Capsule endoscopy vs. colonoscopy vs. histopathology in colorectal cancer screening: matched analyses of polyp size, morphology, and location estimates
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Colon capsule endoscopy (CCE) is considered a potential alternative to optical colonoscopy (OC) for colorectal cancer screening. However, the accuracy of CCE in polyp size and morphology estimation is unknown.
A fully paired study was performed (2015–2016), where 255 participants from the Danish national screening program had CCE, OC, and histopathology (HP) of all detected polyps. We developed a new algorithm to match CCE and OC polyps, based on objective measures of similarity between polyps. We performed paired comparisons of size, morphology and location of CCE, and OC- and HP-matched polyps. We used cross-validation to develop a model able to predict HP polyp size, based on CCE.
CCE overestimated size assessed by HP (by 4.3 mm; 95%CI 3.3–5.2 mm) and OC (by 2.7 mm; 95%CI 1.4–3.9 mm). Polyps were more likely to being assessed as “pedunculated” and less likely to being assessed as “flat” in CCE, compared to OC (p < 0.0001). Our model could predict HP polyp size ≥ 6 mm, solely using CCE-assessed size, location, and morphology as model inputs, with a sensitivity = 0.93 (95%CI 0.66–1.00) and specificity = 0.50 (95%CI 0.32–0.68).
If CCE is to be used as a screening test, it is essential: (1) to translate CCE polyp estimations into histopathologic polyp sizes and (2) to consider that, compared to OC, CCE has a higher tendency to assess polyps as pedunculated and a lower tendency to assess them as flat.
Clinicaltrials.gov No. NCT02303756
KeywordsColorectal cancer Screening Capsule endoscopy Optical colonoscopy Polyp
The study was financially supported by the Danish Cancer Society, the Research Foundation of the Health Care Region of Southern Denmark, Odense University Hospital Research Foundation, and the Research Foundation of University of Southern Denmark. The company Medtronic provided colon capsules. The work was independent of all study sponsors (they had no influence in the study design, collection, analysis, interpretation of the data, or in the writing of the report).
Victoria Blanes-Vidal performed the data analysis, interpreted the data, and drafted the manuscript. Esmaeil S. Nadimi performed the data analysis, interpreted the data, and provided reviews of the text. Maria Magdalena Buijs collected the data, contributed to interpret the data, and provided reviews of the text. Gunnar Baatrup planned and coordinated the study, collected data, contributed to interpret the data, and provided reviews of the text. All authors have read and approved the manuscript.
Compliance with ethical standards
The authors declare that they have no competing interests.
The study was approved by the Local Ethics Committee (S20140141) and registered at clinicaltrials.gov (NCT02303756—first submitted date, ICMJE November 24, 2014; first posted date, ICMJE December 1, 2014; last update posted date, October 11, 2016; start date, ICMJE August 2015; primary completion date, July 2016)
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