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. 2020 Mar;8(3):E257-E265.
doi: 10.1055/a-1072-4853. Epub 2020 Feb 21.

Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

Alouisa J P van de Wetering  1   2 , Lonne W T Meulen  1   2 , Roel M M Bogie  1   2 , Quirine E W van der Zander  1   2 , Ankie Reumkens  1   2   3 , Bjorn Winkens  4   5 , Hao Ran Cheng  6 , Jan-Willem A Straathof  1   6 , Evelien Dekker  7 , Eric Keulen  3 , C M Bakker  3 , Chantal Hoge  1 , Rogier de Ridder  1 , Ad A M Masclee  1   8 , Silvia Sanduleanu-Dascalescu  1   2
Affiliations

Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

Alouisa J P van de Wetering et al. Endosc Int Open. 2020 Mar.

Abstract

Background and study aims Implementation of optical diagnosis of diminutive polyps may potentially increase the efficacy and cost-effectiveness of colonoscopies. To adopt such strategy in clinical practice, the Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) thresholds provide the basis to be met: ≥ 90 % negative predictive value (NPV) for diagnosis of adenomatous histology and ≥ 90 % agreement on surveillance intervals. We evaluated this within the Dutch Bowel Cancer Screening Program (BCSP). Patients and methods Endoscopic and histological data were collected from participants of the national bowel cancer screening program with an unfavorable fecal immunochemical test referred for colonoscopy between February 2014 and August 2015 at four endoscopy centers. The "resect and discard" scenario was studied, resecting diminutive polyps without histological evaluation. Agreement between optical diagnosis and histological diagnosis was measured for surveillance intervals according to Dutch, European and American post-polypectomy surveillance guideline. Results Fifteen certified endoscopists participated in this study and included 3028 diminutive polyps. In 2,330 patients both optical and histological diagnosis were available. Optical diagnosis of diminutive polyps showed NPV of 84 % (95 % CI 80-87) for adenomatous histology in the rectosigmoid. Applying the 'resect and discard' strategy resulted in 90.6 %, 91.2 %, 90.9 % agreement on surveillance intervals for the Dutch, European and American guideline respectively. Conclusion Our data representing current clinical practice in the Dutch BCSP practice on optical diagnosis of diminutive polyps showed that accuracy of predicting histology remains challenging, and risk of incorrect optical diagnosis is still significant. Therefore, it is too early to safely implement these strategies.

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Conflict of interest statement

Competing interests Disclosures: R.M.M. Bogie: received an educational grant from Pentax Medical Europe. E. Dekker: I have endoscopic equipment on loan of FujiFilm, receive a research grant from FujiFilm. I have received a honorarium for consultancy from FujiFilm, Olympus, Tillots, GI Supply and CPP-FAP and a speakersʼ fee from Olympus, Roche and GI Supply. Besides, I am in the supervisory board of eNose. A.A.M. Masclee: 1. Funding grant from Pentax International GMBH. 2. Project funding from Dutch Cancer Society. S. Sanduleanu-Dascalescu: received a research grant from Pentax Europe.

Figures

Fig. 1
Fig. 1
Flowchart of the included patients and polyps.
See this image and copyright information in PMC

References

    1. Edwards B K, Ward E, Kohler B A et al.Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–573. - PMC - PubMed
    1. Lieberman D A, Rex D K, Winawer S J et al.Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844–857. - PubMed
    1. European Colorectal Cancer Screening Guidelines Working Group . von Karsa L, Patnick J et al.European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy. 2013;45:51–59. - PMC - PubMed
    1. Shaukat A, Mongin S J, Geisser M S et al.Long-term mortality after screening for colorectal cancer. N Engl J Med. 2013;369:1106–1114. - PubMed
    1. Toes-Zoutendijk E, van Leerdam M E, Dekker E et al.Real-time monitoring of results during first year of dutch colorectal cancer screening program and optimization by altering fecal immunochemical test cut-off levels. Gastroenterology. 2017;152:767–775 e762. - PubMed