Post written by Mayenaaz Sidhu, MBBS, from the Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.

This study was conducted to evaluate the incremental benefit of dye-based chromoendoscopy (DBC) to predict the risk of submucosal invasive cancer (SMIC) for large nonpedunculated colorectal polyps (LNPCPs) among independent observers.

Real-time optical evaluation of the lesion’s surface pit and microvascular pattern is critical in LNPCP management because it stratifies lesions at risk for SMIC. Virtual chromoendoscopy (VCE) is widely available and significantly less resource intensive than DBC.

To date, however, studies evaluating the comparative performance of these 2 modalities for lesion assessment for LNPCPs are lacking. In this study, we sought to evaluate the diagnostic performance of VCE and high-definition white-light imaging (HDWL) and the incremental benefit associated with the addition of DBC for prediction of SMIC within LNPCPs.

This prospective study of 400 consecutive lesions demonstrates the use of DBC in addition to VCE and HDWL does not provide any incremental benefit for assessment of SMIC within LNPCPs. In addition, the study highlights the importance of recognizing the presence of a demarcated area on the surface of LNPCPs, where the regular surface pit pattern appears disordered, as a marker of advanced histology.

This study is the first to provide a direct comparison between dye-based and VCE for lesion assessment on the surface of LNPCPs. We have demonstrated VCE and HDWL are alone adequate in predicting the risk of SMIC on the surface of LNPCPs.

This study, however, does not address the expanding role of artificial intelligence technologies for lesion assessment, possibly presenting an avenue for future research.

Examples of large nonpedunculated colorectal polyps with a central area of pit pattern disruption (A-F) consistent with a demarcated area.

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