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Optical diagnosis feasible for assessing histopathology in polyps <10 mm
Optical diagnosis using high-definition white light and nonmagnified narrow band imaging was accurate for diagnosing polyps sized less than 10 mm and may also be cost-saving.
The findings of this prospective study demonstrated that assessment of small polyps and planning of surveillance using optical diagnosis resulted in the same recommended surveillance interval as indicated by pathological assessment in most cases, according to an accompanying editorial by Douglas K. Rex, MD, professor of medicine at Indiana University School of Medicine in Indianapolis.
Researchers examined data from patients with a positive fecal occult blood test or previous adenomas who were under surveillance from June 2008 to June 2009. Two expert colonoscopists, one trainee and one specialist nurse performed the procedures.
In 130 patients, 363 polyps sized less than 10 mm were resected. There were 278 polyps that had both optical and histopathological diagnosis. Eighty were non-neoplastic lesions and 198 were adenomas.
When using white light alone or white light with narrow band imaging (NBI, Olympus) and chromoendoscopy, optical diagnosis correctly diagnosed 186 adenomas with sensitivity of 94% (95% CI, 0.90-0.97). Diagnosis was also correct for 55 of 62 hyperplastic polyps with a specificity of 89% (95% CI, 0.78-0.95). Overall accuracy was 93% (95% CI, 0.89-0.96).
Surveillance intervals using histopathology and optical diagnosis were the same in 80 of 82 patients (98%), according to the researchers. When using optical diagnosis, surveillance intervals would have been identical in 78 of 82 patients (95%) using U.S. guidelines and in 80 of 82 (98%) patients using British Society for Gastroenterology guidelines. Optical diagnosis would have resulted in an overall saving of 77% for the 130 patients.
“The resect and discard approach is poised to become a vast improvement in the cost-effectiveness of colonoscopy,” Rex wrote.
Ignjatovic A. Lancet Oncol. 2009;doi:10.1016/S1470-2045(09)70329-8.
