Endoscopy 2019; 51(04): S93
DOI: 10.1055/s-0039-1681444
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 08:30 – 10:30: Colonic polyps: characterization Club D
Georg Thieme Verlag KG Stuttgart · New York

A CRITICAL EVALUATION OF THE HAZEWINKEL CRITERIA FOR THE OPTICAL DIAGNOSIS OF SESSILE SERRATED LESIONS (SSL) AT THE BEGINNING OF A LEARNING PROCESS

M Bustamante-Balen
1   La Fe Polytechnic University Hospital, Gastrointestinal Endoscopy Unit, Valencia, Spain
2   La Fa Health Research Institute, Gastrointestinal Endoscopy Research Group, Valencia, Spain
,
C Satorres
1   La Fe Polytechnic University Hospital, Gastrointestinal Endoscopy Unit, Valencia, Spain
2   La Fa Health Research Institute, Gastrointestinal Endoscopy Research Group, Valencia, Spain
,
M García-Campos
1   La Fe Polytechnic University Hospital, Gastrointestinal Endoscopy Unit, Valencia, Spain
,
N García-Morales
1   La Fe Polytechnic University Hospital, Gastrointestinal Endoscopy Unit, Valencia, Spain
,
N Alonso
1   La Fe Polytechnic University Hospital, Gastrointestinal Endoscopy Unit, Valencia, Spain
2   La Fa Health Research Institute, Gastrointestinal Endoscopy Research Group, Valencia, Spain
,
M Ponce
1   La Fe Polytechnic University Hospital, Gastrointestinal Endoscopy Unit, Valencia, Spain
2   La Fa Health Research Institute, Gastrointestinal Endoscopy Research Group, Valencia, Spain
,
C Sanchez-Montes
1   La Fe Polytechnic University Hospital, Gastrointestinal Endoscopy Unit, Valencia, Spain
,
V Pons
1   La Fe Polytechnic University Hospital, Gastrointestinal Endoscopy Unit, Valencia, Spain
2   La Fa Health Research Institute, Gastrointestinal Endoscopy Research Group, Valencia, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

 

Aims:

  1. To describe how the main characteristics of the Hazewinkel criteria for SS are identified by a group of non-experienced endoscopists;

  2. To identify which combination of characteristics identifies with more reliability a SSL in a learning background.

Methods:

Prospective study in the setting of a population-based CRC screening program. Six endoscopists attended a short session on optical diagnosis of SSL. For every lesion all endoscopists described the presence of the Hazewinkel criteria (cloud appearance, irregular shape, indistinct limits and black dots) and categorized lesions following the NICE classification. The presence of ≥2 criteria was considered diagnostic of SSL.

Results:

A total of 2505 lesions were included. Among them, 116 (4.6%) SSL were identified [median size (SD) 4 (6.2); proximal location 68 (58.6%)]. Accuracy of ≥2 criteria for the diagnosis of SSP was 0.93. Overall positive predictive value (PPV) was 0.25 without differences among endoscopists, while the NICE PPV for adenoma was 0.84. The frequency of identification of each criterion in every SSLs was: cloud-like surface 45 (38.8%), irregular shape 27 (23.3%), indistinctive borders 30 (25.9%) and black dots 14 (12.1%). All criteria were more prevalent in SSL > 10 mm. The proportion of SSL diagnosed in lesions harboring each criteria combination is summarized in Tab. 1.

Tab. 1:

Proportion of SSL diagnosed in lesions harboring each criteria combination

NICE1

NICE2

Size 1 – 10 mm

Size > 10 mm

Cloud-like +irregular shape

28.6

12.5

5.6

28.6

Cloud-like + indistictive borders

50.0

-

36.4

100

Cloud-like+black dots

25.0

-

20.0

-

Cloud-like+irregular shape+indictinctive borders

35.3

25.0

22.9

57.1

Conclusions:

  1. A great proportion of SSL does not have the optical diagnosis criteria;

  2. The identification of the Hazewinkel criteria improves with size and NICE1 lesions.

  3. Cloud-like surface is the most prevalent characteristic found in SSL.