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1
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Djinbachian R, Rex DK, von Renteln D. Optical Polyp Diagnosis in the Era or Artificial Intelligence. Am J Gastroenterol 2024:00000434-990000000-01436. [PMID: 39526672 DOI: 10.14309/ajg.0000000000003195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Accepted: 11/05/2024] [Indexed: 11/16/2024]
Abstract
The development of new image enhancement modalities and improved endoscopic imaging quality has not led to increased adoption of resect-and-discard in routine practice. Studies have shown that endoscopists have the capacity to achieve quality thresholds to perform optical diagnosis; however, this has not led to acceptance of optical diagnosis as a replacement for pathology for diminutive (1-5 mm) polyps. In recent years, artificial intelligence (AI)-based computer-assisted characterization of diminutive polyps has recently emerged as a strategy that could potentially represent a breakthrough technology to enable widespread adoption of resect-and-discard. Recent evidence suggests that pathology-based diagnosis is suboptimal, as polyp nonretrieval, fragmentation, sectioning errors, incorrect diagnosis as "normal mucosa," and interpathologist variability limit the efficacy of pathology for the diagnosis of 1-5 mm polyps. New paradigms in performing polyp diagnosis with or without AI have emerged to compete with pathology in terms of efficacy. Strategies, such as autonomous AI, AI-assisted human diagnosis, AI-unassisted human diagnosis, and combined strategies have been proposed as potential paradigms for resect-and-discard, although further research is still required to determine the optimal strategy. Implementation studies with high patient acceptance, where polyps are truly being discarded without histologic diagnosis, are paving the way toward normalizing resect-and-discard in routine clinical practice. Ultimately the largest challenges for computer-assisted characterization remain liability perceptions from endoscopists. The potential benefits of AI-based resect-and-discard are many, with very little potential harm. Real-world implementation studies are therefore required to pave the way for the acceptability of such strategies in routine practice.
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Affiliation(s)
- Roupen Djinbachian
- Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
- Division of Gastroenterology, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Douglas K Rex
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel von Renteln
- Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
- Division of Gastroenterology, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
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2
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Brown I, Bettington M. Sporadic Polyps of the Colorectum. Gastroenterol Clin North Am 2024; 53:155-177. [PMID: 38280746 DOI: 10.1016/j.gtc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Colorectal polyps are common, and their diagnosis and classification represent a major component of gastrointestinal pathology practice. The majority of colorectal polyps represent precursors of either the chromosomal instability or serrated neoplasia pathways to colorectal carcinoma. Accurate reporting of these polyps has major implications for surveillance and thus for cancer prevention. In this review, we discuss the key histologic features of the major colorectal polyps with a particular emphasis on diagnostic pitfalls and areas of contention.
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Affiliation(s)
- Ian Brown
- Envoi Pathology, Brisbane; Pathology Queensland, Royal Brisbane and Women's Hospital Cnr Herston and Bowen Bridge Roads, Herston Qld 4006, Australia; University of Queensland, St Lucia, Qld 4072, Australia.
| | - Mark Bettington
- Envoi Pathology, Brisbane; University of Queensland, St Lucia, Qld 4072, Australia; Queensland Institute of Medical Research, 300 Herston Road, Herston QLD 4006, Australia
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3
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Soons E, Siersema PD, van Lierop LMA, Bisseling TM, van Kouwen MCA, Nagtegaal ID, van der Post RS, Atsma F. Laboratory variation in the grading of dysplasia of duodenal adenomas in familial adenomatous polyposis patients. Fam Cancer 2023; 22:177-186. [PMID: 36401146 PMCID: PMC10020317 DOI: 10.1007/s10689-022-00320-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/06/2022] [Indexed: 11/20/2022]
Abstract
To prevent duodenal and ampullary cancer in familial adenomatous polyposis (FAP) patients, a diagnosis of high grade dysplasia (HGD) plays an important role in the clinical management. Previous research showed that FAP patients are both over- and undertreated after a misdiagnosis of HGD, indicating unwarranted variation. We aimed to investigate the laboratory variation in dysplasia grading of duodenal adenomas and explore possible explanations for this variation. We included data from all Dutch pathology laboratories between 1991 and 2020 by retrieving histology reports from upper endoscopy specimens of FAP patients from the Dutch nationwide pathology databank (PALGA). Laboratory variation was investigated by comparing standardized proportions of HGD. To describe the degree of variation between the laboratories a factor score was calculated. A funnel plot was used to identify outliers. A total of 3050 specimens from 25 laboratories were included in the final analyses. The mean observed HGD proportion was 9.4%. The top three HGD-diagnosing laboratories diagnosed HGD 3.9 times more often than the lowest three laboratories, even after correcting for case-mix. No outliers were identified. Moderate laboratory variation was found in HGD diagnoses of duodenal tissue of FAP patients after adjusting for case-mix. Despite the fact that no outliers were observed, there may well be room for quality improvement. Concentration of these patients in expertise centers may decrease variation. To further reduce unwarranted variation, we recommend (inter)national guidelines to become more uniform in their recommendations regarding duodenal tissue sampling and consequences of HGD diagnoses.
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Affiliation(s)
- E Soons
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - P D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M A van Lierop
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T M Bisseling
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M C A van Kouwen
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I D Nagtegaal
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R S van der Post
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F Atsma
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Kim SY, Kwak MS, Yoon SM, Jung Y, Kim JW, Boo SJ, Oh EH, Jeon SR, Nam SJ, Park SY, Park SK, Chun J, Baek DH, Choi MY, Park S, Byeon JS, Kim HK, Cho JY, Lee MS, Lee OY, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases. Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition. Intest Res 2023; 21:20-42. [PMID: 36751043 PMCID: PMC9911266 DOI: 10.5217/ir.2022.00096] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/30/2022] [Accepted: 10/05/2022] [Indexed: 02/09/2023] Open
Abstract
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.
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Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Kyung Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Young Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Kil Kim
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Moon Sung Lee
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Society of Gastrointestinal Endoscopy
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Society of Gastroenterology
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Association for the Study of Intestinal Diseases
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
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5
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Yavuz A, Alpsoy A, Gedik EO, Celik MY, Bassorgun CI, Unal B, Elpek GO. Artificial intelligence applications in predicting the behavior of gastrointestinal cancers in pathology. Artif Intell Gastroenterol 2022; 3:142-162. [DOI: 10.35712/aig.v3.i5.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/25/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
Recent research has provided a wealth of data supporting the application of artificial intelligence (AI)-based applications in routine pathology practice. Indeed, it is clear that these methods can significantly support an accurate and rapid diagnosis by eliminating errors, increasing reliability, and improving workflow. In addition, the effectiveness of AI in the pathological evaluation of prognostic parameters associated with behavior, course, and treatment in many types of tumors has also been noted. Regarding gastrointestinal system (GIS) cancers, the contribution of AI methods to pathological diagnosis has been investigated in many studies. On the other hand, studies focusing on AI applications in evaluating parameters to determine tumor behavior are relatively few. For this purpose, the potential of AI models has been studied over a broad spectrum, from tumor subtyping to the identification of new digital biomarkers. The capacity of AI to infer genetic alterations of cancer tissues from digital slides has been demonstrated. Although current data suggest the merit of AI-based approaches in assessing tumor behavior in GIS cancers, a wide range of challenges still need to be solved, from laboratory infrastructure to improving the robustness of algorithms, before incorporating AI applications into real-life GIS pathology practice. This review aims to present data from AI applications in evaluating pathological parameters related to the behavior of GIS cancer with an overview of the opportunities and challenges encountered in implementing AI in pathology.
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Affiliation(s)
- Aysen Yavuz
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Turkey
| | - Anil Alpsoy
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Turkey
| | - Elif Ocak Gedik
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Turkey
| | | | | | - Betul Unal
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Turkey
| | - Gulsum Ozlem Elpek
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Turkey
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Wang Z, Saoud C, Wangsiricharoen S, James AW, Popel AS, Sulam J. Label Cleaning Multiple Instance Learning: Refining Coarse Annotations on Single Whole-Slide Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:3952-3968. [PMID: 36037454 PMCID: PMC9825360 DOI: 10.1109/tmi.2022.3202759] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Annotating cancerous regions in whole-slide images (WSIs) of pathology samples plays a critical role in clinical diagnosis, biomedical research, and machine learning algorithms development. However, generating exhaustive and accurate annotations is labor-intensive, challenging, and costly. Drawing only coarse and approximate annotations is a much easier task, less costly, and it alleviates pathologists' workload. In this paper, we study the problem of refining these approximate annotations in digital pathology to obtain more accurate ones. Some previous works have explored obtaining machine learning models from these inaccurate annotations, but few of them tackle the refinement problem where the mislabeled regions should be explicitly identified and corrected, and all of them require a - often very large - number of training samples. We present a method, named Label Cleaning Multiple Instance Learning (LC-MIL), to refine coarse annotations on a single WSI without the need for external training data. Patches cropped from a WSI with inaccurate labels are processed jointly within a multiple instance learning framework, mitigating their impact on the predictive model and refining the segmentation. Our experiments on a heterogeneous WSI set with breast cancer lymph node metastasis, liver cancer, and colorectal cancer samples show that LC-MIL significantly refines the coarse annotations, outperforming state-of-the-art alternatives, even while learning from a single slide. Moreover, we demonstrate how real annotations drawn by pathologists can be efficiently refined and improved by the proposed approach. All these results demonstrate that LC-MIL is a promising, lightweight tool to provide fine-grained annotations from coarsely annotated pathology sets.
