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Cited by 87Colorectal Cancer Screening and DetectionColorectal Cancer Surgical TreatmentsGenetic factors in colorectal cancer

Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy

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Patel, Swati G., Schoenfeld, Philip, Kim, Hyungjin Myra, Ward, Emily K., Bansal, Ajay, Kim, Yeonil, Hosford, Lindsay, Myers, Aimee +7 more·2016·Gastroenterology
DOI 10.1053/j.gastro.2015.10.042PMC PMC4940991
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Abstract

Background & aims Narrow-band imaging (NBI) allows real-time histologic classification of colorectal polyps. We investigated whether endoscopists without prior training in NBI can achieve the following thresholds recommended by the American Society for Gastrointestinal Endoscopy: for diminutive colorectal polyps characterized with high confidence, a ≥90% negative predictive value for adenomas in the rectosigmoid and a ≥90% agreement in surveillance intervals. Methods Twenty-six endoscopists from 2 tertiary care centers underwent standardized training in NBI interpretation. Endoscopists made real-time predictions of diminutive colorectal polyp histology and surveillance interval predictions based on NBI. Their performance was evaluated by comparing predicted with actual findings from histologic analysis. Multilevel logistic regression was used to assess predictors of performance. Cumulative summation analysis was used to characterize learning curves. Results The endoscopists performed 1451 colonoscopies and made 3012 diminutive polyp predictions (74.3% high confidence) using NBI. They made 898 immediate post-procedure surveillance interval predictions. An additional 505 surveillance intervals were determined with histology input. The overall negative predictive value for high-confidence characterizations in the rectosigmoid was 94.7% (95% confidence interval: 92.6%-96.8%) and the surveillance interval agreement was 91.2% (95% confidence interval: 89.7%-92.7%). Overall, 97.0% of surveillance interval predictions would have brought patients back on time or early. High-confidence characterization was the strongest predictor of accuracy (odds ratio = 3.42; 95% confidence interval: 2.72-4.29; P < .001). Performance improved over time, however, according to cumulative summation analysis, only 7 participants (26.9%) identified adenomas with sufficient sensitivity such that further auditing is not required. Conclusions With standardized training, gastroenterologists without prior expertise in NBI were able to meet the negative predictive value and surveillance interval thresholds set forth by the American Society for Gastrointestinal Endoscopy. The majority of disagreement in surveillance interval brought patients back early. Performance improves with time, but most endoscopists will require ongoing auditing of performance. ClinicalTrials.gov ID NCT02441998.

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  • The limited clinical uptake of diagnose-and-leave and resect-and-discard strategies is due to their suboptimal accuracy.

    “However, the limited clinical uptake of these strategies is due to their suboptimal accuracy.3-6”

    From Structured Integration of an Artificial Intelligence-Based System for the Optical Diagnosis of Colorectal Polyps (2026) · cites this paper as [5]

    The Discussion reports that studies involving less-experienced endoscopists have not consistently met accuracy benchmarks, supporting performance as one obstacle. But it also identifies lack of incentives, auditing resources, and quality monitoring as barriers to widespread implementation; it does not establish that limited clinical uptake of both strategies is due to suboptimal accuracy alone. Page numbers are unavailable in our copy. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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Authors
Patel, S. G., Schoenfeld, P., Kim, H. M., Ward, E. K., Bansal, A., Kim, Y., Hosford, L., Myers, A., Foster, S., Craft, J., Shopinski, S., Wilson, R. H., Ahnen, D. J., Rastogi, A., & Wani, S.
Affiliations
  • University of Colorado Anschutz (US)
  • University of Michigan (US)
  • University of Kansas Medical Center (US)
  • Northwestern University (US)
Corresponding author
Patel, Swati G.
ORCID
Venue
Gastroenterology
Publisher
Elsevier BV
Published
2016-02
Volume
150
Issue
2
Pages
406-418
ISSN
0016-5085 (ISSN-L)
DOI
10.1053/j.gastro.2015.10.042
PMC
PMC4940991
OpenAlex
W2148401964
Cited by
87
References
1
Citations by year
2026: 1 · 2025: 2 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 6 · 2020: 5 · 2019: 18 · 2018: 17 · 2017: 15 · 2016: 7 · 2014: 1
FWCI
5.68
Type
journal article
Language
en
Open access
Licence
Locations
  • Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (K24DK084208)
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Genetic factors in colorectal cancer
Keywords
diminutive colorectal polyps, resect and discard strategy, adenoma detection, negative predictive value, endoscopist training, learning curve, colorectal cancer prevention
MeSH terms
Formative Feedback, Clinical Competence, Colonic Polyps, Colonoscopy, Female, Humans, Male, Predictive Value of Tests, Prospective Studies, Task Performance and Analysis, United States, Colorectal Neoplasms, Reproducibility of Results, Multivariate Analysis, Logistic Models, Odds Ratio, Adenomatous Polyps, Learning Curve, Narrow Band Imaging, Tertiary Care Centers

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