NBI International Colorectal Endoscopic–derived high-confidence optical diagnosis of small polyps compared with histology: understanding errors to improve diagnostic accuracy.
Developments in image-enhancing endoscopy and polyp classification systems have led to a number of gastroenterology societies endorsing an optical diagnosis (OD) approach for small polyps at colonoscopy. In this study we performed a root-cause analysis of ODs to determine the most likely causes of O...
| Published in: | Gastrointestinal Endoscopy Vol. 97; no. 1; pp. 78 - 89 |
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| Main Authors: | , , , |
| Format: | research Journal Article |
| Published: |
Elsevier B.V.
Jan2023
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=160757822&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 160757822 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00165107 4A9 jtl: Gastrointestinal Endoscopy issn: 00165107 maglogo: N pubinfo: dt: Jan2023 vid: 97 iid: 1 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 160757822 160757822 160757822 10.1016/j.gie.2022.08.032 160757822 ppf: 78 ppct: 11 formats: tig: atl: NBI International Colorectal Endoscopic–derived high-confidence optical diagnosis of small polyps compared with histology: understanding errors to improve diagnostic accuracy. aug: au: Ahmad, Ahmir Moorghen, Morgan Wilson, Ana Saunders, Brian P. affil: Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK sug: subj: Colorectal Neoplasms Diagnosis Colonic Polyps Diagnosis Endoscopy, Gastrointestinal Methods Histology Diagnostic Errors Prevention and Control Sensitivity and Specificity International Agencies Endoscopy, Gastrointestinal Evaluation Human Gastroenterology Care Organizations Internal Medicine Organizations Image Enhancement Prospective Studies Confidence Descriptive Statistics Colorectal Neoplasms Pathology Colonic Polyps Pathology Photography Documentation Colorectal Neoplasms Classification Colonic Polyps Classification Algorithms ab: Developments in image-enhancing endoscopy and polyp classification systems have led to a number of gastroenterology societies endorsing an optical diagnosis (OD) approach for small polyps at colonoscopy. In this study we performed a root-cause analysis of ODs to determine the most likely causes of OD error. As part of a prospective feasibility study, DISCARD3 (Detect InSpect ChAracterise Resect and Discard 3), evaluating implementation and quality assurance of a "resect and discard" strategy for consecutive small polyps <10 mm, a root-cause analysis of 184 cases of high-confidence OD error was performed. In all cases, histopathology underwent a second blinded review and, where discrepancy persisted, further review with deeper levels. After a root-cause analysis, 133 of 184 true OD errors were identified and classified into 4 types: A (OD, adenoma; histology, serrated), 45/133 (33.8%); B (OD, serrated; histology, adenoma), 55/133 (41.4%); C (OD, adenoma; histology, normal), 19/133 (14.3%); and D (OD, serrated; histology, normal), 14/133 (10.5%). The remaining 51 of 184 errors were because of a pathology error requiring deeper levels (43/184), pathology observer or laboratory error (7/184), or other error (1/184). OD errors can be related to endoscopist-related factors such as poor photodocumentation, failures of current classification systems, and incomplete histology. We identified a subset of serrated polyps frequently misdiagnosed as adenomas ("pseudoadenomas") using the NBI International Colorectal Endoscopic (NICE) classification. An enhanced algorithm for OD is proposed based on the NICE classification including morphologic and adjunct polyp features. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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