Optical diagnosis of colorectal neoplasia: A Western perspective

Abstract

Optical diagnosis is an emerging paradigm in Western endoscopic practice for the colonoscopic management of diminutive polyps, and includes two complementary clinical strategies: 'resect and discard', in which diminutive high-confidence adenomas are identified, and then removed and discarded without pathological assessment; and 'diagnose and leave', where diminutive highconfidence hyperplastic polyps are identified in the rectosigmoid and then left without resection or biopsy. Like other aspects of colonoscopy performance, adoption of optical diagnosis in Western practice is limited by operator dependency and variation in clinical effectiveness. There is substantial potential for optical diagnosis of colorectal neoplasia during colonoscopy to alleviate the rising costs of health care in the West. However, operator dependence in diagnostic performance together with critical system factors such as informed consent, credentialing, medical legal support and reimbursement incentives must be overcome before optical diagnosis of diminutive lesions is considered for widespread adoption in Western clinical practice.

Improved Real-Time Optical Diagnosis of Colorectal Polyps Following a Comprehensive Training Program

“…A recent review article insisted on the importance of developing more definitive criteria for HC and validated training programs to correct overconfidence in endoscopists who do not reach competency. 23 According to a meta-analysis, HC characterization was the most significant predictor of optical diagnostic accuracy and HC prediction was made in 77% of study polyps. 4 In previous multicenter studies of novices, the proportion of HC was 74% in the study by Patel et al 11 and 73.5% in the study by Vleugels et al 22 In this study, the proportion of HC diagnosis was similar, 72.1%.…”

Rapid, High-Resolution, Label-Free, and 3-Dimensional Imaging to Differentiate Colorectal Adenomas and Non-Neoplastic Polyps With Micro-Optical Coherence Tomography

“…The conventional paradigm for polyps treatment is to remove all the visible polyps and subsequent pathological assessment, regardless of the size or appearance (10). A survey shows that at least 67.2% patients would pay $150 per polyp for pathological assessment of a diminutive lesion, while of all detected polyps, 70%–80% are diminutive, and most of which are non-neoplastic (5,11,12).…”