Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Abstract

Background The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1 – 5 mm). Methods A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80 % agreement was reached after a maximum of three voting rounds. Recommendation 1 In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 90 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm in the rectosigmoid. Histopathology is used as the gold standard.Level of agreement 95 %. Recommendation 2 In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 80 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm. Histopathology is used as the gold standard.Level of agreement 100 %. Conclusion The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps.

Artificial intelligence-assisted optical diagnosis for the resect-and-discard strategy in clinical practice: the Artificial intelligence BLI Characterization (ABC) study

“…Regarding accuracy parameters, diagnoses made both by the endoscopist alone and with AI assistance were able to achieve the PIVI criteria. This was not unexpected as approximately two-thirds of optical diagnoses were performed by expert endoscopists, who have been shown to match such criteria, irrespective of their use of AI [3,26,27]. However, the equivalent accuracy between pre-and post-AI endoscopist diagnoses should not be underestimated.…”

“…shown to match such criteria, irrespectively of the use of AI [3,26,27]. However, the equivalent accuracy between pre-and post-AI endoscopist diagnosis should not be undercut.…”

In vivo computer-aided diagnosis of colorectal polyps using white light endoscopy

“…Conversely, if we increase the allowed confidence value, less but more confident outputs will be provided, with the risk of missing some of the lesions without a prediction. The so-called Simple Optical Diagnosis Accuracy or SODA criteria, which were recently published by the ESGE Curricula Working Group 26 , are more flexible than the PIVI criteria and emphasize the importance of not leaving any diminutive lesion with advanced neoplasia in situ. In accordance with SODA criteria, we considered sensitivity to be the most important outcome of the intelligent system.…”

Methodological framework for development of competence standards for optical diagnosis in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

“…Criteria for selection will include the clinical relevance of the optical diagnosis competence standard. As a first step, in 2021, the ESGE task force on optical diagnosis competence standards for diminutive colorectal polyps was initiated (the resulting Position Statement is published in this issue [3]). We anticipate activating additional initiatives for other diseases managed by upper and lower gastrointestinal endoscopy.…”