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ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps
Open accessAbstract
In vivo real-time assessment of the histology of diminutive (≤5 mm) colorectal polyps detected at colonoscopy can be achieved by means of an "optical biopsy" by using currently available endoscopic technologies. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met. We conducted direct meta-analyses calculating the pooled negative predictive value (NPV) for narrow-band imaging (NBI), i-SCAN, and Fujinon Intelligent Color Enhancement (FICE)-assisted optical biopsy for predicting adenomatous polyp histology of small/diminutive colorectal polyps. We also calculated the pooled percentage agreement with histopathology when assigning postpolypectomy surveillance intervals based on combining real-time optical biopsy of colorectal polyps 5 mm or smaller with histopathologic assessment of polyps larger than 5 mm. Random-effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I(2) statistics. Our meta-analyses indicate that optical biopsy with NBI, exceeds the NPV threshold for adenomatous polyp histology, supporting a "diagnose-and-leave" strategy for diminutive predicted nonneoplastic polyps in the rectosigmoid colon. The pooled NPV of NBI for adenomatous polyp histology by using the random-effects model was 91% (95% confidence interval [CI], 88-94). This finding was associated with a high degree of heterogeneity (I(2) = 89%). Subgroup analysis indicated that the pooled NPV was greater than 90% for academic medical centers (91.8%; 95% CI, 89-94), for experts (93%; 95% CI, 91-96), and when the optical biopsy assessment was made with high confidence (93%; 95% CI, 90-96). Our meta-analyses also indicate that the agreement in assignment of postpolypectomy surveillance intervals based on optical biopsy with NBI of diminutive colorectal polyps is 90% or greater in academic settings (91%; 95% CI, 86-95), with experienced endoscopists (92%; 95% CI, 88-96) and when optical biopsy assessments are made with high confidence (91%; 95% CI, 88-95). Our systematic review and meta-analysis confirms that the thresholds established by the ASGE PIVI for real-time endoscopic assessment of the histology of diminutive polyps have been met, at least with NBI optical biopsy, with endoscopists who are expert in using this advanced imaging technology and when assessments are made with high confidence.
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“Previous studies on cadx systems for colonoscopy focused on assessing the performances of ai against the accuracy of physicians19,20,27–30, or against the criteria established by gastroenterology societies for implementing the technology in a clinical setting31–34.”
From Experimental evidence of effective human–AI collaboration in medical decision-making (2022) · cites this paper as [31]
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“Computer-aided diagnosis (CADx) systems based on artificial intelligence (AI) can help endoscopists in the optical diagnosis of colorectal polyps by predicting the histopathology.”
From Appropriate trust in artificial intelligence for the optical diagnosis of colorectal polyps: the role of human/artificial intelligence interaction (2024) · cites this paper as [2]
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“The stand-alone performance of CADx systems and comparisons of CADx performances with thresholds for clinical implementation have been evaluated and show promising results.[1][2][3][4][5][6][7]”
From Appropriate trust in artificial intelligence for the optical diagnosis of colorectal polyps: the role of human/artificial intelligence interaction (2024) · cites this paper as [2]
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Cites
Prevention of Colorectal Cancer by Colonoscopic Polypectomy
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Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo
