Post written by Britt B.S.L. Houwen, MD, from the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Implementation of the optical diagnosis strategy for diminutive colorectal polyps by endoscopists and computer-aided diagnosis (CADx) systems is hampered as the current competence criteria [PIVI] are impractical to use in daily practice. To provide guidance for setting alternative easy-to-adopt competence criteria, we systematically determined the lowest proportion of diminutive polyps that should have a correct optical diagnosis to meet the currently used PIVI.
Our simulation study clearly showed that the proportion of correctly optically diagnosed diminutive polyps that is required to meet the PIVI depends on guidelines and clinical setting. We believe that this target proportion of correctly optically diagnosed diminutive colorectal polyps represents an easier-to-adopt and to measure competence criterion for optical diagnosis compared to the PIVI. The results of this study could serve as a general guidance for a consensus procedure by policy-making endoscopy societies to define alternative competence criteria for optical diagnosis.
Figure 3. The relation between the proportion of correctly optically diagnosed diminutive polyps (regardless of the histopathologic subtype) and the agreement with each PIVI Preservation and Incorporation of Valuable Endoscopic Innovation (PIVI) criterion in a colonoscopy (A-C) and fecal immunochemical test (FIT)-positive screening setting (D-F). The relation between the proportion of correctly diagnosed diminutive polyps (regardless of the histopathologic subtype) and (A and D) the surveillance interval agreement using U.S. surveillance guidelines, (B and E) the surveillance interval agreement using the European Society of Gastrointestinal Endoscopy (ESGE) surveillance guidelines, and (C and F) the negative predictive value (NPV) for neoplastic lesions in the rectosigmoid is shown. Each dot represents 1 of the 756 strategies, each with a different combination of proportions of correctly diagnosed adenomas, sessile serrated lesions, and hyperplastic polyps. The horizontal dotted lines represent achievement of a PIVI criterion. The upper graphs show the results for a colonoscopy screening program, whereas the lower graphs show the results in a FIT-positive screening program. It can be observed that with the same overall proportion of correctly diagnosed diminutive polyps, different surveillance interval agreements and NPVs are achieved. This is because with different combinations of proportions of correctly diagnosed polyp subtypes, the same proportion of correctly diagnosed polyps can be achieved but each with a different influence on surveillance interval agreement and NPV. The discontinuities in the graphs can be explained as follows: When we determined the 756 diagnostic performance strategies, larger interval steps were taken for lower proportions of correctly diagnosed diminutive polyps (eg, for diminutive adenomas in the range .40-.60 interval .2, in the range .60-.80 interval .02, in the range .90-1.00 interval .01). Thus, we did not evaluate the intermediate strategies resulting in discontinuities in the graph.
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