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Multicenter Study
. 2024 Oct;56(10):770-779.
doi: 10.1055/a-2313-4996. Epub 2024 Apr 24.

Effect of optical diagnosis training on recognition and treatment of submucosal invasive colorectal cancer in community hospitals: a prospective multicenter intervention study

Lonne W T Meulen  1   2 , Krijn J C Haasnoot  3 , Marije S Vlug  4 , Frank H J Wolfhagen  5 , Martine A M C Baven-Pronk  6 , Michael P J A van der Voorn  7 , Matthijs P Schwartz  8 , Lauran Vogelaar  9 , Wouter H de Vos Tot Nederveen Cappel  10 , Tom C J Seerden  11 , Wouter L Hazen  12 , Ruud W M Schrauwen  13 , Lorenza Alvarez-Herrero  14 , Ramon-Michel Schreuder  15 , Annick B van Nunen  16 , Esther Stoop  17 , Gijs J de Bruin  18 , Philip Bos  19 , Willem A Marsman  20 , Edith Kuiper  21 , Marc de Bièvre  22 , Yasser A Alderlieste  23 , Robert Roomer  24 , John Groen  25 , Marloes Bigirwamungu-Bargeman  26 , Peter D Siersema  27 , Sjoerd G Elias  28 , Ad A M Masclee  1 , Leon M G Moons  3 ; OPTICAL-STAR study team and the Dutch T1 CRC Working Group
Affiliations
Multicenter Study

Effect of optical diagnosis training on recognition and treatment of submucosal invasive colorectal cancer in community hospitals: a prospective multicenter intervention study

Lonne W T Meulen et al. Endoscopy. 2024 Oct.

Abstract

Background: Recognition of submucosal invasive colorectal cancer (T1 CRC) is difficult, with sensitivities of 35 %-60 % in Western countries. We evaluated the real-life effects of training in the OPTICAL model, a recently developed structured and validated prediction model, in Dutch community hospitals.

Methods: In this prospective multicenter study (OPTICAL II), 383 endoscopists from 40 hospitals were invited to follow an e-learning program on the OPTICAL model, to increase sensitivity in detecting T1 CRC in nonpedunculated polyps. Real-life recognition of T1 CRC was then evaluated in 25 hospitals. Endoscopic and pathologic reports of T1 CRCs detected during the next year were collected retrospectively, with endoscopists unaware of this evaluation. Sensitivity for T1 CRC recognition, R0 resection rate, and treatment modality were compared for trained vs. untrained endoscopists.

Results: 1 year after e-learning, 528 nonpedunculated T1 CRCs were recorded for endoscopies performed by 251 endoscopists (118 [47 %] trained). Median T1 CRC size was 20 mm. Lesions were mainly located in the distal colorectum (66 %). Trained endoscopists recognized T1 CRCs more frequently than untrained endoscopists (sensitivity 74 % vs. 62 %; mixed model analysis odds ratio [OR] 2.90, 95 %CI 1.54-5.45). R0 resection rate was higher for T1 CRCs detected by trained endoscopists (69 % vs. 56 %; OR 1.73, 95 %CI 1.03-2.91).

Conclusion: Training in optical recognition of T1 CRCs in community hospitals was associated with increased recognition of T1 CRCs, leading to higher en bloc and R0 resection rates. This may be an important step toward more organ-preserving strategies.

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Conflict of interest statement

The authors declare that P. Siersema received grants or speaker's fees from Pentax Japan, The E-Nose Company The Netherlands, Microtech China, Lucid Diagnostics USA, Magentiq Eye Israel, Norgine UK/The Netherlands, and Motus GI USA; A. Masclee received research grants from the Dutch Cancer Society (KWF) and the Dutch Organization for Health Research and Innovation (ZonMW); L. Moons acts as a consultant for Boston Scientific. The other authors declare that no conflicts of interest exist.

Figures

Fig. 1
Fig. 1
Three submucosal invasive colorectal cancers in white-light and advanced imaging.
Fig. 2
Fig. 2
Flow chart of study design and inclusions. 1 Trained endoscopists completed the e-learning program (with or without post-test). Untrained endoscopists did not register or dropped out during the e-learning program. T1 CRC, submucosal invasive colorectal cancer.
See this image and copyright information in PMC

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