Real-time optical biopsy of colon polyps with narrow band imaging in community practice does not yet meet key thresholds for clinical decisions

Accurate optical analysis of colorectal polyps (optical biopsy) could prevent unnecessary polypectomies or allow a "resect and discard" strategy with surveillance intervals determined based on the results of the optical biopsy; this could be less expensive than histopathologic analysis of...

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Vydáno v:	Gastroenterology (New York, N.Y. 1943) Ročník 144; číslo 1; s. 81
Hlavní autoři:	Ladabaum, Uri, Fioritto, Ann, Mitani, Aya, Desai, Manisha, Kim, Jane P, Rex, Douglas K, Imperiale, Thomas, Gunaratnam, Naresh
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.01.2013
Témata:	Adenoma - pathology Biopsy Colonic Neoplasms - pathology Colonic Polyps - pathology Colonoscopy - education Colonoscopy - standards Community Health Services - standards Confidence Intervals Gastroenterology - standards Humans Image Enhancement Learning Curve Odds Ratio Optical Imaging - standards Predictive Value of Tests
ISSN:	1528-0012, 1528-0012
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Abstract	Accurate optical analysis of colorectal polyps (optical biopsy) could prevent unnecessary polypectomies or allow a "resect and discard" strategy with surveillance intervals determined based on the results of the optical biopsy; this could be less expensive than histopathologic analysis of polyps. We prospectively evaluated real-time optical biopsy analysis of polyps with narrow band imaging (NBI) by community-based gastroenterologists. We first analyzed a computerized module to train gastroenterologists (N = 13) in optical biopsy skills using photographs of polyps. Then we evaluated a practice-based learning program for these gastroenterologists (n = 12) that included real-time optical analysis of polyps in vivo, comparison of optical biopsy predictions to histopathologic analysis, and ongoing feedback on performance. Twelve of 13 subjects identified adenomas with >90% accuracy at the end of the computer study, and 3 of 12 subjects did so with accuracy ≥90% in the in vivo study. Learning curves showed considerable variation among batches of polyps. For diminutive rectosigmoid polyps assessed with high confidence at the end of the study, adenomas were identified with mean (95% confidence interval [CI]) accuracy, sensitivity, specificity, and negative predictive values of 81% (73%-89%), 85% (74%-96%), 78% (66%-92%), and 91% (86%-97%), respectively. The adjusted odds ratio for high confidence as a predictor of accuracy was 1.8 (95% CI, 1.3-2.5). The agreement between surveillance recommendations informed by high-confidence NBI analysis of diminutive polyps and results from histopathologic analysis of all polyps was 80% (95% CI, 77%-82%). In an evaluation of real-time optical biopsy analysis of polyps with NBI, only 25% of gastroenterologists assessed polyps with ≥90% accuracy. The negative predictive value for identification of adenomas, but not the surveillance interval agreement, met the American Society for Gastrointestinal Endoscopy-recommended thresholds for optical biopsy. Better results in community practice must be achieved before NBI-based optical biopsy methods can be used routinely to evaluate polyps; ClinicalTrials.gov number, NCT01638091.
AbstractList	Accurate optical analysis of colorectal polyps (optical biopsy) could prevent unnecessary polypectomies or allow a "resect and discard" strategy with surveillance intervals determined based on the results of the optical biopsy; this could be less expensive than histopathologic analysis of polyps. We prospectively evaluated real-time optical biopsy analysis of polyps with narrow band imaging (NBI) by community-based gastroenterologists.BACKGROUND & AIMSAccurate optical analysis of colorectal polyps (optical biopsy) could prevent unnecessary polypectomies or allow a "resect and discard" strategy with surveillance intervals determined based on the results of the optical biopsy; this could be less expensive than histopathologic analysis of polyps. We prospectively evaluated real-time optical biopsy analysis of polyps with narrow band imaging (NBI) by community-based gastroenterologists.We first analyzed a computerized module to train gastroenterologists (N = 13) in optical biopsy skills using photographs of polyps. Then we evaluated a practice-based learning program for these gastroenterologists (n = 12) that included real-time optical analysis of polyps in vivo, comparison of optical biopsy predictions to histopathologic analysis, and ongoing feedback on performance.METHODSWe first analyzed a computerized module to train gastroenterologists (N = 13) in optical biopsy skills using photographs of polyps. Then we evaluated a practice-based learning program for these gastroenterologists (n = 12) that included real-time optical analysis of polyps in vivo, comparison of optical biopsy