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7
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Kim SY, Kwak MS, Yoon SM, Jung Y, Kim JW, Boo SJ, Oh EH, Jeon SR, Nam SJ, Park SY, Park SK, Chun J, Baek DH, Choi MY, Park S, Byeon JS, Kim HK, Cho JY, Lee MS, Lee OY. [Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revised Edition]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:115-134. [PMID: 36156035 DOI: 10.4166/kjg.2022.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: 1) adenoma ≥10 mm in size; 2) 3-5 (or more) adenomas; 3) tubulovillous or villous adenoma; 4) adenoma containing high-grade dysplasia; 5) traditional serrated adenoma; 6) sessile serrated lesion (SSL) containing any grade of dysplasia; 7) serrated polyp of at least 10 mm in size; and 8) 3-5 (or more) SSLs. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.
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Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Kwak
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Young Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Kil Kim
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
| | - Moon Sung Lee
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea, Korea
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Kim SY, Kwak MS, Yoon SM, Jung Y, Kim JW, Boo SJ, Oh EH, Jeon SR, Nam SJ, Park SY, Park SK, Chun J, Baek DH, Choi MY, Park S, Byeon JS, Kim HK, Cho JY, Lee MS, Lee OY, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases. [Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revised Edition]. Clin Endosc 2022; 80:115-134. [PMID: 36156035 PMCID: PMC9726446 DOI: 10.5946/ce.2022.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022] Open
Abstract
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: 1) adenoma ≥10 mm in size; 2) 3-5 (or more) adenomas; 3) tubulovillous or villous adenoma; 4) adenoma containing high-grade dysplasia; 5) traditional serrated adenoma; 6) sessile serrated lesion (SSL) containing any grade of dysplasia; 7) serrated polyp of at least 10 mm in size; and 8) 3-5 (or more) SSLs. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.
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Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Kyung Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Young Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Suyeon Park
- Department of biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Kil Kim
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
| | - Moon Sung Lee
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Society of Gastrointestinal Endoscopy
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
- Department of biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Society of Gastroenterology
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
- Department of biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Association for the Study of Intestinal Diseases
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
- Department of biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
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9
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Wong ANN, He Z, Leung KL, To CCK, Wong CY, Wong SCC, Yoo JS, Chan CKR, Chan AZ, Lacambra MD, Yeung MHY. Current Developments of Artificial Intelligence in Digital Pathology and Its Future Clinical Applications in Gastrointestinal Cancers. Cancers (Basel) 2022; 14:3780. [PMID: 35954443 PMCID: PMC9367360 DOI: 10.3390/cancers14153780] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023] Open
Abstract
The implementation of DP will revolutionize current practice by providing pathologists with additional tools and algorithms to improve workflow. Furthermore, DP will open up opportunities for development of AI-based tools for more precise and reproducible diagnosis through computational pathology. One of the key features of AI is its capability to generate perceptions and recognize patterns beyond the human senses. Thus, the incorporation of AI into DP can reveal additional morphological features and information. At the current rate of AI development and adoption of DP, the interest in computational pathology is expected to rise in tandem. There have already been promising developments related to AI-based solutions in prostate cancer detection; however, in the GI tract, development of more sophisticated algorithms is required to facilitate histological assessment of GI specimens for early and accurate diagnosis. In this review, we aim to provide an overview of the current histological practices in AP laboratories with respect to challenges faced in image preprocessing, present the existing AI-based algorithms, discuss their limitations and present clinical insight with respect to the application of AI in early detection and diagnosis of GI cancer.
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Affiliation(s)
- Alex Ngai Nick Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (A.N.N.W.); (Z.H.); (K.L.L.); (C.Y.W.); (S.C.C.W.); (J.S.Y.)
| | - Zebang He
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (A.N.N.W.); (Z.H.); (K.L.L.); (C.Y.W.); (S.C.C.W.); (J.S.Y.)
| | - Ka Long Leung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (A.N.N.W.); (Z.H.); (K.L.L.); (C.Y.W.); (S.C.C.W.); (J.S.Y.)
| | - Curtis Chun Kit To
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; (C.C.K.T.); (C.K.R.C.); (M.D.L.)
| | - Chun Yin Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (A.N.N.W.); (Z.H.); (K.L.L.); (C.Y.W.); (S.C.C.W.); (J.S.Y.)
| | - Sze Chuen Cesar Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (A.N.N.W.); (Z.H.); (K.L.L.); (C.Y.W.); (S.C.C.W.); (J.S.Y.)
| | - Jung Sun Yoo
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (A.N.N.W.); (Z.H.); (K.L.L.); (C.Y.W.); (S.C.C.W.); (J.S.Y.)
| | - Cheong Kin Ronald Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; (C.C.K.T.); (C.K.R.C.); (M.D.L.)
| | - Angela Zaneta Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Shatin, Hong Kong SAR, China;
| | - Maribel D. Lacambra
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; (C.C.K.T.); (C.K.R.C.); (M.D.L.)
| | - Martin Ho Yin Yeung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China; (A.N.N.W.); (Z.H.); (K.L.L.); (C.Y.W.); (S.C.C.W.); (J.S.Y.)
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10
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Sekiguchi M, Matsuda T, Hotta K, Saito Y. Post-polypectomy surveillance: the present and the future. Clin Endosc 2022; 55:489-495. [PMID: 35811404 PMCID: PMC9329642 DOI: 10.5946/ce.2022.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/10/2022] [Indexed: 11/14/2022] Open
Abstract
An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.
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Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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11
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Jiang Y, Wang J, Chen Y, Sun H, Dong Z, Xu S. Discrepancy Between Forceps Biopsy and Resection in Colorectal Polyps: A 1686 Paired Screening-Therapeutic Colonoscopic Finding. Ther Clin Risk Manag 2022; 18:561-569. [PMID: 35602262 PMCID: PMC9121885 DOI: 10.2147/tcrm.s358708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify pathology discrepancy between forceps biopsies and polypectomy specimens in colorectal polyps, as well as the reliability of biopsy-based treatment strategy. Methods All endoscopic polypectomy cases with forceps biopsies performed within 6 months were included in the study. The biopsies were compared with polypectomy specimens in terms of concordance of histological diagnosis. A logistic regression model was used to investigate the independent predictors of upgrade in histological diagnosis compared with concordance in histological diagnosis. Results A total of 1686 paired screening-therapeutic colonoscopies and 1739 paired biopsy-polypectomy specimens were enrolled in the study. The grade of dysplasia in 84.5% of biopsy specimens were concordant to polypectomy specimens, but this proportion decreased to 75.4% when the specimens were classified using tubular or villousness structure. 10.1% and 5.4% of biopsy specimens were upgraded and downgraded in assessing grade of dysplasia, respectively, while 14.3% and 10.3% of biopsy specimens were upgraded and downgraded in assessing tubular or villousness structure, respectively. In subgroup analysis stratified by size of polyps, 9.0% and 10.6% of biopsies obtained from polyps smaller than 10 mm were upgraded in assessing dysplasia and tubular or villousness structure, respectively. This proportion increased to 10.7% and 21.3%, respectively, in biopsies obtained from polyps larger than 10 mm. Larger size of polyps and pedunculated polyps were associated with a higher incidence of upgrade in histological diagnosis. Nearly 25% of biopsy specimens with high-grade dysplasia were identified as adenocarcinoma in polypectomy specimens. Conclusion The concordance between biopsy and polypectomy specimens is not adequate. The biopsy-based treatment strategy is not reliable and should not be considered as an indicator for further treatment, particularly in large or pedunculated polyps.
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Affiliation(s)
- Yuanxi Jiang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Junwen Wang
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Ying Chen
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Huihui Sun
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Zhiyu Dong
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Shuchang Xu
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Correspondence: Shuchang Xu; Zhiyu Dong, Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Putuo District, Shanghai, People’s Republic of China, Tel +86-136 0199 9711, Email ;
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12
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Post-polypectomy colonoscopy surveillance: Can we improve the diagnostic yield? GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:474-487. [PMID: 34848307 DOI: 10.1016/j.gastrohep.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022]
Abstract
Although adenomas and serrated polyps are the preneoplastic lesions of colorectal cancer, only few of them will eventually progress to cancer. This review provides a comprehensive overview of the present and future of post-polypectomy colonoscopy surveillance. Post-polypectomy surveillance guidelines have recently been updated and all share the aim towards more selective and less frequent surveillance. We have examined these current guidelines and compared the recommendations of each of them. To improve the diagnostic yield of post-polypectomy surveillance it is important to find predictors of metachronous polyps that better identify high-risk individuals of developing advanced neoplasia. For this reason, we have also conducted a literature review of the molecular biomarkers of metachronous advanced colorectal polyps. Finally, we have discussed future directions of post-polypectomy surveillance and identified possible strategies to improve the use of endoscopic resources with the COVID-19 pandemic.
