Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study)

Backes, Yara; Schwartz, Matthijs P.; Borg, Frank ter; Wolfhagen, Frank H.J.; Groen, John N.; Cappel, Wouter H. de Vos tot Nederveen; Bergeijk, J.D. van; Geesing, Joost M J; Spanier, B.W.M.; Didden, Paul; Vleggaar, Frank P.; Laclé, Miangela M.; Elias, Sjoerd G.; Moons, Leon M.G.

doi:10.1136/gutjnl-2017-314723

Cited by 72 publications

(60 citation statements)

References 40 publications

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“…specificity 77.9 %) using imagebased analysis [18]. Although application of NBI for identification of T1b stage CRCs on non-magnified images may facilitate an improved performance of a CAD system, non-magnified NBI did not demonstrate excellent diagnostic performance (sensitivity 58.4 %, specificity 96.4 %) in the latest clinical trial [6]. Furthermore, any image-enhanced endoscopy including NBI is not so familiar to general colonoscopists and not universally used in routine colonoscopy.…”

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confidence: 98%

“…However, the accuracy of identifying protruding type CRCs was relatively low (82 %) even for experts [5]. In spite of using narrow band imaging (NBI), recent multicenter clinical trials of non-magnified colonoscopy failed to improve diagnostic performance for T1b lesions (sensitivity 63 % [6], 58 % [7]). These results suggest that it is still difficult to identify T1b CRCs based on non-magnified colonoscopic observation alone.…”

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confidence: 99%

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Diagnostic performance of artificial intelligence to identify deeply invasive colorectal cancer on non-magnified plain endoscopic images

et al. 2020

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Background and study aims Colorectal cancers (CRC) with deep submucosal invasion (T1b) could be metastatic lesions. However, endoscopic images of T1b CRC resemble those of mucosal CRCs (Tis) or with superficial invasion (T1a). The aim of this study was to develop an automatic computer-aided diagnosis (CAD) system to identify T1b CRC based on plain endoscopic images. Patients and methods In two hospitals, 1839 non-magnified plain endoscopic images from 313 CRCs (Tis 134, T1a 46, T1b 56, beyond T1b 37) with sessile morphology were extracted for training. A CAD system was trained with the data augmented by rotation, saturation, resizing and exposure adjustment. Diagnostic performance was assessed using another dataset including 44 CRCs (Tis 23, T1b 21) from a third hospital. CAD generated a probability level for T1b diagnosis for each image, and > 95 % of probability level was defined as T1b. Lesions with at least one image with a probability level > 0.95 were regarded as T1b. Primary outcome is specificity. Six physicians separately read the same testing dataset. Results Specificity was 87 % (95 % confidence interval: 66–97) for CAD, 100 % (85–100) for Expert 1, 96 % (78–100) for Expert 2, 61 % (39–80) for both gastroenterology trainees, 48 % (27–69) for Novice 1 and 22 % (7–44) for Novice 2. Significant differences were observed between CAD and both novices (P = 0.013, P = 0.0003). Other diagnostic values of CAD were slightly lower than of the two experts. Conclusions Specificity of CAD was superior to novices and possibly to gastroenterology trainees but slightly inferior to experts.

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Diagnostic performance of artificial intelligence to identify deeply invasive colorectal cancer on non-magnified plain endoscopic images

et al. 2020

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“…This was a retrospective analysis of a multicenter cohort of patients who underwent EMR for large (≥ 2 cm) non-pedunculated colorectal polyps (LNPCPs). Patients were extracted from the OPTICAL study, in which LNPCPs of consecutive patients from eight hospitals (seven non-academic and one academic hospital) were prospectively registered between September 2015 and December 2016 [11]. In addition, patients were collected from a prospective registry of consecutive patients who underwent colorectal EMR in the same academic hospital between March 2012 and October 2017.…”

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confidence: 99%

Management of delayed bleeding after endoscopic mucosal resection of large colorectal polyps: a retrospective multi-center cohort study

et al. 2020

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Background and study aims Delayed bleeding (DB) is the most frequent major adverse event after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs). Evidence-based guidelines for management of DB are lacking. We aimed to evaluate the clinical presentation, treatment and outcome of patients with DB and to determine factors associated with hemostatic therapy. Patients and methods Patients with DB were identified by analyzing all consecutive EMR procedures for LNPCPs (≥ 2 cm) from one academic center (2012–2017) and seven regional hospitals (2015–2017). DB was defined as any postprocedural bleeding necessitating emergency department presentation, hospitalization or reintervention. Outcome of DB was assessed for three clinical scenarios: continued bleeding (CB), spontaneous resolution without recurrent bleeding during 24 hours observation (SR), and recurrent bleeding (RB). Variables associated with hemostatic therapy were analyzed using logistic regression. Results DB occurred after 42/542 (7.7 %) EMR procedures and re-colonoscopy was performed in 30 patients (72 %). Re-colonoscopy and hemostatic therapy rates were 92 % and 75 % for CB (n = 24), 25 % and 8 % for SR (n = 12), and 83 % and 67 % for RB (n = 6), respectively. Frequent hematochezia (≥ hourly) was the only factor significantly associated with hemostatic therapy (RR 2.23, p = 0.01). Re-bleeding after endoscopic hemostatic therapy occurred in 3/22 (13.6 %) patients. Conclusion Ongoing or recurrent hematochezia is associated with a high rate of hemostatic therapy, warranting re-colonoscopy in these patients. A conservative approach is justified when bleeding spontaneously settles, and without recurrent hematochezia during 24 hours observation patients can be safely discharged without endoscopic re-examination.

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“…Although intramucosal adenocarcinomas are most often not considered T1 colorectal cancers (T1-CRC) in European series [1], they are, nonetheless, cancerous tumors (T1a) owing to invasion into the chorion, and are considered as such by Japanese endoscopists. These lesions have no or negligible risk of lymph node metastasis and most Western endoscopists consider piecemeal endoscopic mucosal resection (EMR) suitable for them, dismissing the need for tumor-free resection margins.…”

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Considerable practice variation in use of pathological high-risk T1-CRC criteria: Why, and how to do better?

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Saito

2020

Endosc Int Open

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Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study)

Abstract: NTR5561.

Cited by 72 publications

References 40 publications

Diagnostic performance of artificial intelligence to identify deeply invasive colorectal cancer on non-magnified plain endoscopic images

Diagnostic performance of artificial intelligence to identify deeply invasive colorectal cancer on non-magnified plain endoscopic images

Management of delayed bleeding after endoscopic mucosal resection of large colorectal polyps: a retrospective multi-center cohort study

Considerable practice variation in use of pathological high-risk T1-CRC criteria: Why, and how to do better?

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