predictions to histopathologic analysis, and ongoing feedback on performance.Twelve of 13 subjects identified adenomas with >90% accuracy at the end of the computer study, and 3 of 12 subjects did so with accuracy ≥90% in the in vivo study. Learning curves showed considerable variation among batches of polyps. For diminutive rectosigmoid polyps assessed with high confidence at the end of the study, adenomas were identified with mean (95% confidence interval [CI]) accuracy, sensitivity, specificity, and negative predictive values of 81% (73%-89%), 85% (74%-96%), 78% (66%-92%), and 91% (86%-97%), respectively. The adjusted odds ratio for high confidence as a predictor of accuracy was 1.8 (95% CI, 1.3-2.5). The agreement between surveillance recommendations informed by high-confidence NBI analysis of diminutive polyps and results from histopathologic analysis of all polyps was 80% (95% CI, 77%-82%).RESULTSTwelve of 13 subjects identified adenomas with >90% accuracy at the end of the computer study, and 3 of 12 subjects did so with accuracy ≥90% in the in vivo study. Learning curves showed considerable variation among batches of polyps. For diminutive rectosigmoid polyps assessed with high confidence at the end of the study, adenomas were identified with mean (95% confidence interval [CI]) accuracy, sensitivity, specificity, and negative predictive values of 81% (73%-89%), 85% (74%-96%), 78% (66%-92%), and 91% (86%-97%), respectively. The adjusted odds ratio for high confidence as a predictor of accuracy was 1.8 (95% CI, 1.3-2.5). The agreement between surveillance recommendations informed by high-confidence NBI analysis of diminutive polyps and results from histopathologic analysis of all polyps was 80% (95% CI, 77%-82%).In an evaluation of real-time optical biopsy analysis of polyps with NBI, only 25% of gastroenterologists assessed polyps with ≥90% accuracy. The negative predictive value for identification of adenomas, but not the surveillance interval agreement, met the American Society for Gastrointestinal Endoscopy-recommended thresholds for optical biopsy. Better results in community practice must be achieved before NBI-based optical biopsy methods can be used routinely to evaluate polyps; ClinicalTrials.gov number, NCT01638091.CONCLUSIONSIn an evaluation of real-time optical biopsy analysis of polyps with NBI, only 25% of gastroenterologists assessed polyps with ≥90% accuracy. The negative predictive value for identification of adenomas, but not the surveillance interval agreement, met the American Society for Gastrointestinal Endoscopy-recommended thresholds for optical biopsy. Better results in community practice must be achieved before NBI-based optical biopsy methods can be used routinely to evaluate polyps; ClinicalTrials.gov number, NCT01638091. Accurate optical analysis of colorectal polyps (optical biopsy) could prevent unnecessary polypectomies or allow a "resect and discard" strategy with surveillance intervals determined based on the results of the optical biopsy; this could be less expensive than histopathologic analysis of polyps. We prospectively evaluated real-time optical biopsy analysis of polyps with narrow band imaging (NBI) by community-based gastroenterologists. We first analyzed a computerized module to train gastroenterologists (N = 13) in optical biopsy skills using photographs of polyps. Then we evaluated a practice-based learning program for these gastroenterologists (n = 12) that included real-time optical analysis of polyps in vivo, comparison of optical biopsy predictions to histopathologic analysis, and ongoing feedback on performance. Twelve of 13 subjects identified adenomas with >90% accuracy at the end of the computer study, and 3 of 12 subjects did so with accuracy ≥90% in the in vivo study. Learning curves showed considerable variation among batches of polyps. For diminutive rectosigmoid polyps assessed with high confidence at the end of the study, adenomas were identified with mean (95% confidence interval [CI]) accuracy, sensitivity, specificity, and negative predictive values of 81% (73%-89%), 85% (74%-96%), 78% (66%-92%), and 91% (86%-97%), respectively. The adjusted odds ratio for high confidence as a predictor of accuracy was 1.8 (95% CI, 1.3-2.5). The agreement between surveillance recommendations informed by high-confidence NBI analysis of diminutive polyps and results from histopathologic analysis of all polyps was 80% (95% CI, 77%-82%). In an evaluation of real-time optical biopsy analysis of polyps with NBI, only 25% of gastroenterologists assessed polyps with ≥90% accuracy. The negative predictive value for identification of adenomas, but not the surveillance interval agreement, met the American Society for Gastrointestinal Endoscopy-recommended thresholds for optical biopsy. Better results in community practice must be achieved before NBI-based optical biopsy methods can be used routinely to evaluate polyps; ClinicalTrials.gov number, NCT01638091.