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13
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Smits LJH, Vink-Börger E, van Lijnschoten G, Focke-Snieders I, van der Post RS, Tuynman JB, van Grieken NCT, Nagtegaal ID. Diagnostic variability in the histopathological assessment of advanced colorectal adenomas and early colorectal cancer in a screening population. Histopathology 2021; 80:790-798. [PMID: 34813117 PMCID: PMC9306715 DOI: 10.1111/his.14601] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/18/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022]
Abstract
Aim The aim of this study was to evaluate interobserver variability between individual pathologists and a panel of pathologists in the histopathological assessment of advanced colorectal neoplasms in the Dutch bowel cancer screening population. Methods and results Histological slides of adenomas with high‐grade dysplasia and early colorectal carcinomas (CRC) from 20 different laboratories were reviewed by the pathology panel of the Dutch bowel screening programme. Interobserver variability was reported by descriptive statistics. In addition, potential clinical consequences of discrepancies were evaluated. A total of 104 cases of adenomas with high‐grade dysplasia and 83 early CRCs were reviewed. Discrepancies were observed in 41 of 104 (39.4%) adenoma cases, which potentially had clinical consequences in 16 (15.4%) cases. For CRC, discrepancies were shown in 44 of 83 cases (53.0%) and would have potentially led to alternative treatment strategies in 25 (30.1%) cases. Most frequently, discrepancies were observed in the assessment of lymphovascular invasion (23 of 73 cases, 31.5%). Conclusion This study showed that considerable interobserver variability is present in the histopathological assessment of advanced colorectal neoplasia, which may impact upon treatment choices. Additional stains and education, as well as intercollegial consultation, might decrease this variability.
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Affiliation(s)
- Lisanne J H Smits
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Centre Amsterdam, the Netherlands
| | - Elisa Vink-Börger
- Radboud university medical center, Radboud Institute for Molecular Life Sciences, Department of Pathology, Nijmegen, The Netherlands
| | | | | | - Rachel S van der Post
- Radboud university medical center, Radboud Institute for Molecular Life Sciences, Department of Pathology, Nijmegen, The Netherlands
| | - Jurriaan B Tuynman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Surgery, Cancer Centre Amsterdam, the Netherlands
| | - Nicole C T van Grieken
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology, Cancer Centre Amsterdam, the Netherlands
| | - Iris D Nagtegaal
- Radboud university medical center, Radboud Institute for Molecular Life Sciences, Department of Pathology, Nijmegen, The Netherlands
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14
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Nasir-Moin M, Suriawinata AA, Ren B, Liu X, Robertson DJ, Bagchi S, Tomita N, Wei JW, MacKenzie TA, Rees JR, Hassanpour S. Evaluation of an Artificial Intelligence-Augmented Digital System for Histologic Classification of Colorectal Polyps. JAMA Netw Open 2021; 4:e2135271. [PMID: 34792588 PMCID: PMC8603082 DOI: 10.1001/jamanetworkopen.2021.35271] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/26/2021] [Indexed: 12/17/2022] Open
Abstract
Importance Colorectal polyps are common, and their histopathologic classification is used in the planning of follow-up surveillance. Substantial variation has been observed in pathologists' classification of colorectal polyps, and improved assessment by pathologists may be associated with reduced subsequent underuse and overuse of colonoscopy. Objective To compare standard microscopic assessment with an artificial intelligence (AI)-augmented digital system that annotates regions of interest within digitized polyp tissue and predicts polyp type using a deep learning model to assist pathologists in colorectal polyp classification. Design, Setting, and Participants In this diagnostic study conducted at a tertiary academic medical center and a community hospital in New Hampshire, 100 slides with colorectal polyp samples were read by 15 pathologists using a microscope and an AI-augmented digital system, with a washout period of at least 12 weeks between use of each modality. The study was conducted from February 10 to July 10, 2020. Main Outcomes and Measures Accuracy and time of evaluation were used to compare pathologists' performance when a microscope was used with their performance when the AI-augmented digital system was used. Outcomes were compared using paired t tests and mixed-effects models. Results In assessments of 100 slides with colorectal polyp specimens, use of the AI-augmented digital system significantly improved pathologists' classification accuracy compared with microscopic assessment from 73.9% (95% CI, 71.7%-76.2%) to 80.8% (95% CI, 78.8%-82.8%) (P < .001). The overall difference in the evaluation time per slide between the digital system (mean, 21.7 seconds; 95% CI, 20.8-22.7 seconds) and microscopic examination (mean, 13.0 seconds; 95% CI, 12.4-13.5 seconds) was -8.8 seconds (95% CI, -9.8 to -7.7 seconds), but this difference decreased as pathologists became more familiar and experienced with the digital system; the difference between the time of evaluation on the last set of 20 slides for all pathologists when using the microscope and the digital system was 4.8 seconds (95% CI, 3.0-6.5 seconds). Conclusions and Relevance In this diagnostic study, an AI-augmented digital system significantly improved the accuracy of pathologic interpretation of colorectal polyps compared with microscopic assessment. If applied broadly to clinical practice, this tool may be associated with decreases in subsequent overuse and underuse of colonoscopy and thus with improved patient outcomes and reduced health care costs.
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Affiliation(s)
- Mustafa Nasir-Moin
- Department of Biomedical Data Science, Geisel School of Medicine, Hanover, New Hampshire
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Arief A. Suriawinata
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Bing Ren
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Xiaoying Liu
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Douglas J. Robertson
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
- Department of Medicine, Geisel School of Medicine, Hanover, New Hampshire
- Section of Gastroenterology, Veterans Affairs Medical Center, White River Junction, Vermont
| | - Srishti Bagchi
- Department of Biomedical Data Science, Geisel School of Medicine, Hanover, New Hampshire
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Naofumi Tomita
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Jason W. Wei
- Department of Biomedical Data Science, Geisel School of Medicine, Hanover, New Hampshire
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Todd A. MacKenzie
- Department of Biomedical Data Science, Geisel School of Medicine, Hanover, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
- Department of Medicine, Geisel School of Medicine, Hanover, New Hampshire
| | - Judy R. Rees
- Department of Community and Family Medicine, Geisel School of Medicine, Hanover, New Hampshire
- Department of Epidemiology, Geisel School of Medicine, Hanover, New Hampshire
| | - Saeed Hassanpour
- Department of Biomedical Data Science, Geisel School of Medicine, Hanover, New Hampshire
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
- Department of Epidemiology, Geisel School of Medicine, Hanover, New Hampshire
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15
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Abu-Freha N, Katz LH, Kariv R, Vainer E, Laish I, Gluck N, Half EE, Levi Z. Post-polypectomy surveillance colonoscopy: Comparison of the updated guidelines. United European Gastroenterol J 2021; 9:681-687. [PMID: 34077635 PMCID: PMC8280808 DOI: 10.1002/ueg2.12106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background Recently, three updated guidelines for post‐polypectomy colonoscopy surveillance (PPCS) have been published. These guidelines are based on a comprehensive summary of the literature, while some recommendations are similar, different surveillance intervals are recommended after detection of specific types of polyps. Aim In this review, we aimed to compare and contrast these recommendations. Methods The updated guidelines for PPCS were reviewed and the recommendations were compared. Results For patients with 1–4 adenomas <10 mm with low‐grade dysplasia, irrespective of villous components, or 1–4 serrated polyps <10 mm without dysplasia, the European Society of Gastrointestinal Endoscopy (ESGE) and British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE) (BSG/ACPGBI/PHE) guidelines do not recommend colonoscopic surveillance and instead recommend that the participate in routine CRC screening program (typically based on the fecal immunochemical test), while the USMSTF recommends surveillance colonoscopies 7–10 years after diagnosis of 1–2 tubular adenomas <10 mm and 3–5 years for 3–4 tubular adenomas of the same size. The USMSTF define adenomas with tubulovillous or villous histology as high‐risk adenomas; thus, surveillance colonoscopy is recommended after 3 years. However, the ESGE and BSG do not consider such histology as a criterion for repeating colonoscopy at this short interval. For patients with 1–2 sessile serrated polyps (SSPs) <10 mm and those with 3–4 SSPs <10 mm, the USMSTF recommends surveillance colonosocopy after 5–10 and 3–5 years, respectively.
