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Accuracy and Inter-observer Agreement Among Endoscopists for Visual Identification of Colorectal Polyps Using Endoscopy Images

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An Editorial to this article was published on 05 September 2022

Abstract

Background

It is essential to accurately distinguish small benign hyperplastic colon polyps (HP) from sessile serrated lesions (SSL) or adenomatous polyps (TA) based on endoscopic appearances. Our objective was to determine the accuracy and inter-observer agreements for the endoscopic diagnosis of small polyps.

Methods

High-quality endoscopic images of 30 small HPs, SSLs, and TAs were used randomly to create two-timed PowerPoint slide sets—one with and another one without information on polyp size and location. Seven endoscopists viewed the slides on two separate occasions 90 days apart, identified the polyp type, and graded their confidence level. Overall and polyp-specific accuracies were assessed for the group and individual endoscopists. Chi-square tests and Kappa (κ) statistics were used to compare differences as appropriate.

Results

When polyp size and location were provided, overall accuracy was 67.1% for TAs, 50.0% for SSLs, and 41.4% for HPs; the corresponding accuracies were 60%, 44.3%, and 34.3% when polyp size and location were withheld (p < .001). Inter-observer agreement was moderate for TAs (κ = 0.50) and fair for SSLs (κ = 0.26) and HPs (κ = 0.29); the corresponding inter-observer agreements were 0.44, 0.31, and 0.17 with polyp size and location withheld. Accuracy was not affected by knowledge of polyp size, location, or confidence level. Endoscopists with ≥ 10 years (vs. < 10 years) of colonoscopy experience had marginally higher (56% vs. 40%, p = 0.05) accuracy for SSL diagnosis.

Conclusions

The ability to distinguish between small TAs, SSLs, and HPs on their endoscopic appearance is poor regardless of the endoscopists' knowledge of polyp size and location.

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References

  1. Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–696.

    Article  CAS  Google Scholar 

  2. Kaltenbach T, Anderson JC, Burke CA et al. Endoscopic Removal of Colorectal Lesions: Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2020;115:435–464.

    Article  Google Scholar 

  3. Wang FW, Hsu PI, Chuang HY et al. Prevalence and risk factors of asymptomatic colorectal polyps in Taiwan. Gastroenterol Res Pract. 2014;2014:985205.

    Article  Google Scholar 

  4. Spring KJ, Zhao ZZ, Karamatic R et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology. 2006;131:1400–1407.

    Article  CAS  Google Scholar 

  5. Crockett SD, Nagtegaal ID. Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia. Gastroenterology. 2019;157:949–966.

    Article  Google Scholar 

  6. Szylberg Ł, Janiczek M, Popiel A, Marszałek A. Large Bowel Genetic Background and Inflammatory Processes in Carcinogenesis-Systematic Review. Adv Clin Exp Med. 2015;24:555–563.

    Article  Google Scholar 

  7. Myers DJ, Arora K. Villous Adenoma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 10, 2021.

  8. Hamilton SR, Aaltonen LA. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. 3rd ed. IARC Press; 2000.

  9. Rex DK, Ahnen DJ, Baron JA et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol. 2012;107:1315–1330.

    Article  Google Scholar 

  10. McCarthy AJ, O’Reilly SM, Shanley J et al. Colorectal Serrated Neoplasia: An Institutional 12-Year Review Highlights the Impact of a Screening Programme. Gastroenterol Res Pract. 2019;2019:1592306.

    Article  CAS  Google Scholar 

  11. Burgess NG, Tutticci NJ, Pellise M, Bourke MJ. Sessile serrated adenomas/polyps with cytologic dysplasia: a triple threat for interval cancer. Gastrointest Endosc. 2014;80:307–310.

    Article  Google Scholar 

  12. Kim SY, Kim TI. Serrated neoplasia pathway as an alternative route of colorectal cancer carcinogenesis. Intest Res. 2018;16:358–365.

    Article  Google Scholar 

  13. Tadepalli US, Feihel D, Miller KM et al. A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video). Gastrointest Endosc. 2011;74:1360–1368.

    Article  Google Scholar 

  14. Ahadi M, Sokolova A, Brown I, Chou A, Gill AJ. The 2019 World Health Organization Classification of appendiceal, colorectal and anal canal tumours: an update and critical assessment. Pathology. 2021;53:454–461.

    Article  Google Scholar 

  15. Yamada M, Sakamoto T, Otake Y et al. Investigating endoscopic features of sessile serrated adenomas/polyps by using narrow-band imaging with optical magnification. Gastrointest Endosc. 2015;82:108–117.

    Article  Google Scholar 

  16. Vleugels JLA, Hazewinkel Y, Fockens P, Dekker E. Natural history of diminutive and small colorectal polyps: a systematic literature review. Gastrointest Endosc. 2017;85:1169–1176.

    Article  Google Scholar 

  17. Rex DK, Kahi C, O’Brien M et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc. 2011;73:419–422.

    Article  Google Scholar 

  18. Yang HJ, Lee JI, Park SK et al. External Validation of the Endoscopic Features of Sessile Serrated Adenomas in Expert and Trainee Colonoscopists. Clin Endosc. 2017;50:279–286.