Author	Fioritto, Ann Imperiale, Thomas Mitani, Aya Desai, Manisha Ladabaum, Uri Rex, Douglas K Gunaratnam, Naresh Kim, Jane P
Author_xml	– sequence: 1 givenname: Uri surname: Ladabaum fullname: Ladabaum, Uri email: uri.ladabaum@stanford.edu organization: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA. uri.ladabaum@stanford.edu – sequence: 2 givenname: Ann surname: Fioritto fullname: Fioritto, Ann – sequence: 3 givenname: Aya surname: Mitani fullname: Mitani, Aya – sequence: 4 givenname: Manisha surname: Desai fullname: Desai, Manisha – sequence: 5 givenname: Jane P surname: Kim fullname: Kim, Jane P – sequence: 6 givenname: Douglas K surname: Rex fullname: Rex, Douglas K – sequence: 7 givenname: Thomas surname: Imperiale fullname: Imperiale, Thomas – sequence: 8 givenname: Naresh surname: Gunaratnam fullname: Gunaratnam, Naresh
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/23041328$$D View this record in MEDLINE/PubMed
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References_xml	– reference: 19909747 - Gastroenterology. 2010 Mar;138(3):834-42 – reference: 18828077 - Endoscopy. 2008 Oct;40(10):811-7 – reference: 21266811 - Digestion. 2011;83(3):167-72 – reference: 18691708 - Gastrointest Endosc. 2008 Dec;68(6):1136-45 – reference: 20621680 - Clin Gastroenterol Hepatol. 2010 Oct;8(10):865-9, 869.e1-3 – reference: 18951131 - Gastrointest Endosc. 2009 Feb;69(2):278-83 – reference: 21184878 - Gastrointest Endosc. 2011 Jan;73(1):128-33 – reference: 21353837 - Gastrointest Endosc. 2011 Mar;73(3):419-22 – reference: 21762907 - Gastrointest Endosc. 2011 Sep;74(3):603-9 – reference: 19251016 - Gastrointest Endosc. 2009 Mar;69(3 Pt 2):716-22 – reference: 21419769 - Gastroenterology. 2011 Jun;140(7):1887-94 – reference: 19899031 - Endoscopy. 2010 Jan;42(1):22-7 – reference: 21271465 - Endoscopy. 2011 Feb;43(2):94-9 – reference: 19187781 - Gastroenterology. 2009 Apr;136(4):1174-81 – reference: 18384785 - Gastroenterology. 2008 May;134(5):1570-95 – reference: 19491863 - Am J Gastroenterol. 2009 Jun;104(6):1498-507 – reference: 19595313 - Gastrointest Endosc. 2009 Nov;70(5):947-55 – reference: 20493482 - Gastrointest Endosc. 2010 Jul;72(1):127-35 – reference: 19111693 - Gastrointest Endosc. 2009 Jan;69(1):124-35 – reference: 19910250 - Lancet Oncol. 2009 Dec;10(12):1171-8 – reference: 19584829 - Am J Gastroenterol. 2009 Oct;104(10):2422-30 – reference: 18668472 - Endoscopy. 2008 Oct;40(10):818-22 – reference: 21802078 - Gastrointest Endosc. 2011 Sep;74(3):593-602 – reference: 20561618 - Gastrointest Endosc. 2010 Sep;72(3):572-6 – reference: 22032847 - Gastrointest Endosc. 2012 Mar;75(3):494-502 – reference: 22763141 - Gastroenterology. 2012 Sep;143(3):844-857 – reference: 20381799 - Gastrointest Endosc. 2010 Jul;72(1):118-26 – reference: 19168154 - Clin Gastroenterol Hepatol. 2009 Mar;7(3):288-95 – reference: 18155210 - Gastrointest Endosc. 2008 Feb;67(2):280-6
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Snippet	Accurate optical analysis of colorectal polyps (optical biopsy) could prevent unnecessary polypectomies or allow a "resect and discard" strategy with...
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SubjectTerms	Adenoma - pathology Biopsy Colonic Neoplasms - pathology Colonic Polyps - pathology Colonoscopy - education Colonoscopy - standards Community Health Services - standards Confidence Intervals Gastroenterology - standards Humans Image Enhancement Learning Curve Odds Ratio Optical Imaging - standards Predictive Value of Tests
Title	Real-time optical biopsy of colon polyps with narrow band imaging in community practice does not yet meet key thresholds for clinical decisions
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