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Gut. 2019 Feb;68(2):271-279. doi: 10.1136/gutjnl-2017-314723. Epub 2018 Jan 3.

Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study).

Author information

1
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
2
Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
3
Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.
4
Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
5
Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands.
6
Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands.
7
Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands.
8
Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands.
9
Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
10
Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
11
Julius Center for Health Sciences and Primary Care, University Medical Center, University Utrecht, Utrecht, The Netherlands.

Abstract

OBJECTIVE:

This study evaluated the preresection accuracy of optical diagnosis of T1 colorectal cancer (CRC) in large non-pedunculated colorectal polyps (LNPCPs).

DESIGN:

In this multicentre prospective study, endoscopists predicted the histology during colonoscopy in consecutive patients with LNPCPs using a standardised procedure for optical assessment. The presence of morphological features assessed with white light, and vascular and surface pattern with narrow-band imaging (NBI) were recorded, together with the optical diagnosis, the confidence level of prediction and the recommended treatment. A risk score chart was developed and validated using a multivariable mixed effects binary logistic least absolute shrinkage and selection (LASSO) model.

RESULTS:

Among 343 LNPCPs, 47 cancers were found (36 T1 CRCs and 11 ≥T2 CRCs), of which 11 T1 CRCs were superficial invasive T1 CRCs (23.4% of all malignant polyps). Sensitivity and specificity for optical diagnosis of T1 CRC were 78.7% (95% CI 64.3 to 89.3) and 94.2% (95% CI 90.9 to 96.6), and 63.3% (95% CI 43.9 to 80.1) and 99.0% (95% CI 97.1 to 100.0) for optical diagnosis of endoscopically unresectable lesions (ie, ≥T1 CRC with deep invasion), respectively. A LASSO-derived model using white light and NBI features discriminated T1 CRCs from non-invasive polyps with a cross-validation area under the curve (AUC) of 0.85 (95% CI 0.80 to 0.90). This model was validated in a temporal validation set of 100 LNPCPs (AUC of 0.81; 95% CI 0.66 to 0.96).

CONCLUSION:

Our study provides insights in the preresection accuracy of optical diagnosis of T1 CRC. Sensitivity is still limited, so further studies will show how the risk score chart could be improved and finally used for clinical decision making with regard to the type of endoresection to be used and whether to proceed to surgery instead of endoscopy.

TRIAL REGISTRATION NUMBER:

NTR5561.

KEYWORDS:

colonoscopy; colorectal adenomas; colorectal cancer; colorectal carcinoma

PMID:
29298873
DOI:
10.1136/gutjnl-2017-314723
[Indexed for MEDLINE]

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