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Affiliation(s)
- Naim Abu-Freha
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior H Katz
- Department of Gastroenterology and Hepatology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Revital Kariv
- Department of Gastroenterology and Hepatology, Sourasky Medical Center, and Tel Aviv University, Tel Aviv, Israel
| | - Elez Vainer
- Department of Gastroenterology and Hepatology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ido Laish
- Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nathan Gluck
- Department of Gastroenterology and Hepatology, Sourasky Medical Center, and Tel Aviv University, Tel Aviv, Israel
| | - Elizabeth E Half
- Department of Gastroenterology, Rambam Health Care Campus, The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Zohar Levi
- Department of Gastroenterology, Beilinson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jiang AC, Buckingham L, Bishehsari F, Sutherland S, Ma K, Melson JE. Correlation of LINE-1 Hypomethylation With Size and Pathologic Extent of Dysplasia in Colorectal Tubular Adenomas. Clin Transl Gastroenterol 2021; 12:e00369. [PMID: 34060495 PMCID: PMC8162511 DOI: 10.14309/ctg.0000000000000369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Conventional adenomas (tubular adenoma [TA] or tubulovillous adenoma) and sessile serrated lesions (SSLs) are neoplastic precancerous lesions frequently detected in patients undergoing average risk screening colonoscopy and polyp surveillance. Metachronous risk stratification of adenomas is currently limited to histologic features and size of polyps. We report long interspersed nucleotide element-1 (LINE-1) methylation levels in SSL in comparison to TA and the impact of TA size and presence of high-grade dysplasia (HGD) on LINE-1 methylation. METHODS LINE-1 methylation was assessed by pyrosequencing of bisulfite-converted DNA. We compared LINE-1 methylation between TA and SSL, among varying sizes of TA, and between TA with HGD and low-grade dysplasia (LGD). RESULTS LINE-1 methylation declined with increasing polyp size in TA when comparing those <5 mm (72.31 ± 6.11), 5 to <10 mm (67.50 ± 7.00), and ≥10 mm (66.75 ± 11.89). There were lower LINE-1 methylation levels in TA with LGD (n = 119) compared with SSLs (n = 29) (69.11 ± 8.62 vs 81.41 ± 2.43, P < 0.001). TA containing HGD (n = 26) had lower LINE-1 methylation levels than those with LGD (n = 119) (59.86 ± 7.93 vs 69.11 ± 8.62, P < 0.001). DISCUSSION HGD and increasing size of TA/tubulovillous adenoma were associated with lower LINE-1 methylation. This supports a hypothesis that LINE-1 hypomethylation in TAs indicates advancement along the CRC tumorigenesis pathway. Lower LINE-1 methylation and greater variance of global DNA methylation was seen in TA compared with SSL. LINE-1 methylation in adenomas correlates with polyp size and degree of dysplasia and deserves further study as a predictor of metachronous colorectal cancer risk.
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Affiliation(s)
- Alice C. Jiang
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Lela Buckingham
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Faraz Bishehsari
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Karen Ma
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua E. Melson
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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17
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Matsuda T, Fujii T, Sano Y, Kudo SE, Oda Y, Hotta K, Shimoda T, Saito Y, Kobayashi N, Sekiguchi M, Konishi K, Ikematsu H, Iishi H, Takeuchi Y, Igarashi M, Kobayashi K, Sada M, Yamaguchi Y, Hasuda K, Shinohara T, Ishikawa H, Murakami Y, Taniguchi H, Fujimori T, Ajioka Y, Yoshida S. Randomised comparison of postpolypectomy surveillance intervals following a two-round baseline colonoscopy: the Japan Polyp Study Workgroup. Gut 2020; 70:1469-1478. [PMID: 33139269 PMCID: PMC8292600 DOI: 10.1136/gutjnl-2020-321996] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/13/2020] [Accepted: 09/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess whether follow-up colonoscopy after polypectomy at 3 years only, or at 1 and 3 years would effectively detect advanced neoplasia (AN), including nonpolypoid colorectal neoplasms (NP-CRNs). DESIGN A prospective multicentre randomised controlled trial was conducted in 11 Japanese institutions. The enrolled participants underwent a two-round baseline colonoscopy (interval: 1 year) to remove all neoplastic lesions. Subsequently, they were randomly assigned to undergo follow-up colonoscopy at 1 and 3 years (2-examination group) or at 3 years only (1-examination group). The incidence of AN, defined as lesions with low-grade dysplasia ≥10 mm, high-grade dysplasia or invasive cancer, at follow-up colonoscopy was evaluated. RESULTS A total of 3926 patients were enrolled in this study. The mean age was 57.3 (range: 40-69) years, and 2440 (62%) were male. Of these, 2166 patients were assigned to two groups (2-examination: 1087, 1-examination: 1079). Overall, we detected 29 AN in 28 patients at follow-up colonoscopy in both groups. On per-protocol analysis (701 in 2-examination vs 763 in 1-examination group), the incidence of AN was similar between the two groups (1.7% vs 2.1%, p=0.599). The results of the non-inferiority test were significant (p=0.017 in per-protocol, p=0.001 in intention-to-treat analysis). NP-CRNs composed of dominantly of the detected AN (62%, 18/29), and most of them were classified into laterally spreading tumour non-granular type (83%, 15/18). CONCLUSION After a two-round baseline colonoscopy, follow-up colonoscopy at 3 years detected AN, including NP-CRNs, as effectively as follow-up colonoscopies performed after 1 and 3 years.
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Affiliation(s)
- Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yasushi Sano
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Kobe, Hyogo, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yasushi Oda
- Oda GI Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Tadakazu Shimoda
- Division of Pathology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nozomu Kobayashi
- Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Konishi
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroyasu Iishi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiro Igarashi
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kiyonori Kobayashi
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Kanagawa, Japan
| | - Miwa Sada
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Kanagawa, Japan
| | - Yuichiro Yamaguchi
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Kiwamu Hasuda
- Hattori GI Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | - Tomoaki Shinohara
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Nagano, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Hirokazu Taniguchi
- Pathology and Clinical Laboratory Division, JR Tokyo General Hospital, Tokyo, Japan
| | | | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Mollasharifi T, Ahadi M, Jamali E, Moradi A, Asghari P, Maroufizadeh S, Kazeminezhad B. Interobserver Agreement in Assessing Dysplasia in Colorectal Adenomatous Polyps: A Multicentric Iranian Study. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:167-174. [PMID: 32754211 PMCID: PMC7354064 DOI: 10.30699/ijp.2020.115021.2250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/01/2020] [Indexed: 01/04/2023]
Abstract
Background & Objective: Most colorectal cancers (CRCs) arise from adenomatous polyps, and clinical management of this type of polyp is highly dependent on the reliability and validity of the pathological diagnosis. The aim of this study was to examine the interobserver agreement of five pathologists in assessing dysplasia in adenomatous polyps. Methods: In this study, a total of 146 adenomatous polyps of patients undergoing colonoscopy were selected from hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran between 2017 and 2018. Five pathologists independently classified adenomatous polyps according to histologic type, nuclear pseudostratification, mitotic activity, nuclear polarity, nuclear pleomorphism, nuclear shape, nucleolus, chromatin pattern, cytology grade, architectural features, dysplasia, and final diagnosis. The overall kappa statistic (k) was used to assess agreement among pathologists. Results: The mean age of the patients was 62.06 ± 13.06 (mean ± SD) with a male-to-female ratio of 2.2:1. The most common site of resection was the sigmoid colon (28.1%). The highest agreement was found for dysplasia grade (k=0.415) and histologic type (k=0.401), whereas the lowest agreement was found for mitotic activity (k=0.185), nuclear shape (k=0.187), and nucleolus (k=0.196). Conclusion: Our findings indicate that agreement among pathologists in assessing dysplasia in adenomatous polyps is within fair to moderate levels of agreement. Therefore, there is a vital need to better clarify the current diagnostic criteria.
