Incremental benefit of dye-based chromoendoscopy to predict the risk of submucosal invasive cancer in large nonpedunculated colorectal polyps - 15/02/22
Abstract |
Background and Aims |
Detailed lesion assessment of large nonpedunculated colorectal polyps (LNPCPs; ≥20 mm) can help predict the risk of submucosal invasive cancer (SMIC). Traditionally this has required the use of dye-based chromoendoscopy (DBC). We sought to assess the accuracy and incremental benefit of DBC in addition to high-definition white-light imaging (HDWLI) and virtual chromoendoscopy (VCE) for the prediction of SMIC within LNPCPs.
Methods |
A prospective observational study of consecutive LNPCPs at a single tertiary referral center was performed. Before resection all lesions were assessed for the presence of a demarcated area (DA), defined as an area of disordered pit or microvascular pattern, by 2 trained endoscopists before and after DBC. Diagnostic performance characteristics were calculated with histology as the reference criterion standard, and overall agreement was calculated using the κ statistic.
Results |
Over 39 months to March 2021, 400 consecutive LNPCPs (median lesion size, 35 mm; interquartile range, 25-45) were analyzed. The overall rate of SMIC was 6.5%. Presence of a DA had an accuracy of 91% (95% confidence interval, 87.7-93.5) for SMIC, independent of the use of DBC. The rate of interobserver agreement for presence of a DA using HDWLI + VCE was very high (κ = .96) with no benefit gained by the addition of DBC.
Conclusions |
The use of HDWLI and VCE is likely to be adequate for lesion assessment for the prediction of SMIC among LNPCPs. Further, the absence of a DA is strongly predictive for the absence of SMIC, independent to the use of DBC. (Clinical trial registration number: NCT03506321.)
Le texte complet de cet article est disponible en PDF.Abbreviations : CI, DA, DBC, d-SMIC, ESD, HDWLI, IQR, LNPCP, NPV, PPV, SMIC, VCE
Plan
| DISCLOSURE: The following author received research support for this study from the University of British Columbia Clinician Investigator Program: N. Shahidi. In addition, the following authors disclosed financial relationships: N. Shahidi: Honorarium from and speaker for Pharmascience and Boston Scientific. M. J. Bourke: Research support from Olympus, Cook Medical, andBoston Scientific. All other authors disclosed no financial relationships. Research support for this study was provided by the Cancer Institute of New South Wales for a research nurse and data manager to assist with the administration of the study. |
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| DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure ethnic or other types of diversity in the recruitment of human subjects. We worked to ensure that the language of the study questionnaires reflected inclusion. One or more of the authors of this article self-identifies as a member of the LGBTQ+ community. The author list of this article includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. |
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| If you would like to chat with an author of this article, you may contact Dr Bourke at micheal@citywestgastro.com.au. |
Vol 95 - N° 3
P. 527 - mars 2022 Retour au numéro
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