OC-024 Detect inspect characterise resect and discard 2: are we ready to dispense with histology?

Rajasekhar, PT; Mason, James; Wilson, Ana; Close, Helen; Rutter, Matthew D.; Saunders, Brian P.; East, James E.; Maier, Rebecca; Moorghen, Morgan; Rees, Colin

doi:10.1136/gutjnl-2015-309861.24

Cited by 4 publications

(5 citation statements)

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“…Biopsies can create diagnostic uncertainty through sampling error, burden pathology services and compromise endoscopic therapy [ 16 ]. Identifying malignant features by optical polyp characterisation is vital for decision-making [ 17 ] and the European Society of Gastroenterology now recommend a core curriculum to improve this [ 18 ].This can be challenging [ 19 ], but quality imaging and training allows final decisions to be made later by those with expertise in this field.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies—a multi-centre observational study

Parker

Gupta

Shenbagaraj

et al. 2023

Int J Colorectal Dis

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Purpose Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches. Method This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers. Results Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology. Conclusion Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.

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Section: Discussionmentioning

confidence: 99%

Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies—a multi-centre observational study

Parker

Gupta

Shenbagaraj

et al. 2023

Int J Colorectal Dis

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“…[ 2 ] Furthermore, colorectal cancer can be prevented by detection of colonic adenomatous polyps, premalignant lesions which may progress toward colorectal cancer. It is estimated that 20%–40%[ 3 ] of patients undergoing colonoscopy present polyps. Of these detected polyps, 29%–42% are hyperplastic and entail little or no malignant risk, whereas the rest are neoplastic and could progress to colorectal cancer if not removed.…”

Section: Introductionmentioning

confidence: 99%

“…Of these detected polyps, 29%–42% are hyperplastic and entail little or no malignant risk, whereas the rest are neoplastic and could progress to colorectal cancer if not removed. [ 3 4 5 ] When multiple polyps (i.e., 5–10) are detected in a patient, the current gold standard procedure is the complete removal of all the polyps, using a technique appropriate to each polyp size and shape, followed by subsequent histopathological analysis. Resection of hyperplastic polyps, which carry no malignant potential, and the subsequent costly analysis together with patient trauma and bleeding risks could be avoided if they were accurately and objectively identified at the time of endoscopy.…”

Section: Introductionmentioning

confidence: 99%

Analysis on the Characterization of Multiphoton Microscopy Images for Malignant Neoplastic Colon Lesion Detection under Deep Learning Methods

Terradillos

Saratxaga

Mattana³

et al. 2021

Journal of Pathology Informatics

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Background: Colorectal cancer has a high incidence rate worldwide, with over 1.8 million new cases and 880,792 deaths in 2018. Fortunately, its early detection significantly increases the survival rate, reaching a cure rate of 90% when diagnosed at a localized stage. Colonoscopy is the gold standard technique for detection and removal of colorectal lesions with potential to evolve into cancer. When polyps are found in a patient, the current procedure is their complete removal. However, in this process, gastroenterologists cannot assure complete resection and clean margins which are given by the histopathology analysis of the removed tissue, which is performed at laboratory. Aims: In this paper, we demonstrate the capabilities of multiphoton microscopy (MPM) technology to provide imaging biomarkers that can be extracted by deep learning techniques to identify malignant neoplastic colon lesions and distinguish them from healthy, hyperplastic, or benign neoplastic tissue, without the need for histopathological staining. Materials and Methods: To this end, we present a novel MPM public dataset containing 14,712 images obtained from 42 patients and grouped into 2 classes. A convolutional neural network is trained on this dataset and a spatially coherent predictions scheme is applied for performance improvement. Results: We obtained a sensitivity of 0.8228 ± 0.1575 and a specificity of 0.9114 ± 0.0814 on detecting malignant neoplastic lesions. We also validated this approach to estimate the self-confidence of the network on its own predictions, obtaining a mean sensitivity of 0.8697 and a mean specificity of 0.9524 with the 18.67% of the images classified as uncertain. Conclusions: This work lays the foundations for performing in vivo optical colon biopsies by combining this novel imaging technology together with deep learning algorithms, hence avoiding unnecessary polyp resection and allowing in situ diagnosis assessment.

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“…Screening programmes allow for early detection of CRC. Colonoscopy, which is the main detection method, reveals that up to 40% of patients have one or more polyps [ 5 ], with potentially non-malignant hyperplastic polyps being the 29–42% of them, and neoplastic ones with malignant potential the rest [ 5 ]. However, almost 30% of the polyps are not detected [ 6 ], so it is important to improve the adenoma detection rates (ADR), as every 1% of its increase is associated to a 3% decrease of CRC risk, and 5% decrease of mortality related to CRC [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Medical needs related to the endoscopic technology and colonoscopy for colorectal cancer diagnosis

et al. 2021

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Background The high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis. This study aims at extracting the medical needs related to the endoscopic technology and the colonoscopy procedure currently used for colorectal cancer diagnosis, essential for designing these demanded technologies. Methods Semi-structured interviews and an online survey were used. Results Six endoscopists were interviewed and 103 were surveyed, obtaining the demanded needs that can be divided into: a) clinical needs, for better polyp detection and classification (especially flat polyps), location, size, margins and penetration depth; b) computer-aided diagnosis (CAD) system needs, for additional visual information supporting polyp characterization and diagnosis; and c) operational/physical needs, related to limitations of image quality, colon lighting, flexibility of the endoscope tip, and even poor bowel preparation. Conclusions This study shows some undertaken initiatives to meet the detected medical needs and challenges to be solved. The great potential of advanced optical technologies suggests their use for a better polyp detection and classification since they provide additional functional and structural information than the currently used image enhancement technologies. The inspection of remaining tissue of diminutive polyps (< 5 mm) should be addressed to reduce recurrence rates. Few progresses have been made in estimating the infiltration depth. Detection and classification methods should be combined into one CAD system, providing visual aids over polyps for detection and displaying a Kudo-based diagnosis suggestion to assist the endoscopist on real-time decision making. Estimated size and location of polyps should also be provided. Endoscopes with 360° vision are still a challenge not met by the mechanical and optical systems developed to improve the colon inspection. Patients and healthcare providers should be trained to improve the patient’s bowel preparation.

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OC-024 Detect inspect characterise resect and discard 2: are we ready to dispense with histology?

Cited by 4 publications

References 0 publications

Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies—a multi-centre observational study

Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies—a multi-centre observational study

Analysis on the Characterization of Multiphoton Microscopy Images for Malignant Neoplastic Colon Lesion Detection under Deep Learning Methods

Medical needs related to the endoscopic technology and colonoscopy for colorectal cancer diagnosis

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