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Accuracy in optical diagnosis for polyps between 5 and 15 mm and its implications on surveillance. A prospective, multicenter study. (POPS study)

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Abstract

Background and aims

Polyps histology and diameter up to 1 cm determine whether a patient needs a colonoscopy after 3 years or less, or far ahead. Endoscopists’ and pathologists’ size estimations can be imprecise. Our aim was to assess endoscopist ability to correctly recommend surveillance colonoscopies for patients with polyps around the 10 mm threshold, based on its endoscopic sizing and optical diagnosis by NBI.

Methods

NBI-assisted diagnosis and endoscopist estimation of polyp size were compared with reference standard, considering this as the post resection polyp measurements by the nurse assistant and the pathologic results, in a prospective, multicenter, real life study, that recruited adults undergoing colonoscopy in five hospitals. By comparing the endoscopic and pathologist size estimation, with polyps’ measurement after resection, and optical and histological diagnoses in patients with polyps between 5 and 15 mm, sensitivity was assessed at the patient level by means of two characteristics: the presence of adenoma, and the surveillance interval. Surveillance intervals were established by the endoscopist, based on optical diagnosis, and by another gastroenterologist, grounded on the pathologic report. Determinants of accuracy were explored at the polyp level.

Results

532 polyps were resected in 451 patients. Size estimation was more precise for the endoscopist. Endoscopist sensitivity for the presence of adenoma or carcinoma was 98.7%. Considering the presence of high-grade dysplasia or cancer, sensitivity was 82.6% for the endoscopic optical diagnosis. Sensitivity for a correct 3-year surveillance interval was 91.5%, specificity 82.3%, with a PPV of 93.2% and NPV of 78.5% for the endoscopist. 6.51% of patients would have had their follow-up colonoscopy delayed, whereas 22 (4.8%) would have it been performed earlier, had endoscopist recommendations been followed.

Conclusion

Our study observes that NBI optical diagnosis can be recommended in routine practice to establish surveillance intervals for polyps between 5 and 15 mm.

Clinical Trials Registration Number: NCT04232176

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Acknowledgements

This research is part of Dr Heredia-Carrasco PhD thesis.

Funding

Authors have no financial support to declare. All of the patients were enrolled from the public Spanish National Health Service, were all the procedures were performed.

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Authors and Affiliations

  1. Endoscopy Unit, Department of Gastroenterology and Hepatology, “Virgen de Las Nieves” University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain

    Eduardo Redondo-Cerezo, Clara Heredia-Carrasco, Eva Julissa Ortega-Suazo, Juan Gabriel Martínez-Cara, Francisco Valverde-Lopez, Mercedes López de Hierro, Damián Sánchez-Capilla & Rita Jimenez-Rosales

  2. Internal Medicine Service, Hospital Comarcal “Santa Ana”, Motril, Spain

    Carlos Alegría-Motte, Antonio Caballero-Mateos & Virgilio Martos-Ruiz

  3. Internal Medicine Service, Hospital Comarcal “Virgen del Puerto”, Plasencia, Spain

    Francisco Vadillo-Calles

  4. Gastroenterology Service, Hospital Comarcal de Poniente, El Ejido, Spain

    Jose Luis Ariza-Fernández

  5. Internal Medicine Service, Hospital Comarcal “Vega Baja”, Orihuela, Spain

    Elisabet López-González

  6. Pathology Department, “Virgen de Las Nieves” University Hospital, Granada, Spain

    Javier Luis López-Hidalgo

Authors
  1. Eduardo Redondo-Cerezo
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  2. Clara Heredia-Carrasco
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  3. Carlos Alegría-Motte
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  4. Antonio Caballero-Mateos
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  5. Francisco Vadillo-Calles
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  6. Eva Julissa Ortega-Suazo
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  7. Virgilio Martos-Ruiz
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  8. Jose Luis Ariza-Fernández
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  9. Elisabet López-González
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  10. Juan Gabriel Martínez-Cara
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  11. Francisco Valverde-Lopez
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  12. Mercedes López de Hierro
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  13. Damián Sánchez-Capilla
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  14. Javier Luis López-Hidalgo
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  15. Rita Jimenez-Rosales
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Contributions

RC and HC designed the study, all of the authors performed the procedures and collected data. LH performed a centralized quality control of the biopsy samples RC performed the statistical analysis and wrote the paper. All the authors made comments to the final draft and approved the final version. Full study protocol can be requested from the corresponding author.

Corresponding author

Correspondence to Eduardo Redondo-Cerezo.

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Disclosures

Dr. Eduardo Redondo-Cerezo, Dr. Clara Heredia-Carrasco, Dr. Carlos Alegría-Motte, Dr. Antonio Caballero-Mateos, Dr. Francisco Vadillo-Calles, Dr. Eva Julissa Ortega-Suazo, Dr. Virgilio Martos-Ruiz, Dr. Jose Luis Ariza-Fernández, Dr. Elisabet López-González, Dr. Juan Gabriel Martínez-Cara, Dr. Francisco Valverde-Lopez, Dr. Mercedes López de Hierro, Dr. Damián Sánchez-Capilla, Dr. Javier Luis López-Hidalgo, and Dr. Rita Jimenez-Rosales have no conflict of interest or financial ties to disclose.

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Redondo-Cerezo, E., Heredia-Carrasco, C., Alegría-Motte, C. et al. Accuracy in optical diagnosis for polyps between 5 and 15 mm and its implications on surveillance. A prospective, multicenter study. (POPS study). Surg Endosc 36, 5356–5365 (2022). https://doi.org/10.1007/s00464-021-08917-w

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