Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy.
Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy.
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DOI：
10.1053/j.gastro.2015.10.042
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发表时间：
2016-02
期刊：
影响因子：
29.4
通讯作者：
Wani S
中科院分区：
文献类型：
--
作者：
Patel SG;Schoenfeld P;Kim HM;Ward EK;Bansal A;Kim Y;Hosford L;Myers A;Foster S;Craft J;Shopinski S;Wilson RH;Ahnen DJ;Rastogi A;Wani S
窄带成像 (NBI) 可以对结直肠息肉进行实时组织学分类。我们调查了未经 NBI 培训的内窥镜医师是否可以达到美国胃肠内窥镜检查协会推荐的以下阈值：对于具有高置信度特征的小型结直肠息肉，直肠乙状结肠腺瘤的阴性预测值≥90%，以及监测间隔的一致性≥90%。来自 2 个三级护理中心的 26 名内窥镜医师接受了 NBI 判读标准化培训。内镜医师基于NBI对小型结直肠息肉组织学进行实时预测并预测监测间隔。通过将组织学分析的预测结果与实际结果进行比较来评估他们的表现。使用多级逻辑回归来评估绩效预测因素。累积求和分析用于表征学习曲线。内窥镜医师使用 NBI 进行了 1451 次结肠镜检查并做出了 3012 次小型息肉预测（74.3% 高置信度）。他们立即进行了 898 次术后监测间隔预测。另外 505 个监测间隔是根据组织学输入确定的。直肠乙状结肠高置信度特征的总体阴性预测值为 94.7%（95% 置信区间：92.6%–96.8%），监测区间一致性为 91.2%（95% 置信区间：89.7%–92.7%）。总体而言，97.0% 的监测间隔预测将使患者按时或提早返回。高置信度表征是准确性的最强预测因子（优势比 = 3.42；95% 置信区间：2.72–4.29；P < .001）。随着时间的推移，性能有所提高，但根据累积求和分析，只有 7 名参与者 (26.9%) 识别出腺瘤具有足够的敏感性，因此不需要进一步审核。通过标准化培训，之前没有 NBI 专业知识的胃肠病学家能够满足美国胃肠内窥镜学会规定的阴性预测值和监测间隔阈值。监测间隔的大多数分歧导致患者提前返回。性能随着时间的推移而提高，但大多数内窥镜医师将需要持续审核性能。
Narrow-band imaging (NBI) allows real-time histologic classification of colorectal polyps. We investigated whether endoscopists without prior training in NBI can achieve the following thresholds recommended by the American Society for Gastrointestinal Endoscopy: for diminutive colorectal polyps characterized with high confidence, a ≥90% negative predictive value for adenomas in the rectosigmoid and a ≥90% agreement in surveillance intervals. Twenty-six endoscopists from 2 tertiary care centers underwent standardized training in NBI interpretation. Endoscopists made real-time predictions of diminutive colorectal polyp histology and surveillance interval predictions based on NBI. Their performance was evaluated by comparing predicted with actual findings from histologic analysis. Multilevel logistic regression was used to assess predictors of performance. Cumulative summation analysis was used to characterize learning curves. The endoscopists performed 1451 colonoscopies and made 3012 diminutive polyp predictions (74.3% high confidence) using NBI. They made 898 immediate post-procedure surveillance interval predictions. An additional 505 surveillance intervals were determined with histology input. The overall negative predictive value for high-confidence characterizations in the rectosigmoid was 94.7% (95% confidence interval: 92.6%–96.8%) and the surveillance interval agreement was 91.2% (95% confidence interval: 89.7%–92.7%). Overall, 97.0% of surveillance interval predictions would have brought patients back on time or early. High-confidence characterization was the strongest predictor of accuracy (odds ratio = 3.42; 95% confidence interval: 2.72–4.29; P < .001). Performance improved over time, however, according to cumulative summation analysis, only 7 participants (26.9%) identified adenomas with sufficient sensitivity such that further auditing is not required. With standardized training, gastroenterologists without prior expertise in NBI were able to meet the negative predictive value and surveillance interval thresholds set forth by the American Society for Gastrointestinal Endoscopy. The majority of disagreement in surveillance interval brought patients back early. Performance improves with time, but most endoscopists will require ongoing auditing of performance.