutani C, Hisano Y, Fujimori T, Sano Y. Narrow-band imaging observation of colorectal lesions using NICE classification to avoid discarding significant lesions. World J Gastrointest Endosc 2014; 6:600-605. [PMID: 25512769 PMCID: PMC4265957 DOI: 10.4253/wjge.v6.i12.600] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/04/2014] [Accepted: 11/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the “resect and discard” policy.
METHODS: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancers and their endoscopic features were assessed.
RESULTS: In total, we found 681 cases of diminutive (1-5 mm) lesions in 402 patients and 197 cases of small (6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal (SM) scanty invasive carcinomas, 1 and 1 were SM-d carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 endoscopically.
CONCLUSION: The risk of failing to detect diminutive and small colorectal invasive cancer with the “resect and discard” strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.
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