Endosc Int Open 2014; 02(03): E127-E132
DOI: 10.1055/s-0034-1377173
Original article
© Georg Thieme Verlag KG Stuttgart · New York

The accuracy of polyp assessment during colonoscopy in FIT-screening is not acceptable on a routine basis[1]

Inge Stegeman
1  Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, Netherlands
,
Sascha van Doorn
2  Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
,
Rosalie Mallant-Hent
3  Department of Gastroenterology and Hepatology, Flevoziekenhuis Almere, Netherlands
,
Manon van der Vlugt
2  Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
,
Marco Mundt
3  Department of Gastroenterology and Hepatology, Flevoziekenhuis Almere, Netherlands
,
Paul Fockens
2  Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
,
Patrick Bossuyt
1  Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, Netherlands
,
Evelien Dekker
2  Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
› Author Affiliations
Further Information

Publication History

submitted 25 May 2014

accepted after revision 22 April 2014

Publication Date:
23 June 2014 (online)

  

Background: During colonoscopy, correct assessment of polyps is important. Recognition of early carcinomas is needed for tailor-made treatment and avoidance of unnecessary complications. Moreover, accurate diagnosis of diminutive lesions could result in a safe resect and discard strategy. We assessed the accuracy of polyp assessment by general endoscopists without specific training or experience in image-enhanced endoscopy during routine colonoscopies within a fecal immunochemical test (FIT)-based screening program.

Methods: Data were collected in the third round of a FIT-based colorectal cancer screening pilot program. Patients diagnosed as FIT-positive (318) underwent colonoscopy using Olympus (160 and 180 series) endoscopes without magnification or routine use of (virtual) chromoendoscopy. Endoscopists received no special training. They made an on-site evaluation and classified detected polyps as hyperplastic, adenoma, carcinoma. Samples of resected lesions were sent for histopathology. Sensitivity and specificity were calculated. We differentiated for fellows and consultants.

Results: In the 318 patients with a positive FIT-screening result, 683 lesions were detected; 564 lesions were included in the analyses. The pathologist classified these lesions as 141 hyperplastic polyps, 349 adenomas, 16 carcinomas, and 58 other. Sensitivity for diagnosis of adenomas was 88 % (95 %CI 84 – 91); specificity 49 % (95 %CI 42 – 55). Of the 16 colorectal carcinomas, endoscopists diagnosed four incorrectly (sensitivity 75 % [95 %CI 44 – 89]; specificity 99 % [95 %CI 98 – 100]), including three stage I cancers and one stage III cancer. There were no differences in accuracy of diagnosis that related to different sizes of lesions or the experience of the endoscopist.

Conclusion: In a routine FIT-based screening setting and without specific training or routine use of (digital) chromoendoscopy, endoscopic prediction of the histopathology of colonic lesions is inaccurate when the procedure is performed by general endoscopists.

1 Funding: The study was supported by a grant from The Netherlands Organization for Health Research and Development of the Dutch Ministry of Health (ZonMW 12010095420).