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Affiliation(s)
- Tahmineh Mollasharifi
- Department of Pathology, Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Ahadi
- Department of Pathology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elena Jamali
- Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moradi
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Asghari
- Department of Pathology, Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Behrang Kazeminezhad
- Department of Pathology, Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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19
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Yen AW, Leung JW, Wilson MD, Leung FW. Underwater versus conventional endoscopic resection of nondiminutive nonpedunculated colorectal lesions: a prospective randomized controlled trial (with video). Gastrointest Endosc 2020; 91:643-654.e2. [PMID: 31628954 PMCID: PMC7039760 DOI: 10.1016/j.gie.2019.09.039] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Incomplete resection of colorectal neoplasia decreases the efficacy of colonoscopy. Conventional resection (CR) of polyps, performed in a gas-distended colon, is the current standard, but incomplete resection rates of approximately 2% to 30% for nondiminutive (>5 mm), nonpedunculated lesions are reported. Underwater resection (UR) is a novel technique. The aim of this study was to determine the incomplete resection rates of colorectal lesions removed by UR versus CR. METHODS In a randomized controlled trial, patients with small (6-9 mm) and large (≥10 mm) nonpedunculated lesions were assigned to CR (gas-distended lumen) or UR (water-filled, gas-excluded lumen). Small lesions in both arms were removed with a dedicated cold snare. For CR, large lesions were removed with a hot snare after submucosal injection. For UR, large lesions were removed with a hot snare without submucosal injection. Four-quadrant biopsy samples around the resection sites were used to evaluate for incomplete resection. RESULTS Four hundred sixty-two eligible polyps (248 UR vs 214 CR) from 255 patients were removed. Incomplete resection rates for UR and CR were low and did not differ (2% vs 1.9%, P = .91). UR was performed significantly faster for lesions ≥10 mm in size (10-19 mm, 2.9 minutes vs 5.6 minutes, P < .0001); ≥20 mm, 7.3 minutes vs 9.5 minutes, P = .015). CONCLUSIONS Low incomplete resection rates are achievable with UR and CR. UR is effective and safe with the advantage of faster resection and potential cost savings for removal of larger (≥10 mm) lesions by avoiding submucosal injection. As an added approach, UR has potential to improve the cost-effectiveness of colonoscopy by increasing efficiency and reducing cost while maintaining quality. (Clinical trial registration number: NCT02889679.).
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Affiliation(s)
- Andrew W. Yen
- Sacramento Veterans Affairs Medical Center, VA Northern California Health Care System, Division of Gastroenterology, Mather, CA 95655,University of California Davis School of Medicine, Sacramento, CA 95817
| | - Joseph W. Leung
- Sacramento Veterans Affairs Medical Center, VA Northern California Health Care System, Division of Gastroenterology, Mather, CA 95655,University of California Davis School of Medicine, Sacramento, CA 95817
| | - Machelle D. Wilson
- Clinical and Translational Science Center, Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento CA 95817
| | - Felix W. Leung
- Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, Division of Gastroenterology, North Hills, CA 91343,David Geffen School of Medicine at UCLA, Los Angeles, CA 90095
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20
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Rutter MD, East J, Rees CJ, Cripps N, Docherty J, Dolwani S, Kaye PV, Monahan KJ, Novelli MR, Plumb A, Saunders BP, Thomas-Gibson S, Tolan DJM, Whyte S, Bonnington S, Scope A, Wong R, Hibbert B, Marsh J, Moores B, Cross A, Sharp L. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut 2020; 69:201-223. [PMID: 31776230 PMCID: PMC6984062 DOI: 10.1136/gutjnl-2019-319858] [Citation(s) in RCA: 254] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.
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Affiliation(s)
- Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - James East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | - Neil Cripps
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | | | - Sunil Dolwani
- Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Philip V Kaye
- Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Kevin J Monahan
- Family History of Bowel Cancer Clinic, West Middlesex University Hospital, London, UK
- Imperial College, London, UK
| | | | | | | | | | - Damian J M Tolan
- Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sophie Whyte
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | | | - Amanda Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine of Imperial College, Imperial College London, London, UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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21
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Zorzi M, Zappa M. Synthetic indicator of the impact of colorectal cancer screening programmes on incidence rates. Gut 2020; 69:311-316. [PMID: 31040168 DOI: 10.1136/gutjnl-2019-318589] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 12/08/2022]
Abstract
OBJECTIVE The impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists' sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence. DESIGN We defined the 'rate of advanced adenoma on the target population' (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50-69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50-74 year old subjects and the cumulative AA-TAP. RESULTS In 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013-2014 and those in 2003-2004 (p=0.009). CONCLUSION The AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
| | - Marco Zappa
- Clinical Epidemiology Unit, ISPRO, Florence, Italy
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22
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Bormann F, Rodríguez-Paredes M, Lasitschka F, Edelmann D, Musch T, Benner A, Bergman Y, Dieter SM, Ball CR, Glimm H, Linhart HG, Lyko F. Cell-of-Origin DNA Methylation Signatures Are Maintained during Colorectal Carcinogenesis. Cell Rep 2019; 23:3407-3418. [PMID: 29898408 DOI: 10.1016/j.celrep.2018.05.045] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 12/12/2022] Open
Abstract
Colorectal adenomas are precursor lesions of colorectal cancers and represent clonal amplifications of single cells from colonic crypts. DNA methylation patterns specify cell-type identity during cellular differentiation and, therefore, provide opportunities for the molecular analysis of tumors. We have now analyzed DNA methylation patterns in colorectal adenomas and identified three biologically defined subclasses that describe different intestinal crypt differentiation stages. Importantly, colorectal carcinomas could be classified into the same methylation subtypes, reflecting their shared cell types of origin with adenomas. Further data analysis also revealed significantly reduced overall survival for one of the subtypes. Our results provide a concept for understanding the methylation patterns observed in colorectal cancer and provide opportunities for tumor subclassification and patient stratification.
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Affiliation(s)
- Felix Bormann
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Manuel Rodríguez-Paredes
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Felix Lasitschka
- Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Dominic Edelmann
- Division of Biostatistics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Tanja Musch
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Yehudit Bergman
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University Medical School, 91120 Jerusalem, Israel
| | - Sebastian M Dieter
- Department of Translational Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Claudia R Ball
- Department of Translational Medical Oncology, NCT-Dresden and DKFZ Heidelberg, 01307 Dresden, Germany
| | - Hanno Glimm
- Department of Translational Medical Oncology, NCT-Dresden and DKFZ Heidelberg, 01307 Dresden, Germany; University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Heinz G Linhart
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany; Klinik Lindau, 88131 Lindau, Germany; Department of Gastroenterology, University Hospital Freiburg, 79160 Freiburg, Germany
| | - Frank Lyko
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany.
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Rönnow CF, Uedo N, Stenfors I, Toth E, Thorlacius H. Forceps Biopsies Are Not Reliable in the Workup of Large Colorectal Lesions Referred for Endoscopic Resection: Should They Be Abandoned? Dis Colon Rectum 2019; 62:1063-1070. [PMID: 31318770 DOI: 10.1097/dcr.0000000000001440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Biopsies are routinely obtained in the workup of large colorectal polyps before endoscopic resection. OBJECTIVE This study aimed to examine how reliable biopsies are in terms of reflecting the true histopathology of large colorectal polyps, in the clinical routine. DESIGN This is a retrospective study. SETTINGS Data from patients undergoing polypectomy of large colorectal polyps at the endoscopy unit, Skåne University Hospital Malmö, between January 2014 and December 2016 were scrutinized. PATIENTS A total of 485 colorectal lesions were biopsied within 1 year before complete endoscopic removal. Biopsy-obtained specimens were compared with completely resected specimens in terms of concordance and discordance and if the final result was upgraded or downgraded. MAIN OUTCOME MEASURES The primary outcome measured was the concordance between biopsy-obtained specimens and completely resected specimens. RESULTS Median lesion size was 3 cm (range 1-11). In 189 cases (39%), biopsies did not provide a correct dysplastic grade compared with final pathology after complete resection. One hundred forty-three cases (29%) and 46 cases (9%) were upgraded and downgraded. The percentage of cases with discordant biopsy results was 40% in cases with 1 biopsy taken and 38% in cases where multiple biopsies had been sampled. Time from biopsy to complete resection did not influence the erroneous outcome of biopsies. Notably, the percentage of discordant biopsy results was 37% and 35% in lesions measuring 1 to 2 cm and 2 to 4 cm. However, this percentage increased to 48% in colorectal lesions larger than 4 cm. LIMITATIONS This study was designed to reflect the clinical routine, the number of biopsies obtained and forceps technique were hence not standardized, which constitutes a limitation. CONCLUSIONS This study demonstrates that cancer-negative forceps biopsies of large colorectal polyps, referred for endoscopic resection, are not reliable. Considering that endoscopic resection of lesions containing superficial cancer is plausible, the clinical value of forceps biopsies in lesions suitable for endoscopic resection is questionable. See Video Abstract at http://links.lww.com/DCR/A984. LAS BIOPSIAS CON FÓRCEPS NO SON CONFIABLES EN EL ESTUDIO DE LAS LESIONES COLORRECTALES GRANDES REFERIDAS PARA RESECCIÓN ENDOSCÓPICA: ¿DEBERÍAN ABANDONARSE?: Las biopsias se obtienen de forma rutinaria en el estudio de pólipos colorrectales grandes previo a resección endoscópica. OBJETIVO Analizar que tan confiables son las biopsias en cuanto a reflejar la verdadera histopatología de los pólipos colorrectales grandes, en la rutina clínica. DISEÑO:: Este es un estudio retrospectivo. AJUSTES Los datos de pacientes sometidos a polipectomía de pólipos colorrectales grandes en la unidad de endoscopia, en Skåne University Hospital Malmö, entre enero de 2014 y diciembre de 2016 fueron examinados. PACIENTES Un total de 485 lesiones colorrectales se biopsiaron dentro de un año antes de la resección endoscópica completa. Las muestras obtenidas mediante biopsia se compararon con las muestras completas resecadas en términos de concordancia y discordancia, y si el resultado final ascendió o disminuyó de categoría. PRINCIPALES MEDIDAS DE RESULTADO Concordancia entre muestras obtenidas mediante biopsia y muestras completamente resecadas. RESULTADOS La mediana de tamaño de lesiones fue de 3 cm (rango 1-11). En 189 casos (39%) las biopsias no proporcionaron un grado de displasia correcto en comparación con la patología final después de la resección completa. 143 casos (29%) y 46 casos (9%) ascendieron y descendieron de categoría, respectivamente. El porcentaje de casos con resultados de biopsia discordantes fue del 40% en los casos con una sola biopsia tomada y del 38% en los casos en los que se tomaron múltiples biopsias. El tiempo desde la biopsia hasta la resección completa no influyó en el resultado erróneo de las biopsias. Notablemente, el porcentaje de resultados de biopsia discordantes fue de 37% y 35% en lesiones que midieron 1-2 cm y 2-4 cm, respectivamente. Sin embargo, este porcentaje aumentó a 48% en lesiones colorrectales mayores de 4 cm. LIMITACIONES Este estudio se diseñó para reflejar la rutina clínica, el número de biopsias obtenidas y la técnica de fórceps no fueron estandarizadas, lo que constituye una limitación. CONCLUSIONES Este estudio demuestra que las biopsias con fórceps negativas a cáncer, de pólipos colorrectales grandes referidas para resección endoscópica, no son confiables. Teniendo en cuenta que la resección endoscópica de lesiones que contienen cáncer superficial es posible, el valor clínico de las biopsias con fórceps en lesiones aptas para la resección endoscópica es cuestionable. Vea el Resumen en video en http://links.lww.com/DCR/A984.
