Colorectal surveillance interval assignment based on in vivo prediction of polyp histology: Impact of endoscopic quality improvement program

Susan G. Coe, Colleen Thomas, Juliana Crook, Vivian Ussui, Nancy Diehl, Michael B. Wallace

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Validated training methods are needed before in vivo optical diagnosis can be used to guide colorectal cancer surveillance interval assignments. Objectives: To assess the impact of endoscopist training on accuracy of surveillance intervals based on in vivo optical diagnosis. Design: Prospective, randomized study. Setting: Tertiary referral center. Patients: A total of 1231 patients with colorectal polyps (before training, n = 577; after training, n = 654). Interventions: Endoscopists were randomized to either participate or not participate in two 1-hour training sessions. Endoscopists' in vivo pathology predictions were recorded for all resected polyps. The accuracy of in vivo prediction-guided surveillance intervals were compared with pathology-guided intervals as the criterion standard. Surveillance interval accuracy before and after training were analyzed. Main Outcome Measurements: Surveillance interval accuracy based on in vivo polyp predictions with pathology-guided intervals as criterion standard before and after a training intervention. Results: Optically predicted surveillance intervals for the trained group of endoscopists had an overall accuracy of 84% (242/287) before training and 82% (261/317) after training. There was little evidence to suggest that training had a meaningful impact on the accuracy of optically predicted surveillance intervals (odds ratio 1.20; 95% CI, 0.76-1.89, P = .44). Limitations: Limitations include small sample size, lack of endoscopist prediction confidence levels, and optional use of narrow-band imaging. Conclusions: Surveillance interval accuracy did not meet published thresholds (>90%) to use in vivo optical diagnosis without pathologic confirmation. Larger studies, focused specifically on the impact of training, are needed to validate methods to improve polyp diagnosis and surveillance predication accuracy.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume76
Issue number1
DOIs
StatePublished - Jul 2012

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Quality Improvement
Polyps
Histology
Pathology
Narrow Band Imaging
Tertiary Care Centers
Sample Size
Colorectal Neoplasms
Odds Ratio
Prospective Studies

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Colorectal surveillance interval assignment based on in vivo prediction of polyp histology : Impact of endoscopic quality improvement program. / Coe, Susan G.; Thomas, Colleen; Crook, Juliana; Ussui, Vivian; Diehl, Nancy; Wallace, Michael B.

In: Gastrointestinal Endoscopy, Vol. 76, No. 1, 07.2012.

Research output: Contribution to journalArticle

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abstract = "Background: Validated training methods are needed before in vivo optical diagnosis can be used to guide colorectal cancer surveillance interval assignments. Objectives: To assess the impact of endoscopist training on accuracy of surveillance intervals based on in vivo optical diagnosis. Design: Prospective, randomized study. Setting: Tertiary referral center. Patients: A total of 1231 patients with colorectal polyps (before training, n = 577; after training, n = 654). Interventions: Endoscopists were randomized to either participate or not participate in two 1-hour training sessions. Endoscopists' in vivo pathology predictions were recorded for all resected polyps. The accuracy of in vivo prediction-guided surveillance intervals were compared with pathology-guided intervals as the criterion standard. Surveillance interval accuracy before and after training were analyzed. Main Outcome Measurements: Surveillance interval accuracy based on in vivo polyp predictions with pathology-guided intervals as criterion standard before and after a training intervention. Results: Optically predicted surveillance intervals for the trained group of endoscopists had an overall accuracy of 84{\%} (242/287) before training and 82{\%} (261/317) after training. There was little evidence to suggest that training had a meaningful impact on the accuracy of optically predicted surveillance intervals (odds ratio 1.20; 95{\%} CI, 0.76-1.89, P = .44). Limitations: Limitations include small sample size, lack of endoscopist prediction confidence levels, and optional use of narrow-band imaging. Conclusions: Surveillance interval accuracy did not meet published thresholds (>90{\%}) to use in vivo optical diagnosis without pathologic confirmation. Larger studies, focused specifically on the impact of training, are needed to validate methods to improve polyp diagnosis and surveillance predication accuracy.",
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N2 - Background: Validated training methods are needed before in vivo optical diagnosis can be used to guide colorectal cancer surveillance interval assignments. Objectives: To assess the impact of endoscopist training on accuracy of surveillance intervals based on in vivo optical diagnosis. Design: Prospective, randomized study. Setting: Tertiary referral center. Patients: A total of 1231 patients with colorectal polyps (before training, n = 577; after training, n = 654). Interventions: Endoscopists were randomized to either participate or not participate in two 1-hour training sessions. Endoscopists' in vivo pathology predictions were recorded for all resected polyps. The accuracy of in vivo prediction-guided surveillance intervals were compared with pathology-guided intervals as the criterion standard. Surveillance interval accuracy before and after training were analyzed. Main Outcome Measurements: Surveillance interval accuracy based on in vivo polyp predictions with pathology-guided intervals as criterion standard before and after a training intervention. Results: Optically predicted surveillance intervals for the trained group of endoscopists had an overall accuracy of 84% (242/287) before training and 82% (261/317) after training. There was little evidence to suggest that training had a meaningful impact on the accuracy of optically predicted surveillance intervals (odds ratio 1.20; 95% CI, 0.76-1.89, P = .44). Limitations: Limitations include small sample size, lack of endoscopist prediction confidence levels, and optional use of narrow-band imaging. Conclusions: Surveillance interval accuracy did not meet published thresholds (>90%) to use in vivo optical diagnosis without pathologic confirmation. Larger studies, focused specifically on the impact of training, are needed to validate methods to improve polyp diagnosis and surveillance predication accuracy.

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