Accuracy of in vivo colorectal polyp discrimination by using dual-focus high-definition narrow-band imaging colonoscopy

Michael B. Wallace, Juliana Crook, Susan Coe, Vivian Ussui, Estela Staggs, Cristina Almansa, Mihir K. Patel, Ernest Bouras, John Cangemi, Andrew Keaveny, Michael Picco, Douglas Riegert-Johnson

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background Discriminating neoplastic from non-neoplastic polyps can significantly reduce the cost of colonoscopy. The American Society for Gastrointestinal Endoscopy (ASGE) recently set threshold levels for optical diagnostic accuracy to be acceptable for clinical use.

Objective In this study, we compare a novel colonoscope capable of dual-focus imaging with standard colonoscopy with respect to the ASGE guidelines.

Setting An academic medical center ambulatory surgical center.

Patients and Interventions Patients at average risk were randomized to standard colonoscopy (Olympus CF-H180 and Exera II 180 colonoscopes, Olympus America, Center Valley, Pa) or dual-focus colonoscopy (Olympus CF-HQ190 and Exera III 190 colonoscopes, Olympus America). All polyps were given an optical diagnosis and compared with histology.

Results A total of 600 patients were consented and 522 completed all aspects of the procedure. A total of 927 polyps were analyzed. Optical diagnostic accuracy was 79% (95% confidence interval, 74%-83%) for the 190 and 77% (95% confidence interval, 73%-81%) for the 180 colonoscope. Adenoma detection rates were also similar between the 2 groups (50% for the 190 vs 52% for the 180 colonoscope). For small distal rectosigmoid polyps with a high confidence diagnosis, the negative predictive value for adenoma was 96% (range 89%-99%) for the 180 in the narrow-band imaging (NBI) mode and 97% (range 88%-99%) for the 190 colonoscope in NBI mode. Agreement of surveillance intervals by using optical diagnosis was 94% to 95% for all modalities (180 and 190 colonoscopes, white light imaging, NBI).

Limitations Our study evaluated the accuracy of the 180 and 190 colonoscopes at a center with already-established expertise in endoscopic imaging. Conclusions Both traditional and new dual-focus colonoscopes provide highly accurate optical polyp discrimination. There was no difference between the 2 systems in terms of discrimination or adenoma detection. Both systems are consistent with ASGE guidelines for optical diagnosis of selected colorectal polyps without histological confirmation.

Original languageEnglish (US)
Pages (from-to)1072-1087
Number of pages16
JournalGastrointestinal Endoscopy
Volume80
Issue number6
DOIs
StatePublished - Dec 1 2014

Fingerprint

Narrow Band Imaging
Colonoscopes
Colonoscopy
Polyps
Gastrointestinal Endoscopy
Adenoma
Guidelines
Confidence Intervals
Histology

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Accuracy of in vivo colorectal polyp discrimination by using dual-focus high-definition narrow-band imaging colonoscopy. / Wallace, Michael B.; Crook, Juliana; Coe, Susan; Ussui, Vivian; Staggs, Estela; Almansa, Cristina; Patel, Mihir K.; Bouras, Ernest; Cangemi, John; Keaveny, Andrew; Picco, Michael; Riegert-Johnson, Douglas.

In: Gastrointestinal Endoscopy, Vol. 80, No. 6, 01.12.2014, p. 1072-1087.

Research output: Contribution to journalArticle

Wallace, MB, Crook, J, Coe, S, Ussui, V, Staggs, E, Almansa, C, Patel, MK, Bouras, E, Cangemi, J, Keaveny, A, Picco, M & Riegert-Johnson, D 2014, 'Accuracy of in vivo colorectal polyp discrimination by using dual-focus high-definition narrow-band imaging colonoscopy', Gastrointestinal Endoscopy, vol. 80, no. 6, pp. 1072-1087. https://doi.org/10.1016/j.gie.2014.05.305
Wallace, Michael B. ; Crook, Juliana ; Coe, Susan ; Ussui, Vivian ; Staggs, Estela ; Almansa, Cristina ; Patel, Mihir K. ; Bouras, Ernest ; Cangemi, John ; Keaveny, Andrew ; Picco, Michael ; Riegert-Johnson, Douglas. / Accuracy of in vivo colorectal polyp discrimination by using dual-focus high-definition narrow-band imaging colonoscopy. In: Gastrointestinal Endoscopy. 2014 ; Vol. 80, No. 6. pp. 1072-1087.
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abstract = "Background Discriminating neoplastic from non-neoplastic polyps can significantly reduce the cost of colonoscopy. The American Society for Gastrointestinal Endoscopy (ASGE) recently set threshold levels for optical diagnostic accuracy to be acceptable for clinical use.Objective In this study, we compare a novel colonoscope capable of dual-focus imaging with standard colonoscopy with respect to the ASGE guidelines.Setting An academic medical center ambulatory surgical center.Patients and Interventions Patients at average risk were randomized to standard colonoscopy (Olympus CF-H180 and Exera II 180 colonoscopes, Olympus America, Center Valley, Pa) or dual-focus colonoscopy (Olympus CF-HQ190 and Exera III 190 colonoscopes, Olympus America). All polyps were given an optical diagnosis and compared with histology.Results A total of 600 patients were consented and 522 completed all aspects of the procedure. A total of 927 polyps were analyzed. Optical diagnostic accuracy was 79{\%} (95{\%} confidence interval, 74{\%}-83{\%}) for the 190 and 77{\%} (95{\%} confidence interval, 73{\%}-81{\%}) for the 180 colonoscope. Adenoma detection rates were also similar between the 2 groups (50{\%} for the 190 vs 52{\%} for the 180 colonoscope). For small distal rectosigmoid polyps with a high confidence diagnosis, the negative predictive value for adenoma was 96{\%} (range 89{\%}-99{\%}) for the 180 in the narrow-band imaging (NBI) mode and 97{\%} (range 88{\%}-99{\%}) for the 190 colonoscope in NBI mode. Agreement of surveillance intervals by using optical diagnosis was 94{\%} to 95{\%} for all modalities (180 and 190 colonoscopes, white light imaging, NBI).Limitations Our study evaluated the accuracy of the 180 and 190 colonoscopes at a center with already-established expertise in endoscopic imaging. Conclusions Both traditional and new dual-focus colonoscopes provide highly accurate optical polyp discrimination. There was no difference between the 2 systems in terms of discrimination or adenoma detection. Both systems are consistent with ASGE guidelines for optical diagnosis of selected colorectal polyps without histological confirmation.",
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AU - Wallace, Michael B.