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Affiliation(s)
- Carl-Fredrik Rönnow
- Section of Surgery, Department of Clinical Sciences, Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Iréne Stenfors
- Section of Gastroenterology, Department of Clinical Sciences, Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ervin Toth
- Section of Gastroenterology, Department of Clinical Sciences, Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Henrik Thorlacius
- Section of Surgery, Department of Clinical Sciences, Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
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Intraobserver and Interobserver Variability in the Assessment of Dysplasia in Ampullary Mucosal Biopsies. Am J Surg Pathol 2019; 42:1095-1100. [PMID: 29738360 DOI: 10.1097/pas.0000000000001079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Endoscopic mucosal biopsies of the ampulla of Vater (AmpBx) are obtained to histologically assess for dysplasia or carcinoma. However, biopsy material is often scant and a host of factors can induce histologic changes that pose diagnostic challenges. We sought to investigate observer variability in interpretation of AmpBx and the impact clinical data may have on diagnostic interpretation. Thirty-one cases from institutional archives were selected, including 12 cases of reactive atypia (RA), 8 indefinite for dysplasia (ID), and 11 showing low-grade dysplasia (LGD). Slides were independently reviewed at 3 time points with and without clinical information by 6 pathologists who categorized the biopsies RA, ID, or LGD. Following the reviews, intraobserver and interobserver agreement was assessed. Review of AmpBx without clinical data showed fair (κ, 0.27), poor (κ, 0.07), and good (κ, 0.42) interobserver agreement for diagnoses of RA, ID, and LGD, respectively. Interobserver agreement improved for LGD (κ, 0.66 and 0.73) when clinical information was provided; however, agreement remained fair for RA (κ, 0.4 and 0.42) and poor-to-fair for ID (κ, 0.17 and 0.25). When follow-up data were reviewed, all cases that reached unanimous agreement had that diagnosis substantiated by subsequent endoscopic or histologic findings. The same was true of 13 of 19 cases that reached majority consensus. Given the potential clinical consequences of these diagnoses combined with the significant intraobserver and interobserver variability found in this study, we conclude that better-defined diagnostic criteria and consensus reads on difficult cases would assist in the histologic assessment of these challenging cases.
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Dattani M, Moran BJ. Understanding variations in the treatment of significant polyps and early colorectal cancer. Colorectal Dis 2019; 21 Suppl 1:57-59. [PMID: 30809918 DOI: 10.1111/codi.14508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/08/2018] [Indexed: 02/08/2023]
Affiliation(s)
- M Dattani
- Pelican Cancer Foundation, Basingstoke, UK
| | - B J Moran
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Alternative approaches to polyp extraction in colonoscopy: a proof of principle study. Gastrointest Endosc 2018; 88:536-541. [PMID: 29885336 DOI: 10.1016/j.gie.2018.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS A limitation of determination of the completeness of resection in polypectomy is polyp fragmentation. When a polyp fragments, the pathologist cannot determine resection completeness. Alternative approaches to reduce polyp fragmentation include reducing shearing forces on the polyp or removing polyps through the instrument channel. The primary aim of this study was to assess fragmentation of polyps extracted using different approaches from conventional polyp retrieval. METHODS Polyps (5-15 mm) resected by cold snare or cautery by 3 colonoscopists were extracted from the colonoscope using 1 of 4 techniques. Method I was the conventional method of pressing the suction valve button and retrieving the polyp through a trap. Method II involved removing the suction valve, covering the open suction valve cylinder with a finger. Method III used a Roth Net polyp retriever placed through the instrument channel. Method IV involved connecting a polyp trap to suction onto the instrument channel port. Fragmentation was defined as multiple pieces of the specimen in formalin, as grossly described by the pathologist. Alternative approaches (methods II, III, and IV) were all compared with the conventional method (method I). RESULTS The method I fragmentation rate of polyps was 60.3% (123/204). Method II extraction reduced fragmentation to 43.0% (52/121, P = .003), proving that fragmentation occurs with passage through the suction valve channel. Method III had a lower fragmentation rate of 23.1% (6/26, P < .001). Method IV likewise showed a reduced fragmentation rate of 18.5% (5/27, P < .001). CONCLUSIONS Polyp fragmentation is reduced by removal of the suction valve button. There is also a decrease in fragmentation rates in removing the polyp by connecting the polyp trap to the instrument port. Our study suggests that decreasing polyp fragmentation and improving pathology margin interpretability is possible through methods that extract polyps through the instrument port with currently available devices.
