Background & Aims

Blue-light imaging (BLI) is a chromoendoscopy technique that uses direct (not filtered) emission of blue light with short wavelength (410 nm) to increase visibility of microvascular pattern and superficial mucosa. A BLI-based classification system for colorectal polyps (also called BLI Adenomas Serrated International Classification, BASIC) has been created and was validated using still images or short videos. We aimed to validate BASIC in a clinical practice setting, using thresholds recommended by the American Society for Gastrointestinal Endoscopy for the resect and discard strategy as the reference standard.

Methods

We studied 333 patients (mean age, 62.7±8.1 y; 176 men) who underwent screening colonoscopy from January through July 2019. Six endoscopists trained in BASIC participated in the study. All detected diminutive polyps were characterized by real-time BLI and categorized as adenoma or non-adenoma according to BASIC. All polyps were removed and evaluated by histopathology. The BLI-directed surveillance intervals (based on high-confidence characterization of polyps 5 mm or smaller and pathology feature for others) were compared with histology-directed surveillance intervals, according to United States Multi-society Task Force and European Society of Gastrointestinal Endoscopy recommendations. We calculated negative-predictive values of optical real-time analysis of diminutive rectosigmoid adenomas.

Results

When we applied BASIC, 748 polyps smaller than 5 mm were categorized with 89% accuracy (95% CI, 85.9%–90.6%). BLI-directed surveillance was correct for 90% of patients according to the United States Multi-society task force criteria (95% CI, 86%–93%) and for 96% of patients according to European Society of Gastrointestinal Endoscopy criteria (95% CI, 93%–97%). The negative-predictive value for 302 polyps smaller than 5 mm, located in the rectosigmoid colon and evaluated with high confidence, based on histologic features of adenomatous polyps, was 91% (95% CI, 85%–95%).

Conclusions

Our analysis of data from 333 patients undergoing screen colonoscopies supports the validity of BASIC discriminating diminutive colorectal polyps with histologic features of adenomas from non-adenomas. This allows for the implementation of the resect and discard strategy based on BLI in clinical practice. ClinicalTrials.gov no: NCT03746171.

中文翻译：

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小型结直肠息肉切除和丢弃策略基本分类的临床验证。

背景与目标

蓝光成像 (BLI) 是一种色素内窥镜技术，它使用短波长 (410 nm) 的蓝光直接（未过滤）发射来增加微血管图案和浅表粘膜的可见性。已经创建了基于 BLI 的结直肠息肉分类系统（也称为 BLI 锯齿状腺瘤国际分类，BASIC），并使用静止图像或短视频进行了验证。我们的目标是在临床实践环境中验证 BASIC，使用美国胃肠内镜学会推荐的切除和丢弃策略阈值作为参考标准。

方法

我们研究了从 2019 年 1 月到 2019 年 7 月接受结肠镜检查的 333 名患者（平均年龄为 62.7±8.1 岁；176 名男性）。六名接受过 BASIC 培训的内镜医师参与了这项研究。所有检测到的小息肉均以实时 BLI 为特征，并根据 BASIC 分类为腺瘤或非腺瘤。所有的息肉都被切除并通过组织病理学进行评估。根据美国多社会工作组和欧洲胃肠内镜学会的建议，将 BLI 指导的监测间隔（基于 5 毫米或更小的息肉的高置信度表征和其他人的病理学特征）与组织学指导的监测间隔进行比较. 我们计算了小型直肠乙状结肠腺瘤的光学实时分析的负预测值。

结果

当我们应用 BASIC 时，对 748 个小于 5 mm 的息肉进行分类，准确率为 89%（95% CI，85.9%–90.6%）。根据美国多社会工作组标准（95% CI，86%–93%）和根据欧洲胃肠内镜协会标准（95%置信区间，93%–97%）。根据腺瘤性息肉的组织学特征，302 个小于 5 mm 的息肉位于直肠乙状结肠并以高置信度进行评估，其阴性预测值为 91%（95% CI，85%–95%）。

结论

我们对 333 名接受结肠镜检查的患者的数据分析支持 BASIC 区分具有腺瘤和非腺瘤组织学特征的小型结直肠息肉的有效性。这允许在临床实践中实施基于 BLI 的切除和丢弃策略。ClinicalTrials.gov 编号：NCT03746171。