AU - Crook, Juliana

AU - Coe, Susan

AU - Ussui, Vivian

AU - Staggs, Estela

AU - Almansa, Cristina

AU - Patel, Mihir K.

AU - Bouras, Ernest

AU - Cangemi, John

AU - Keaveny, Andrew

AU - Picco, Michael

AU - Riegert-Johnson, Douglas

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N2 - Background Discriminating neoplastic from non-neoplastic polyps can significantly reduce the cost of colonoscopy. The American Society for Gastrointestinal Endoscopy (ASGE) recently set threshold levels for optical diagnostic accuracy to be acceptable for clinical use.Objective In this study, we compare a novel colonoscope capable of dual-focus imaging with standard colonoscopy with respect to the ASGE guidelines.Setting An academic medical center ambulatory surgical center.Patients and Interventions Patients at average risk were randomized to standard colonoscopy (Olympus CF-H180 and Exera II 180 colonoscopes, Olympus America, Center Valley, Pa) or dual-focus colonoscopy (Olympus CF-HQ190 and Exera III 190 colonoscopes, Olympus America). All polyps were given an optical diagnosis and compared with histology.Results A total of 600 patients were consented and 522 completed all aspects of the procedure. A total of 927 polyps were analyzed. Optical diagnostic accuracy was 79% (95% confidence interval, 74%-83%) for the 190 and 77% (95% confidence interval, 73%-81%) for the 180 colonoscope. Adenoma detection rates were also similar between the 2 groups (50% for the 190 vs 52% for the 180 colonoscope). For small distal rectosigmoid polyps with a high confidence diagnosis, the negative predictive value for adenoma was 96% (range 89%-99%) for the 180 in the narrow-band imaging (NBI) mode and 97% (range 88%-99%) for the 190 colonoscope in NBI mode. Agreement of surveillance intervals by using optical diagnosis was 94% to 95% for all modalities (180 and 190 colonoscopes, white light imaging, NBI).Limitations Our study evaluated the accuracy of the 180 and 190 colonoscopes at a center with already-established expertise in endoscopic imaging. Conclusions Both traditional and new dual-focus colonoscopes provide highly accurate optical polyp discrimination. There was no difference between the 2 systems in terms of discrimination or adenoma detection. Both systems are consistent with ASGE guidelines for optical diagnosis of selected colorectal polyps without histological confirmation.

AB - Background Discriminating neoplastic from non-neoplastic polyps can significantly reduce the cost of colonoscopy. The American Society for Gastrointestinal Endoscopy (ASGE) recently set threshold levels for optical diagnostic accuracy to be acceptable for clinical use.Objective In this study, we compare a novel colonoscope capable of dual-focus imaging with standard colonoscopy with respect to the ASGE guidelines.Setting An academic medical center ambulatory surgical center.Patients and Interventions Patients at average risk were randomized to standard colonoscopy (Olympus CF-H180 and Exera II 180 colonoscopes, Olympus America, Center Valley, Pa) or dual-focus colonoscopy (Olympus CF-HQ190 and Exera III 190 colonoscopes, Olympus America). All polyps were given an optical diagnosis and compared with histology.Results A total of 600 patients were consented and 522 completed all aspects of the procedure. A total of 927 polyps were analyzed. Optical diagnostic accuracy was 79% (95% confidence interval, 74%-83%) for the 190 and 77% (95% confidence interval, 73%-81%) for the 180 colonoscope. Adenoma detection rates were also similar between the 2 groups (50% for the 190 vs 52% for the 180 colonoscope). For small distal rectosigmoid polyps with a high confidence diagnosis, the negative predictive value for adenoma was 96% (range 89%-99%) for the 180 in the narrow-band imaging (NBI) mode and 97% (range 88%-99%) for the 190 colonoscope in NBI mode. Agreement of surveillance intervals by using optical diagnosis was 94% to 95% for all modalities (180 and 190 colonoscopes, white light imaging, NBI).Limitations Our study evaluated the accuracy of the 180 and 190 colonoscopes at a center with already-established expertise in endoscopic imaging. Conclusions Both traditional and new dual-focus colonoscopes provide highly accurate optical polyp discrimination. There was no difference between the 2 systems in terms of discrimination or adenoma detection. Both systems are consistent with ASGE guidelines for optical diagnosis of selected colorectal polyps without histological confirmation.

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