    Article  Google Scholar 

  19. Olympus Medical Systems Group. (2021, March 15). FDA Clears Olympus' Narrow Band Imaging® (NBI) for Use in Assessing Colonic Lesions. CISION: PR Newswire. https://www.prnewswire.com/news-releases/fda-clears-olympus-narrow-band-imaging-nbi-for-use-in-assessing-colonic-lesions-301247362.html

  20. Kaminski M, Hassan C, Bisschops R et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2014;46:435–449.

    Article  Google Scholar 

  21. Bhat Y, Abu Dayyeh B, Chauhan S et al. ASGE Technological Status Evaluation Report: High-definition and high-magnification endoscopes. Gastrointestinal Endoscopy. 2014;80:919–927.

    Article  Google Scholar 

  22. Gupta N, Kaltenbach T, Sato T et al. Diagnosis time determines the accuracy of optical diagnosis of diminutive polyp histology. Gastrointest Endosc. 2013;77:AB553–AB554.

    Article  Google Scholar 

  23. Anderson JC, Lisovsky M, Greene MA et al. Factors Associated With Classification of Hyperplastic Polyps as Sessile Serrated Adenomas/Polyps on Morphologic Review. J Clin Gastroenterol. 2018;52:524–529.

    Article  Google Scholar 

  24. Gill P, Rafferty H, Munday D et al. Proximal colon cancer and serrated adenomas - hunting the missing 10%. Clin Med (Lond). 2013;13:557–561.

    Article  Google Scholar 

  25. Singh H, Bay D, Ip S et al. Pathological reassessment of hyperplastic colon polyps in a city-wide pathology practice: implications for polyp surveillance recommendations. Gastrointest Endosc. 2012;76:1003–1008.

    Article  Google Scholar 

  26. Farris AB, Misdraji J, Srivastava A et al. Sessile serrated adenoma: challenging discrimination from other serrated colonic polyps. Am J Surg Pathol. 2008;32:30–35.

    Article  Google Scholar 

  27. Vennelaganti S, Cuatrecasas M, Vennalaganti P et al. Interobserver Agreement Among Pathologists in the Differentiation of Sessile Serrated From Hyperplastic Polyps. Gastroenterology. 2021;160:452–454.

    Article  Google Scholar 

  28. Turner JK, Williams GT, Morgan M, Wright M, Dolwani S. Interobserver agreement in the reporting of colorectal polyp pathology among bowel cancer screening pathologists in Wales. Histopathology. 2013;62:916–924.

    Article  Google Scholar 

  29. Hazewinkel Y, López-Cerón M, East JE et al. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc. 2013;77:916–924.

    Article  Google Scholar 

  30. Pereyra L, Gómez EJ, González R et al. Finding sessile serrated adenomas: is it possible to identify them during conventional colonoscopy? Dig Dis Sci. 2014;59:3021–3026.

    Article  Google Scholar 

  31. Ijspeert JE, Bastiaansen BA, van Leerdam ME et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. J. Gut. 2016;65:963–970.

    Article  Google Scholar 

  32. Maratt JK, Dickens J, Schoenfeld PS et al. Factors Associated with Surveillance Adenoma and Sessile Serrated Polyp Detection Rates. Dig Dis Sci. 2017;62:3579–3585.

    Article  Google Scholar 

  33. Telford J, Gondara L, Pi S, Gentile L, Enns R. Higher adenoma detection, sessile serrated lesion detection and proximal sessile serrated lesion detection are associated with physician specialty and performance on Direct Observation of Procedural Skills. BMJ Open Gastroenterol. 2021;8:e000677.

    Article  Google Scholar 

  34. Sarvepalli S, Garber A, Rothberg MB et al. Association of Adenoma and Proximal Sessile Serrated Polyp Detection Rate, s With Endoscopist. JAMA Surg. 2019;154:627–635.

    Article  Google Scholar 

  35. Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology. 2009;136:1174–1181.

    Article  Google Scholar 

  36. Uraoka T, Higashi R, Horii J et al. Prospective evaluation of endoscopic criteria characteristic of sessile serrated adenomas/polyps. J Gastroenterol. 2015;50:555–563.

    Article  Google Scholar 

  37. Vleugels JLA, Dijkgraaf MGW, Hazewinkel Y et al. Effects of Training and Feedback on Accuracy of Predicting Rectosigmoid Neoplastic Lesions and Selection of Surveillance Intervals by Endoscopists Performing Optical Diagnosis of Diminutive Polyps. Gastroenterology. 2018;154:1682–1693.

    Article  Google Scholar 

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Authors and Affiliations

  1. Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD, USA

    Thi Khuc, Amol Agarwal, Feng Li, Sergey Kantsevoy, Bryan Curtin, Matilda Hagan, Mary Harris, Anurag Maheshwari, Amit Raina, Elinor Zhou & Paul Thuluvath

  2. Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA

    Thi Khuc, Amol Agarwal, Matilda Hagan, Anurag Maheshwari & Paul Thuluvath

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  1. Thi Khuc
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  2. Amol Agarwal
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Contributions

Planning the study: TK, AA, PT. Conducting the study: TK, AA. Collecting data: TK, AA. Interpreting data: TK, AA, FL, PT. Drafting the manuscript: TK. Revising the manuscript: TK, AA, SK, BC, MH, MH, AM, AR, EZ, PT. All authors read and approved the final manuscript.

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Correspondence to Thi Khuc.

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Khuc, T., Agarwal, A., Li, F. et al. Accuracy and Inter-observer Agreement Among Endoscopists for Visual Identification of Colorectal Polyps Using Endoscopy Images. Dig Dis Sci 68, 616–622 (2023). https://doi.org/10.1007/s10620-022-07643-0

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