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High-resolution microendoscopy effectively classified colonic polyps
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High-resolution microendoscopy was deemed a highly accurate modality when combined with white-light endoscopy in differentiating neoplastic and non-neoplastic colonic polyps in vivo in a recent prospective study.
The study, held between September 2010 and April 2013 at a tertiary care center, included 94 patients (median age, 59 years; 55.3% women) with 171 colorectal polyps detected by white-light endoscopy (WLE). Seventy-seven polyps were determined to be neoplastic, of which 57 were tubular adenomas.
Because WLE cannot distinguish between neoplastic and non-neoplastic polyps in vivo, polyp removal for biopsy is necessary, researchers said. They determined, however, that high-resolution microendoscopy (HRME) provided a higher-resolution and a lower-cost alternative compared with WLE.
All polyps were analyzed with HRME and WLE using five criteria: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. When determining neoplastic colonic polyps, HRME outperformed WLE for specificity (94.7% vs. 39.2%; P<.0001); PPV (86.9% vs. 55%; P<.0001) and overall accuracy (94.1% vs. 64.8%; P<.0001).
In looking at small (less than 10 mm) and diminutive (less than 5 mm) colorectal polyps, HRME continued to produce better accuracy (94.6% vs. 64.1% and 95.1% vs. 61.7%, respectively), specificity (97.7% vs. 39.6% and 97.6% vs. 41.4%) and PPV (91.5% vs. 54.8% and 92.6% vs. 52.6) than WLE.
“A combination of standard [WLE] for polyp detection and HRME for polyp classification has the potential to truly allow the endoscopist to selectively determine which lesions can be left in situ, which lesions can simply be discarded and which lesions need formal histopathologic analysis,” the researchers concluded. “High accuracy of HRME, specificity, and NPV [91.3% vs. 92.4%, all polyps] for neoplastic polyps compared not only to high definition WLE but also to [other] advanced modalities making it a very attractive complementary tool.”
Disclosure: Researcher Rebecca Richards-Kortum, PhD, serves as an unpaid scientific adviser, hold patents related to optical diagnostic technologies that have been licensed to and holds minority ownership in Remicalm LLC.
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