Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps
Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps
复制标题
DOI：
10.1136/gutjnl-2014-308411
复制
发表时间：
2016-06-01
期刊：
影响因子：
24.5
通讯作者：
Dekker, Evelien
中科院分区：
文献类型：
--
作者：
IJspeert, Joep E. G.;Bastiaansen, Barbara A. J.;Dekker, Evelien
目的：准确的内镜鉴别诊断将使切除和丢弃小的和微小的结肠病变，从而提高成本效益。然而，目前基于窄带成像（NBI）的分类系统不包括肿瘤性无蒂锯齿状腺瘤/息肉（SSA/Ps）。我们的目的是开发和验证一个新的分类系统，内镜分化腺瘤，增生性息肉和SSA/Ps < 10 mm.Design我们开发了工作组锯齿状息肉和息肉病（WASP）分类，结合NBI国际结直肠内镜分类和标准，在一个逐步的方法区分SSA/Ps。10名顾问胃肠病学家预测息肉组织学，包括置信水平，根据内镜方面的45息肉，之前和之后参加培训的WASP分类。6个月后，相同的内窥镜医师预测一组新的50个息肉的息肉组织学，病变的比例与日常practice.Results的光学诊断的准确性是0.63（95%CI 0.54至0.71）在基线，提高到0.79（95%CI 0.72至0.86，P< 0.001）培训后。对于以高置信度诊断的息肉，准确度为0.73（95% CI 0.64至0.82），提高至0.87（95% CI 0.80至0.95，p< 0.01）。6个月后光学诊断的准确性为0.76（95% CI 0.72 - 0.80），考虑到高置信度诊断，增加至0.84（95% CI 0.81 - 0.88）。联合阴性预测值与高置信度的小肿瘤病变（腺瘤和SSA/Ps一起）为0.91（95%CI 0.83至0.96）。结论我们开发并验证了第一个综合分类方法内镜鉴别小和小型腺瘤，增生性息肉和SSA/Ps。在静态图像评估设置中，引入WASP分类显著提高了光学诊断的整体准确性，特别是SSA/P，这在6个月后被证明是可持续的。
Objective Accurate endoscopic differentiation would enable to resect and discard small and diminutive colonic lesions, thereby increasing cost-efficiency. Current classification systems based on narrow band imaging (NBI), however, do not include neoplastic sessile serrated adenomas/polyps (SSA/Ps). We aimed to develop and validate a new classification system for endoscopic differentiation of adenomas, hyperplastic polyps and SSA/Ps < 10 mm.Design We developed the Workgroup serrAted polypS and Polyposis (WASP) classification, combining the NBI International Colorectal Endoscopic classification and criteria for differentiation of SSA/Ps in a stepwise approach. Ten consultant gastroenterologists predicted polyp histology, including levels of confidence, based on the endoscopic aspect of 45 polyps, before and after participation in training in the WASP classification. After 6 months, the same endoscopists predicted polyp histology of a new set of 50 polyps, with a ratio of lesions comparable to daily practice.Results The accuracy of optical diagnosis was 0.63 (95% CI 0.54 to 0.71) at baseline, which improved to 0.79 (95% CI 0.72 to 0.86, p< 0.001) after training. For polyps diagnosed with high confidence the accuracy was 0.73 (95% CI 0.64 to 0.82), which improved to 0.87 (95% CI 0.80 to 0.95, p< 0.01). The accuracy of optical diagnosis after 6 months was 0.76 (95% CI 0.72 to 0.80), increasing to 0.84 (95% CI 0.81 to 0.88) considering high confidence diagnosis. The combined negative predictive value with high confidence of diminutive neoplastic lesions (adenomas and SSA/Ps together) was 0.91 (95% CI 0.83 to 0.96).Conclusions We developed and validated the first integrative classification method for endoscopic differentiation of small and diminutive adenomas, hyperplastic polyps and SSA/Ps. In a still image evaluation setting, introduction of the WASP classification significantly improved the accuracy of optical diagnosis overall as well as SSA/P in particular, which proved to be sustainable after 6 months.