Journal Article

I-scan optical enhancement for the in vivo prediction of diminutive colorectal polyp histology: Results from a prospective three-phased multicentre trial

Ghosh, Subrata, Gschossmann, Jürgen, Pfeifer, Lukas, Iacucci, Marietta, Rath, Michelle G., Tontini, Gian E., Neufert, Clemens, Zopf, Steffen, Klare, Peter, Rath, Timo, Nägel, Andreas, Mühldorfer, Steffen, Siebler, Jürgen, Vitali, Francesco, Neurath, Markus F., Klenske, Entcho, Fischer, Sarah

2018

Overview

Dye-less chromoendoscopy is an emerging technology for colorectal polyp characterization. Herein, we investigated whether the newly introduced I-scan optical enhancement (OE) can accurately predict polyp histology in vivo in real-time. In this prospective three-phased study, 84 patients with 230 diminutive colorectal polyps were included. During the first two study phases, five endoscopists assessed whether analysis of polyp colour, surface and vascular pattern under i-scan OE can differentiate in vivo between adenomatous and hyperplastic polyps. Finally, junior and experienced endoscopists (JE, EE, each n = 4) not involved in the prior study phases made a post hoc diagnosis of polyp histology using a static i-scan OE image database. Histopathology was used as a gold-standard in all study phases. The overall accuracy of i-scan OE for histology prediction was 90% with a sensitivity, specificity, positive (PPV) and negative prediction value (NPV) of 91%, 90%, 86% and 94%, respectively. In high confidence predictions, the diagnostic accuracy increased to 93% with sensitivity, specificity, PPV and NPV of 94%, 91%, 89% and 96%. Colonoscopy surveillance intervals were predicted correctly in ≥ 90% of patients. In the post hoc analysis EE predicted polyp histology under i-scan OE with an overall accuracy of 91%. After a single training session, JE achieved a comparable diagnostic performance for predicting polyp histology with i-scan OE. The histology of diminutive colorectal polyps can be accurately predicted with i-scan OE in vivo in real-time. Furthermore, polyp differentiation with i-scan OE appears to require only a short learning curve.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aged / Aged, 80 and over / Analysis / Biology and Life Sciences / Colon / Colon - diagnostic imaging / Colon - pathology / Colonic Polyps - diagnosis / Colonic Polyps - diagnostic imaging / Colonic Polyps - pathology / Colonoscopy / Colonoscopy - methods / Colorectal cancer / Diagnosis / Diagnostic systems / Endoscopy / Epidemiology / Female / Gastroenterology / Histochemistry / Histology / Histopathology / Hospitals / Humans / Image Enhancement - methods / In vivo methods and tests / Learning curves / Male / Medical diagnosis / Medicine / Medicine and Health Sciences / Middle Aged / Narrow Band Imaging - methods / Patients / Performance prediction / Phases / Polyps / Prospective Studies / Real time / Rectum - diagnostic imaging / Rectum - pathology / Research and Analysis Methods / Sensitivity / Studies / Surveillance / Systematic review / Tumors