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Atkin W, Brenner A, Martin J, Wooldrage K, Shah U, Lucas F, Greliak P, Pack K, Kralj-Hans I, Thomson A, Perera S, Wood J, Miles A, Wardle J, Kearns B, Tappenden P, Myles J, Veitch A, Duffy SW. The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations. Health Technol Assess 2017; 21:1-536. [PMID: 28621643 PMCID: PMC5483643 DOI: 10.3310/hta21250] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The UK guideline recommends 3-yearly surveillance for patients with intermediate-risk (IR) adenomas. No study has examined whether or not this group has heterogeneity in surveillance needs. OBJECTIVES To examine the effect of surveillance on colorectal cancer (CRC) incidence; assess heterogeneity in risk; and identify the optimum frequency of surveillance, the psychological impact of surveillance, and the cost-effectiveness of alternative follow-up strategies. DESIGN Retrospective multicentre cohort study. SETTING Routine endoscopy and pathology data from 17 UK hospitals (n = 11,944), and a screening data set comprising three pooled cohorts (n = 2352), followed up using cancer registries. SUBJECTS Patients with IR adenoma(s) (three or four small adenomas or one or two large adenomas). PRIMARY OUTCOMES Advanced adenoma (AA) and CRC detected at follow-up visits, and CRC incidence after baseline and first follow-up. METHODS The effects of surveillance on long-term CRC incidence and of interval length on findings at follow-up were examined using proportional hazards and logistic regression, adjusting for patient, procedural and polyp characteristics. Lower-intermediate-risk (LIR) subgroups and higher-intermediate-risk (HIR) subgroups were defined, based on predictors of CRC risk. A model-based cost-utility analysis compared 13 surveillance strategies. Between-group analyses of variance were used to test for differences in bowel cancer worry between screening outcome groups (n = 35,700). A limitation of using routine hospital data is the potential for missed examinations and underestimation of the effect of interval and surveillance. RESULTS In the hospital data set, 168 CRCs occurred during 81,442 person-years (pys) of follow-up [206 per 100,000 pys, 95% confidence interval (CI) 177 to 240 pys]. One surveillance significantly lowered CRC incidence, both overall [hazard ratio (HR) 0.51, 95% CI 0.34 to 0.77] and in the HIR subgroup (n = 9265; HR 0.50, 95% CI 0.34 to 0.76). In the LIR subgroup (n = 2679) the benefit of surveillance was less clear (HR 0.62, 95% CI 0.16 to 2.43). Additional surveillance lowered CRC risk in the HIR subgroup by a further 15% (HR 0.36, 95% CI 0.20 to 0.62). The odds of detecting AA and CRC at first follow-up (FUV1) increased by 18% [odds ratio (OR) 1.18, 95% CI 1.12 to 1.24] and 32% (OR 1.32, 95% CI 1.20 to 1.46) per year increase in interval, respectively, and the odds of advanced neoplasia at second follow-up increased by 22% (OR 1.22, 95% CI 1.09 to 1.36), after adjustment. Detection rates of AA and CRC remained below 10% and 1%, respectively, with intervals to 3 years. In the screening data set, 32 CRCs occurred during 25,745 pys of follow-up (124 per 100,000 pys, 95% CI 88 to 176 pys). One follow-up conferred a significant 73% reduction in CRC incidence (HR 0.27, 95% CI 0.10 to 0.71). Owing to the small number of end points in this data set, no other outcome was significant. Although post-screening bowel cancer worry was higher in people who were offered surveillance, worry was due to polyp detection rather than surveillance. The economic evaluation, using data from the hospital data set, suggested that 3-yearly colonoscopic surveillance without an age cut-off would produce the greatest health gain. CONCLUSIONS A single surveillance benefited all IR patients by lowering their CRC risk. We identified a higher-risk subgroup that benefited from further surveillance, and a lower-risk subgroup that may require only one follow-up. A surveillance interval of 3 years seems suitable for most IR patients. These findings should be validated in other studies to confirm whether or not one surveillance visit provides adequate protection for the lower-risk subgroup of intermediate-risk patients. STUDY REGISTRATION Current Controlled Trials ISRCTN15213649. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Wendy Atkin
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Amy Brenner
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jessica Martin
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Katherine Wooldrage
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Urvi Shah
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Fiona Lucas
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Greliak
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Pack
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ines Kralj-Hans
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ann Thomson
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sajith Perera
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jill Wood
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Centre, University College London, London, UK
| | - Benjamin Kearns
- School of Health and Related Research (ScHARR), Health Economics and Decision Science Section, University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- School of Health and Related Research (ScHARR), Health Economics and Decision Science Section, University of Sheffield, Sheffield, UK
| | - Jonathan Myles
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Allison KH, Rendi MH, Peacock S, Morgan T, Elmore JG, Weaver DL. Histological features associated with diagnostic agreement in atypical ductal hyperplasia of the breast: illustrative cases from the B-Path study. Histopathology 2016; 69:1028-1046. [PMID: 27398812 DOI: 10.1111/his.13035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/08/2016] [Indexed: 01/26/2023]
Abstract
AIMS This study examined the case-specific characteristics associated with interobserver diagnostic agreement in atypical ductal hyperplasia (ADH) of the breast. METHODS AND RESULTS Seventy-two test set cases with a consensus diagnosis of ADH from the B-Path study were evaluated. Cases were scored for 17 histological features, which were then correlated with the participant agreement with the consensus ADH diagnosis. Participating pathologists' perceptions of case difficulty, borderline features or whether they would obtain a second opinion were also examined for associations with agreement. Of the 2070 participant interpretations of the 72 consensus ADH cases, 48% were scored by participants as difficult and 45% as borderline between two diagnoses; the presence of both of these features was significantly associated with increased agreement (P < 0.001). A second opinion would have been obtained in 80% of interpretations, and this was associated with increased agreement (P < 0.001). Diagnostic agreement ranged from 10% to 89% on a case-by-case basis. Cases with papillary lesions, cribriform architecture and obvious cytological monotony were associated with higher agreement. Lower agreement rates were associated with solid or micropapillary architecture, borderline cytological monotony, or cases without a diagnostic area that was obvious on low power. CONCLUSIONS The results of this study suggest that pathologists frequently recognize the challenge of ADH cases, with some cases being more prone to diagnostic variability. In addition, there are specific histological features associated with diagnostic agreement on ADH cases. Multiple example images from cases in this test set are provided to serve as educational illustrations of these challenges.
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Affiliation(s)
- Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mara H Rendi
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Tom Morgan
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Donald L Weaver
- Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
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Kuijpers CCHJ, Sluijter CE, von der Thüsen JH, Grünberg K, van Oijen MGH, van Diest PJ, Jiwa M, Nagtegaal ID, Overbeek LIH, Willems SM. Interlaboratory variability in the grading of dysplasia in a nationwide cohort of colorectal adenomas. Histopathology 2016; 69:187-97. [DOI: 10.1111/his.12923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/21/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Chantal C H J Kuijpers
- Department of Pathology; University Medical Centre Utrecht; Utrecht The Netherlands
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
- Symbiant Pathology Expert Centre; Alkmaar The Netherlands
| | - Caro E Sluijter
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
- Department of Pathology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Jan H von der Thüsen
- Department of Pathology; Erasmus Medical Centre; Rotterdam The Netherlands
- NVVP (Dutch Society of Pathology); Utrecht The Netherlands
| | - Katrien Grünberg
- NVVP (Dutch Society of Pathology); Utrecht The Netherlands
- Department of Pathology; VU University Medical Centre; Amsterdam The Netherlands
| | - Martijn G H van Oijen
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
- Department of Medical Oncology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Paul J van Diest
- Department of Pathology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Mehdi Jiwa
- Department of Pathology; University Medical Centre Utrecht; Utrecht The Netherlands
- Symbiant Pathology Expert Centre; Alkmaar The Netherlands
| | - Iris D Nagtegaal
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
- Department of Pathology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Lucy I H Overbeek
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
| | - Stefan M Willems
- Department of Pathology; University Medical Centre Utrecht; Utrecht The Netherlands
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
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Din S, Ball AJ, Taylor E, Rutter M, Riley SA, Johal S. Polypectomy practices of sub-centimeter polyps in the English Bowel Cancer Screening Programme. Surg Endosc 2015; 29:3224-30. [PMID: 25591413 DOI: 10.1007/s00464-015-4064-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/05/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most colonic polyps are small, and several polypectomy techniques are available. We aimed to describe the variation in polypectomy techniques employed for the removal of sub-centimeter polyps in relation to polyp characteristics, completeness of histological excision and safety. METHODS Prospectively collected data relating to the removal of sub-centimeter polyps over a 3-year period (between January 2010 and December 2012) were retrieved from the English Bowel Cancer Screening Programme. RESULTS A total of 147,174 sub-centimeter polyps were removed during 62,679 procedures. For pedunculated polyps, hot snare was most common in the left (median 92 %, IQR 83.3-97.0 %) and right colon (median 75 %, IQR 3-92 %). For non-pedunculated polyps, cold snare was most common in the right colon (median 24 %, IQR 9-47 %); whereas hot snare remained most common in the left colon (median 32 %, IQR 19-49 %). Surgeons were more likely than physicians to use diathermy-assisted techniques (65.6 vs. 56.5 %, p < 0.001). Twelve (0.03 %) bleeding episodes required transfusion with no polypectomy technique dominating and 16 (0.04 %) perforations with 81 % of polypectomies performed using diathermy-assisted techniques. There was substantial variation between screening centers for the completeness of histological excision. For non-pedunculated polyps, histologically confirmed complete excision was more after EMR (23.4 %) compared with other techniques (cold biopsy forceps 17.7 %, cold snare 15.1 %, hot biopsy forceps 19.1 %, hot snare 21.5 %). The use of cold techniques and EMR has increased over time, whereas the use of hot biopsy forceps and hot snare has decreased (p < 0.001). CONCLUSIONS The removal of sub-centimeter polyps within the BCSP is safe despite wide variations in practice. The use of cold resection techniques and EMR has increased over time. The histological assessment for completeness of excision is limited and should be confirmed endoscopically at the time of polypectomy.
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Affiliation(s)
- Said Din
- Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK.
