TY - JOUR
T1 - Guidance for setting easy-to-adopt competence criteria for optical diagnosis of diminutive colorectal polyps: a simulation approach
AU - Houwen, Britt B. S. L.
AU - Greuter, Marjolein J. E.
AU - Vleugels, Jasper L. A.
AU - Hazewinkel, Yark
AU - Bisschops, Raf
AU - Dekker, Evelien
AU - Coupé, Veerle M. H.
N1 - Funding Information: We thank the participants of the ESGE guideline working group on advanced imaging for detection and differentiation of colorectal neoplasia (Cesare Hassan, Emmanuel Coron, George Cortas, Giulio Antonelli, Gaius Longcroft-Wheaton, Helmut Neumann, Ignasi Puig, James East, Marco Bustamante Bal?n, Maria Pellis?, Marietta Iacucci, Micha? Kami?ski, Nastazaja Pilonis, and Serguei Mouzyka) for their valuable comments during the ESGE meeting held in Prague, Czech Republic on April 3, 2019. We also thank Patrick Bossuyt (Academic Medical Center, Amsterdam, Netherlands), Ard den Heeten (Academic Medical Center, Amsterdam, Netherlands), and Piet van Kalken (LRCB Dutch Expert Centre for Screening) for sharing their expertise. In addition, we thank the DISCOUNT and COCOS study group for the data collection. Last, a sincere thank you to Daisy Jones and Kirsten Schut for their diligent proofreading of this manuscript. DISCLOSURE: The following authors disclosed financial relationships: R. Bisschops: Consultant for Pentax, Fujifilm, GI Supply, Norgine, Ipsen, Medtronic, and Cook; research grants from Pentax and Fujifilm; speaker for Pentax and Fujifilm. E. Dekker: Equipment on loan from Olympus and Fujifilm; research grant from Fujifilm; consultant for Tillots, Fujifilm, GI Supply, CPP-FAP, and PAION; speaker for Roche, Norgine, and GI Supply. All other authors disclosed no financial relationships. Funding Information: DISCLOSURE: The following authors disclosed financial relationships: R. Bisschops: Consultant for Pentax, Fujifilm, GI Supply, Norgine, Ipsen, Medtronic, and Cook; research grants from Pentax and Fujifilm; speaker for Pentax and Fujifilm. E. Dekker: Equipment on loan from Olympus and Fujifilm; research grant from Fujifilm; consultant for Tillots, Fujifilm, GI Supply, CPP-FAP, and PAION; speaker for Roche, Norgine, and GI Supply. All other authors disclosed no financial relationships. Publisher Copyright: © 2021 American Society for Gastrointestinal Endoscopy
PY - 2021/10
Y1 - 2021/10
N2 - Background and Aims: One reason the optical diagnosis strategy for diminutive colorectal polyps has not yet been implemented is that the current competence criteria (Preservation and Incorporation of Valuable Endoscopic Innovation [PIVI] initiative) are difficult to use in daily practice. To provide guidance for setting alternative easy-to-adopt competence criteria, we determined the lowest proportion of diminutive polyps that should have a correct optical diagnosis to meet the PIVI. Methods: For this simulation study, we used datasets from 2 prospectively collected cohorts of patients who underwent colonoscopy in either a primary colonoscopy or fecal immunochemical test (FIT) screening setting. In the simulation approach, virtual endoscopists or computer-aided diagnosis systems performed optical diagnosis of diminutive polyps with a fixed diagnostic performance level (strategy) on all individuals in the cohort who had ≥1 diminutive polyp. Strategies were defined by systematically varying the proportion of correct optical diagnoses for each polyp subtype (ie, adenomas, hyperplastic polyps, sessile serrated lesions). For each strategy, we determined whether PIVI-1 (≥90% agreement with U.S. or European Society for Gastrointestinal Endoscopy [ESGE] surveillance guidelines) and PIVI-2 (≥90% negative predictive value [NPV] for neoplastic lesions in the rectosigmoid) were met using Monte Carlo sampling with 1000 repetitions, with histology as reference. Results: The level of overall diagnostic accuracy to achieve the PIVI differed significantly depending on the clinical setting and guidelines used. In the colonoscopy screening setting, all diagnostic strategies in which 92% of all diminutive polyps (regardless of histology) were diagnosed correctly led to 90% or more agreement with U.S. surveillance intervals (ie, PIVI-1). For all diagnostic strategies in which ≥89% of all diminutive polyps were correctly diagnosed, at least 90% NPV was achieved (ie, PIVI-2). For the FIT screening setting, values were respectively ≥77% and ≥94%. When using ESGE guidelines, PIVI-1 was in both settings already met when 40% of all diminutive polyps were diagnosed correctly. Conclusions: In contrast to the fixed PIVI criteria, our simulation study shows that different thresholds for the proportion of correctly diagnosed diminutive polyps lead to different clinical consequences depending on guidelines and clinical setting. However, this target proportion of diminutive colorectal polyps correctly diagnosed with optical diagnosis represents easier-to-adopt competence criteria.
