CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(03): E257-E265
DOI: 10.1055/a-1072-4853
Original article
Owner and Copyright © Georg Thieme Verlag KG 2020

Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

Alouisa J.P. van de Wetering
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
2  GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Lonne W.T. Meulen*
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
2  GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Roel M.M. Bogie*
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
2  GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Quirine E.W. van der Zander
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
2  GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Ankie Reumkens
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
2  GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
3  Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, The Netherlands
,
Bjorn Winkens
4  Department of Methodology and Statistics, Maastricht University
5  CAPHRI, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
,
Hao Ran Cheng
6  Department of Gastroenterology, Máxima Medical Center, Veldhoven, The Netherlands
,
Jan-Willem A. Straathof
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
6  Department of Gastroenterology, Máxima Medical Center, Veldhoven, The Netherlands
,
Evelien Dekker
7  Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Centre, Amsterdam, The Netherlands
,
Eric Keulen
3  Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, The Netherlands
,
C. M. Bakker
3  Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, The Netherlands
,
Chantal Hoge
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Rogier de Ridder
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Ad A.M. Masclee
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
8  NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
,
Silvia Sanduleanu-Dascalescu
1  Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
2  GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted 05 August 2019

accepted after revision 18 November 2019

Publication Date:
21 February 2020 (online)

Abstract

Background and study aims Implementation of optical diagnosis of diminutive polyps may potentially increase the efficacy and cost-effectiveness of colonoscopies. To adopt such strategy in clinical practice, the Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) thresholds provide the basis to be met: ≥ 90 % negative predictive value (NPV) for diagnosis of adenomatous histology and ≥ 90 % agreement on surveillance intervals. We evaluated this within the Dutch Bowel Cancer Screening Program (BCSP).

Patients and methods Endoscopic and histological data were collected from participants of the national bowel cancer screening program with an unfavorable fecal immunochemical test referred for colonoscopy between February 2014 and August 2015 at four endoscopy centers. The “resect and discard” scenario was studied, resecting diminutive polyps without histological evaluation. Agreement between optical diagnosis and histological diagnosis was measured for surveillance intervals according to Dutch, European and American post-polypectomy surveillance guideline.

Results Fifteen certified endoscopists participated in this study and included 3028 diminutive polyps. In 2,330 patients both optical and histological diagnosis were available. Optical diagnosis of diminutive polyps showed NPV of 84 % (95 % CI 80–87) for adenomatous histology in the rectosigmoid. Applying the ‘resect and discard’ strategy resulted in 90.6 %, 91.2 %, 90.9 % agreement on surveillance intervals for the Dutch, European and American guideline respectively.

Conclusion Our data representing current clinical practice in the Dutch BCSP practice on optical diagnosis of diminutive polyps showed that accuracy of predicting histology remains challenging, and risk of incorrect optical diagnosis is still significant. Therefore, it is too early to safely implement these strategies.

* These authors contributed equally.


Supplementary material