Background and Aims

Optical diagnosis (OD) of polyps can be performed with advanced endoscopic imaging. For high-confidence diagnoses, a “resect and discard” strategy could offer significant histopathology time and cost savings. The implementation threshold is a ≥90% OD-histology surveillance interval concordance. Here we assessed the OD learning curve and feasibility of a resect and discard strategy for ≤5-mm and <10-mm polyps in a bowel cancer screening setting.

Methods

In this prospective feasibility study, 8 bowel cancer screening endoscopists completed a validated OD training module and performed procedures. All <10-mm consecutive polyps had white-light and narrow-band images taken and were given high- or low-confidence diagnoses until 120 high-confidence ≤5-mm polyp diagnoses had been performed. All polyps had standard histology. High-confidence OD errors underwent root-cause analysis. Histology and OD-derived surveillance intervals were calculated.

Results

Of 565 invited patients, 525 patients were included. A total of 1560 <10-mm polyps underwent OD and were resected and retrieved (1329 ≤5 mm and 231 6-9 mm). There were no <10-mm polyp cancers. High-confidence OD was accurate in 81.5% of ≤5-mm and 92.8% of 6-9-mm polyps. Sensitivity for OD of a ≤5-mm adenoma was 93.0% with a positive predictive value of 90.8%. OD-histology surveillance interval concordance for ≤5-mm OD was 91.3% (209/229) for U.S. Multi-Society Task Force, 98.3% (225/229) for European Society of Gastrointestinal Endoscopy, and 98.7% (226/229) for British Society of Gastroenterology guidelines, respectively.

Conclusions

A resect and discard strategy for high-confidence ≤5-mm polyp OD in a group of bowel cancer screening colonoscopists is feasible and safe, with performance exceeding the 90% surveillance interval concordance required for implementation in clinical practice. (Clinical trial registration number: NCT04710693.)

中文翻译：

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在临床实践中采用“切除和丢弃”策略实施光学诊断：DISCARD3 研究

背景和目标

息肉的光学诊断 (OD) 可以通过先进的内窥镜成像进行。对于高置信度诊断，“切除并丢弃”策略可以显着节省组织病理学时间和成本。实施阈值是 ≥ 90% 的 OD-组织学监测间隔一致性。在这里，我们评估了 OD 学习曲线和在肠癌筛查环境中对 ≤ 5 毫米和 < 10 毫米息肉的切除和丢弃策略的可行性。

方法

在这项前瞻性可行性研究中，8 名肠癌筛查内镜医师完成了经过验证的 OD 培训模块并执行了程序。所有小于 10 毫米的连续息肉都拍摄了白光和窄带图像，并给出了高置信度或低置信度诊断，直到执行了 120 个高置信度 ≤ 5 毫米息肉诊断。所有息肉都有标准的组织学。高置信度 OD 错误进行了根本原因分析。计算组织学和 OD 衍生的监测间隔。

结果

在 565 名受邀患者中，525 名患者被纳入。共有 1560 个 <10 毫米息肉接受了 OD 并被切除和回收（1329 个≤5 毫米和 231 个 6-9 毫米）。没有小于 10 毫米的息肉癌。高置信度 OD 在 ≤5 毫米的息肉中准确率为 81.5%，在 6-9 毫米的息肉中准确率为 92.8%。≤5 mm 腺瘤的 OD 的敏感性为93.0%，阳性预测值为 90.8%。≤5mm OD 的 OD 组织学监测间隔一致性在美国多社会工作组中为 91.3% (209/229)，在欧洲胃肠内窥镜学会中为 98.3% (225/229)，在欧洲胃肠内窥镜检查中为 98.7% (226/229)分别适用于英国胃肠病学会指南。

结论

在一组肠癌筛查结肠镜医师中，针对高置信度 ≤ 5 毫米息肉 OD 的切除和丢弃策略是可行且安全的，性能超过临床实践中实施所需的 90% 监测间隔一致性。（临床试验注册号：NCT04710693。）