- Department of Oncology, University of Sheffield Medical School, Sheffield, UK.
| | - Alex J Ball
- Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK
- Department of Oncology, University of Sheffield Medical School, Sheffield, UK
| | - Eleanor Taylor
- Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK
| | - Matthew Rutter
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
- Durham University Medicine, Durham, UK
| | - Stuart A Riley
- Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK
| | - Shawinder Johal
- Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK
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Osmond A, Li-Chang H, Kirsch R, Divaris D, Falck V, Liu DF, Marginean C, Newell K, Parfitt J, Rudrick B, Sapp H, Smith S, Walsh J, Wasty F, Driman DK. Interobserver variability in assessing dysplasia and architecture in colorectal adenomas: a multicentre Canadian study. J Clin Pathol 2014; 67:781-6. [PMID: 25004943 DOI: 10.1136/jclinpath-2014-202177] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Following the introduction of colorectal cancer screening programmes throughout Canada, it became necessary to standardise the diagnosis of colorectal adenomas. Canadian guidelines for standardised reporting of adenomas were developed in 2011. The aims of the present study were (a) to assess interobserver variability in the classification of dysplasia and architecture in adenomas and (b) to determine if interobserver variability could be improved by the adoption of criteria specified in the national guidelines. METHODS An a priori power analysis was used to determine an adequate number of cases and participants. Twelve pathologists independently classified 40 whole-slide images of adenomas according to architecture and dysplasia grade. Following a wash-out period, participants were provided with the national guidelines and asked to reclassify the study set. RESULTS At baseline, there was moderate interobserver agreement for architecture (K=0.4700; 95% CI 0.4427 to 0.4972) and dysplasia grade (K=0.5680; 95% CI 0.5299 to 0.6062). Following distribution of the guidelines, there was improved interobserver agreement in assessing architecture (K=0.5403; 95% CI 0.5133 to 0.5674)). For dysplasia grade, overall interobserver agreement remained moderate but decreased significantly (K=0.4833; 95% CI 0.4452 to 0.5215). Half of the cases contained high-grade dysplasia (HGD). Two pathologists diagnosed HGD in ≥75% of cases. CONCLUSIONS The improvement in interobserver agreement in classifying adenoma architecture suggests that national guidelines can be useful in disseminating knowledge, however, the variability in the diagnosis of HGD, even following guideline review suggests the need for ongoing knowledge-transfer exercises.
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Chausserie S, Levillain R, Puvinel J, Ferrand O, Ruiz A, Raginel T, Lantieri O, Launoy G, Guittet L. Seasonal variations do not affect the superiority of fecal immunochemical tests over guaiac tests for colorectal cancer screening. Int J Cancer 2014; 136:1827-34. [DOI: 10.1002/ijc.29187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/06/2014] [Accepted: 08/12/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Sébastien Chausserie
- Centre Hospitalier Universitaire (CHU) de Caen, Evaluations et recherches en épidémiologie; Caen
- Normandie University; Caen
- Université de Caen Basse-Normandie (UCBN), Cancers and Preventions; Caen
- INSERM U1086, Cancers and preventions; Caen
| | - Romuald Levillain
- Institut InterRégional pour la Santé (IRSA) de Tours, Centre de lecture des tests de recherche de sang dans les selles; La Riche France
| | - Josette Puvinel
- Association Bourbonnaise Interdépartementale de Dépistage des Cancers (ABIDEC); Moulins
| | - Olivier Ferrand
- Action de Dépistage Organisé des Cancers 18 (ADOC18); Saint-Doulchard
| | - Angela Ruiz
- Institut InterRégional pour la Santé (IRSA) de Tours, Centre de lecture des tests de recherche de sang dans les selles; La Riche France
| | - Thibaut Raginel
- Centre Hospitalier Universitaire (CHU) de Caen, Evaluations et recherches en épidémiologie; Caen
- Normandie University; Caen
- Université de Caen Basse-Normandie (UCBN), Cancers and Preventions; Caen
- INSERM U1086, Cancers and preventions; Caen
| | - Olivier Lantieri
- Institut InterRégional pour la Santé (IRSA) de Tours, Centre de lecture des tests de recherche de sang dans les selles; La Riche France
| | - Guy Launoy
- Centre Hospitalier Universitaire (CHU) de Caen, Evaluations et recherches en épidémiologie; Caen
- Normandie University; Caen
- Université de Caen Basse-Normandie (UCBN), Cancers and Preventions; Caen
- INSERM U1086, Cancers and preventions; Caen
| | - Lydia Guittet
- Centre Hospitalier Universitaire (CHU) de Caen, Evaluations et recherches en épidémiologie; Caen
- Normandie University; Caen
- Université de Caen Basse-Normandie (UCBN), Cancers and Preventions; Caen
- INSERM U1086, Cancers and preventions; Caen
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Allison KH, Reisch LM, Carney PA, Weaver DL, Schnitt SJ, O'Malley FP, Geller BM, Elmore JG. Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel. Histopathology 2014; 65:240-51. [PMID: 24511905 DOI: 10.1111/his.12387] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/03/2014] [Indexed: 11/30/2022]
Abstract
AIMS To gain a better understanding of the reasons for diagnostic variability, with the aim of reducing the phenomenon. METHODS AND RESULTS In preparation for a study on the interpretation of breast specimens (B-PATH), a panel of three experienced breast pathologists reviewed 336 cases to develop consensus reference diagnoses. After independent assessment, cases coded as diagnostically discordant were discussed at consensus meetings. By the use of qualitative data analysis techniques, transcripts of 16 h of consensus meetings for a subset of 201 cases were analysed. Diagnostic variability could be attributed to three overall root causes: (i) pathologist-related; (ii) diagnostic coding/study methodology-related; and (iii) specimen-related. Most pathologist-related root causes were attributable to professional differences in pathologists' opinions about whether the diagnostic criteria for a specific diagnosis were met, most frequently in cases of atypia. Diagnostic coding/study methodology-related root causes were primarily miscategorizations of descriptive text diagnoses, which led to the development of a standardized electronic diagnostic form (BPATH-Dx). Specimen-related root causes included artefacts, limited diagnostic material, and poor slide quality. After re-review and discussion, a consensus diagnosis could be assigned in all cases. CONCLUSIONS Diagnostic variability is related to multiple factors, but consensus conferences, standardized electronic reporting formats and comments on suboptimal specimen quality can be used to reduce diagnostic variability.
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Affiliation(s)
- Kimberly H Allison
- Department of Pathology, University of Washington Medical Center, Seattle, WA, USA
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Turner JK, Williams GT, Morgan M, Wright M, Dolwani S. Interobserver agreement in the reporting of colorectal polyp pathology among bowel cancer screening pathologists in Wales. Histopathology 2013; 62:916-24. [PMID: 23611360 DOI: 10.1111/his.12110] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 02/06/2013] [Indexed: 12/27/2022]
Abstract
AIMS To assess the interobserver agreement in the reporting of colorectal polyps among histopathologists participating in the Welsh Bowel Cancer Screening (BCS) programme. METHODS AND RESULTS Twelve benign polyps representative of BCS cases were identified from pathology files and reported by 28 BCS histopathologists using proforma sheets. The level of agreement between the participants and a gold standard was determined using kappa (κ) statistics. A moderate level of agreement was achieved in the reporting of polyp type [κ = 0.45; 95% confidence interval (CI) 0.34-0.59] and adenomatous lesions were distinguished from non-adenomatous lesions in 96% of cases. Substantial agreement was obtained in distinguishing low- and high-grade dysplasias (κ = 0.67; 95% CI 0.50-0.86), but there was only fair agreement in reporting excision margin status (κ = 0.24; 95% CI 0.07-0.43) with frequent use of the 'uncertain' category. Significant issues included categorizing serrated lesions, recognizing focal high-grade dysplasia and epithelial misplacement, and apparent overdiagnosis of villous change in adenomas. CONCLUSIONS Interobserver variability in some aspects of reporting colorectal polyps by BCS pathologists is suboptimal, with a potential impact upon patient management and the efficient running of the screening service. Approaches to addressing this are discussed.
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Affiliation(s)
- Jeff K Turner
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
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Leuraud K, Jezewski-Serra D, Viguier J, Salines E. Colorectal cancer screening by guaiac faecal occult blood test in France: Evaluation of the programme two years after launching. Cancer Epidemiol 2013; 37:959-67. [PMID: 24035240 DOI: 10.1016/j.canep.2013.07.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/27/2013] [Accepted: 07/31/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The French national screening programme for colorectal cancer (CRC) was rolled out nationwide from 2008. It targets men and women aged 50-74 who are invited every 2 years to perform a guaiac faecal occult blood test, followed, if positive, by a colonoscopy. This paper presents the evaluation of the programme for the 46 French districts that conducted a comprehensive screening campaign during 2008-2009, targeting 9.7 million people. METHODS National database gathering information on people who were screened was used to estimate indicators reflecting the programme performance. RESULTS Participation was 34.3%, with nearly three million people being tested. The percentage of positive tests was 2.8%. Completion of colonoscopies following a positive test was 88%. For men, 36.8% of the results of colonic explorations were normal, 40.1% were adenomas, and 9.0% were CRC, based on the most pejorative lesion. For women, corresponding figures were 55.9%, 25.7% and 5.8%. A CRC was detected for 7.5% of people who had a colonic exploration. The advanced adenoma detection rate among those screened was 4.9‰ and the CRC detection rate was 1.9‰. The description of CRC could only be made for 21 districts, for which 1441 invasive colonic adenocarcinomas were diagnosed; of these, 43% were stage I, 23% stage II, 25% stage III and 9% stage IV. CONCLUSION This first evaluation since the programme was rolled out provides an inventory of CRC screening in France and points out some improvements expected, especially in terms of participation which is below the European recommendations. Future evaluations will analyse trends in these indicators.
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Affiliation(s)
- Klervi Leuraud
- Department of Chronic Diseases and Injuries, French Institute for Public Health Surveillance, Saint-Maurice, France
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