PTH-025 Predicting polyp histology - development and validation of an international simple endoscopic classification of small colorectal polyps using the novel i-scan optical enhancement colonoscope
PTH-025 Predicting polyp histology - development and validation of an international simple endoscopic classification of small colorectal polyps using the novel i-scan optical enhancement colonoscope
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PTH-025 预测息肉组织学 - 使用新型 i-scan 光学增强结肠镜开发和验证小结直肠息肉的国际简单内镜分类
DOI：
10.1136/gutjnl-2017-314472.422
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Iacucci M
中科院分区：
文献类型：
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作者：
Iacucci M
前言内镜下对小的结直肠息肉的组织学预测准确性可能有助于制定内镜治疗方案。本研究的目的是1）开发一个简化的内镜下结直肠息肉分类和2）评估的分类预测息肉组织学使用i-扫描光学增强（OE）images.MethodEight内镜医师从欧洲和北美的经验，在虚拟电子chromodendoscopy参加了这项研究。评估了21例小结直肠息肉（增生性=7例，腺瘤性=7例，无蒂锯齿状=7例）的视频库。根据息肉的组织病理学评价内镜医师的诊断性能。在研究的第1阶段，开发了一种新的简化的结肠直肠息肉内镜分类系统（内镜检查期间息肉标记的简化识别方法- SIMPLE）。在第2阶段，评估了训练前后预测息肉组织学的准确性、置信水平和观察者间一致性。单变量和多变量分析息肉的内镜特征，以确定强度的内镜预测腺瘤与非adenoma.ResultsThe SIMPLE分类是由三个息肉的特点：表面，血管模式和病变边界。使用SIMPLE分类，训练前预测息肉组织学的总体准确性为83.1%（95%CI：0.77-0.88），训练后提高至94.0%（95%CI：0.88-0.97; p=0.002）。对于高置信度的息肉诊断，训练前的准确率为90%（95% CI：0.83-0.94），训练后为95%（95% CI：0.89-0.98; p=0.01）。训练后SIMPLE分类的总敏感性、特异性、PPV、NPV分别为96.6%、87.5%、95.0%、91.3%和94.0%。使用SIMPLE分类的息肉组织学诊断的观察者间一致性从基线时的0.46（95% CI：0.30-0.64）提高到培训后的0.66（95% CI：0.48-0.82）。单因素分析显示，表面和血管模式标准是预测腺瘤诊断。腺瘤诊断的优势比为1.8（95%CI：0.7-4.6）时，单独使用表面图案和4.6（95%CI：2.3-9.4）时，单独使用vessel patterns.ConclusionA新的内镜SIMPLE分类预测息肉组织学是由国际专家共识组。使用-i-scan OE系统，新的SIMPLE分类得到验证，并证明了小息肉中腺瘤诊断的高度准确性，符合ASGE PIVI建议。Iacucci冲突：宾得，C Trovato：没有声明，D格林沃尔德：未申报，S Gross：无声明，A霍夫曼：无声明，L杰弗里：未声明，B Lethebe：无声明，M Lowerison：没有声明，J Nayor：未声明，H Neumann：无声明，S Sanduleanu：未声明，P Sharma：无声明，R Kiesslich：无声明，S Ghosh：未声明，J Saltzman：未申报
IntroductionThe endoscopic accuracy to predictin vivothe histology of small colorectal polyps may facilitate tailored endoscopic treatment. The aims of this study were 1) to develop a simplified endoscopic colorectal polyp classification and 2) to evaluate the performance of the classification to predict polyp histology using i-scan Optical Enhancement (OE) images.MethodEight endoscopists from Europe and North America with experience in virtual electronic chromoendoscopy participated in the study. A video-library of 21 small colorectal polyps (hyperplastic=7, adenomatous=7, and sessile serrated=7) was assessed. The diagnostic performance of the endoscopists was evaluated according to the histopathology of the polyp. In phase 1 of the study, a new simplified endoscopic classification system for colorectal polyps (Simplified Identification Method for Polyp Labelling during Endoscopy - SIMPLE ) was developed. In phase 2, the accuracy, level of confidence and inter-observer agreement to predict polyp histology before and after a training were evaluated. Univariate and multivariate analysis of the endoscopic features of polyps were performed to determine the strength of endoscopic predictors for adenoma vs. non-adenoma.ResultsThe SIMPLE classification was consisted of three polyp characteristics: surface, vessel pattern and lesion border. Using the SIMPLE classification,the overall accuracy for prediction of polyp histology was 83.1% (95% CI: 0.77–0.88) before training and improved to 94.0% (95% CI: 0.88–0.97; p=0.002) after training. For polyp diagnosis with high confidence the accuracy before training was 90% (95% CI: 0.83–0.94) and after was 95% (95% CI: 0.89–0.98; p=0.01). The overall sensitivity, specificity, PPV, NPV, of the SIMPLE classification after training were 96.6%, 87.5%, 95.0%, 91.3%, and 94.0%. The inter-observer agreement of polyp histology diagnosis using the SIMPLE classification improved from 0.46 (95% CI: 0.30–0.64) at baseline to 0.66 (95% CI: 0.48–0.82) after training. Univariate analysis showed that the surface and vessel pattern criteria were predictive of an adenoma diagnosis. The odds ratio of adenoma diagnosis were 1.8 (95% CI: 0.7–4.6) when using surface pattern alone and 4.6 (95% CI: 2.3–9.4) when using vessel pattern alone.ConclusionA new endoscopic SIMPLE classification to predict polyp histology was developed by an international expert consensus group. Using the –i-scan OE system, the new SIMPLE classification was validated and demonstrated a high degree of accuracy for adenoma diagnosis in small polyps, meeting the ASGE PIVI recommendations.Disclosure of InterestM. Iacucci Conflict with: Pentax, C Trovato: None Declared, D Greenwald: None Declared, S Gross: None Declared, A Hoffman: None Declared, L Jeffrey: None Declared, B Lethebe: None Declared, M Lowerison: None Declared, J Nayor: None Declared, H Neumann: None Declared, S Sanduleanu: None Declared, P Sharma: None Declared, R Kiesslich: None Declared, S Ghosh: None Declared, J Saltzman: None Declared