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Rex, D. K., Kahi, C., O'Brien, M., Levin, T. R., Pohl, H., Rastogi, A., Burgart, L., Imperiale, T., Ladabaum, U., Cohen, J., et al. (2011) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2011.01.023 · Cited by 629
Self-citationHewett, D. G., Kaltenbach, T. R., Sano, Y., Tanaka, S., Saunders, B. P., Ponchon, T., Soetikno, R. M., & Rex, D. K. (2012) · Gastroenterology · doi:10.1053/j.gastro.2012.05.006 · Cited by 589
Self-citationIgnjatovic, A., East, J. E., Suzuki, N., Vance, M., Guenther, T., & Saunders, B. P. (2009) · The Lancet Oncology · doi:10.1016/s1470-2045(09)70329-8 · Cited by 366
A Resect and Discard Strategy Would Improve Cost-Effectiveness of Colorectal Cancer Screening
Hassan, C., Pickhardt, P. J., & Rex, D. K. (2010) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2010.05.018 · Cited by 294
Self-citationSano, Y., Ikematsu, H., Fu, K. I., Emura, F., Katagiri, A., Horimatsu, T., Kaneko, K., Soetikno, R. M., & Yoshida, S. (2008) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2008.04.066 · Cited by 287
Narrow-Band Imaging Without Optical Magnification for Histologic Analysis of Colorectal Polyps
Rex, D. K. (2008) · Gastroenterology · doi:10.1053/j.gastro.2008.12.009 · Cited by 257
Self-citationLadabaum, U., Fioritto, A., Mitani, A., Desai, M., Kim, J. P., Rex, D. K., Imperiale, T., & Gunaratnam, N. (2013) · Gastroenterology · doi:10.1053/j.gastro.2012.09.054 · Cited by 224
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Ferlitsch, M., Moss, A., Hassan, C., Bhandari, P., Dumonceau, J., Paspatis, G. A., Jover, R., Langner, C., Bronzwaer, M. E. S., Nalankilli, K., et al. (2017) · Endoscopy · doi:10.1055/s-0043-102569 · Cited by 1,107
Byrne, M. F., Chapados, N., Soudan, F., Oertel, C., Linares Pérez, M., Kelly, R., Iqbal, N., Chandelier, F., & Rex, D. K. (2019) · Gut · doi:10.1136/gutjnl-2017-314547 · Cited by 635
Self-citationMori, Y., Kudo, S.-E., Misawa, M., Saito, Y., Ikematsu, H., Hotta, K., Ohtsuka, K., Urushibara, F., Kataoka, S., Ogawa, Y., et al. (2018) · Annals of Internal Medicine · doi:10.7326/m18-0249 · Cited by 509
Kaminski, M. F., Hassan, C., Bisschops, R., Pohl, J., Pellisé, M., Dekker, E., Ignjatovic-Wilson, A., Hoffman, A. W., Longcroft‐Wheaton, G., Heresbach, D., et al. (2014) · Endoscopy · doi:10.1055/s-0034-1365348 · Cited by 432
Accurate Classification of Diminutive Colorectal Polyps Using Computer-Aided Analysis
Chen, P., Lin, M.-C., Lai, M.-J., Lin, J.-C., Lu, H. H., & Tseng, V. S. M. (2017) · Gastroenterology · doi:10.1053/j.gastro.2017.10.010 · Cited by 396
Metadata
- Authors
- Abu Dayyeh, B. K., Thosani, N., Konda, V., Wallace, M. B., Rex, D. K., Chauhan, S. S., Hwang, J. H., Komanduri, S., Manfredi, M., Maple, J. T., Murad, F. M., Siddiqui, U. D., & Banerjee, S.
- ORCID
- Venue
- Gastrointestinal Endoscopy
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 81
- Issue
- 3
- Pages
- 502.e1-502.e16
- ISSN
- 0016-5107 (ISSN-L)
- OpenAlex
- W2055082612
- Cited by
- 389
- References
- 61
- Citations by year
- 2026: 15 · 2025: 23 · 2024: 30 · 2023: 39 · 2022: 38 · 2021: 42 · 2020: 44 · 2019: 42 · 2018: 35 · 2017: 40 · 2016: 24 · 2015: 16
- FWCI
- 4.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastrointestinal Endoscopy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Pathology and Forensic Medicine › Genetic factors in colorectal cancer
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Keywords
- diminutive colorectal polyps, optical biopsy, narrow-band imaging, i-scan, negative predictive value, rectosigmoid colon, polypectomy, histopathological correlation
- MeSH terms
- Biopsy, Colon, Colonoscopy, Humans, Intestinal Polyps, Predictive Value of Tests, Rectum, United States, Colorectal Neoplasms, Models, Statistical, Practice Guidelines as Topic, Adenomatous Polyps, Narrow Band Imaging
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