AB - Background and Aims: One reason the optical diagnosis strategy for diminutive colorectal polyps has not yet been implemented is that the current competence criteria (Preservation and Incorporation of Valuable Endoscopic Innovation [PIVI] initiative) are difficult to use in daily practice. To provide guidance for setting alternative easy-to-adopt competence criteria, we determined the lowest proportion of diminutive polyps that should have a correct optical diagnosis to meet the PIVI. Methods: For this simulation study, we used datasets from 2 prospectively collected cohorts of patients who underwent colonoscopy in either a primary colonoscopy or fecal immunochemical test (FIT) screening setting. In the simulation approach, virtual endoscopists or computer-aided diagnosis systems performed optical diagnosis of diminutive polyps with a fixed diagnostic performance level (strategy) on all individuals in the cohort who had ≥1 diminutive polyp. Strategies were defined by systematically varying the proportion of correct optical diagnoses for each polyp subtype (ie, adenomas, hyperplastic polyps, sessile serrated lesions). For each strategy, we determined whether PIVI-1 (≥90% agreement with U.S. or European Society for Gastrointestinal Endoscopy [ESGE] surveillance guidelines) and PIVI-2 (≥90% negative predictive value [NPV] for neoplastic lesions in the rectosigmoid) were met using Monte Carlo sampling with 1000 repetitions, with histology as reference. Results: The level of overall diagnostic accuracy to achieve the PIVI differed significantly depending on the clinical setting and guidelines used. In the colonoscopy screening setting, all diagnostic strategies in which 92% of all diminutive polyps (regardless of histology) were diagnosed correctly led to 90% or more agreement with U.S. surveillance intervals (ie, PIVI-1). For all diagnostic strategies in which ≥89% of all diminutive polyps were correctly diagnosed, at least 90% NPV was achieved (ie, PIVI-2). For the FIT screening setting, values were respectively ≥77% and ≥94%. When using ESGE guidelines, PIVI-1 was in both settings already met when 40% of all diminutive polyps were diagnosed correctly. Conclusions: In contrast to the fixed PIVI criteria, our simulation study shows that different thresholds for the proportion of correctly diagnosed diminutive polyps lead to different clinical consequences depending on guidelines and clinical setting. However, this target proportion of diminutive colorectal polyps correctly diagnosed with optical diagnosis represents easier-to-adopt competence criteria.
KW - Adenoma/diagnostic imaging
KW - Colon/pathology
KW - Colonic Polyps/diagnostic imaging
KW - Colonoscopy
KW - Colorectal Neoplasms/diagnostic imaging
KW - Humans
KW - Narrow Band Imaging
KW - Predictive Value of Tests
KW - Rectum
UR - http://www.scopus.com/inward/record.url?scp=85110480141&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.gie.2021.04.008
DO - https://doi.org/10.1016/j.gie.2021.04.008
M3 - Article
C2 - 33887268
SN - 0016-5107
VL - 94
SP - 812-822.e43
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 4
ER -