Randomised controlled trial comparing modified Sano’s and narrow band imaging international colorectal endoscopic classifications for colorectal lesions

Abstract

AIMTo assess the utility of modified Sano′s (MS) vs the narrow band imaging international colorectal endoscopic (NICE) classification in differentiating colorectal polyps.METHODSPatients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial. Based on the MS or the NICE classifications, patients were randomised for real-time endoscopic diagnosis. This was followed by biopsies, endoscopic or surgical resection. The endoscopic diagnosis was then compared to the final (blinded) histopathology. The primary endpoint was the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of differentiating neoplastic and non-neoplastic polyps (MS II/IIo / IIIa / IIIb vs I or NICE 1 vs 2/3). The secondary endpoints were “endoscopic resectability” (MS II/IIo/IIIa vs I/IIIb or NICE 2 vs 1/3), NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals.RESULTSA total of 348 patients were evaluated. The Sn, Sp, PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were, 98.9%, 85.7%, 98.2% and 90.9% for MS; and 99.1%, 57.7%, 95.4% and 88.2% for NICE, respectively. The area under the receiver operating characteristic curve (AUC) for MS was 0.92 (95%CI: 0.86-0.98); and AUC for NICE was 0.78 (95%CI: 0.69, 0.88). The Sn, Sp, PPV and NPV in predicting “endoscopic resectability” were 98.9%, 86.1%, 97.8% and 92.5% for MS; and 98.6%, 66.7%, 94.7% and 88.9% for NICE, respectively. The AUC for MS was 0.92 (95%CI: 0.87-0.98); and the AUC for NICE was 0.83 (95%CI: 0.75-0.90). The AUC values were statistically different for both comparisons (P = 0.0165 and P = 0.0420, respectively). The accuracy for diagnosis of sessile serrated adenoma/polyp (SSA/P) with high confidence utilizing MS classification was 93.2%. The differentiation of SSA/P from other lesions achieved Sp, Sn, PPV and NPV of 87.2%, 91.5%, 89.6% and 98.6%, respectively. The NPV for predicting adenomas in diminutive rectosigmoid polyps (n = 150) was 96.6% and 95% with MS and NICE respectively. The calculated accuracy of post-polypectomy surveillance for MS group was 98.2% (167 out of 170) and for NICE group was 92.1% (139 out of 151).CONCLUSIONThe MS classification outperformed the NICE classification in differentiating neoplastic polyps and predicting endoscopic resectability. Both classifications met ASGE PIVI thresholds.

Effect of time of day and specialty on polyp detection rates in Australia

“…It is possible that the effect of the presence of a mucous cap surpassed the effect of the fatigue. The mucous cap feature is known to be important for SSA/P's detection and characterization, as opposed to adenomas . Although it is known that a bad bowel preparation (e.g.…”

“…The mucous cap feature is known to be important for SSA/P's detection and characterization, as opposed to adenomas. 35,36 Although it is known that a bad bowel preparation (e.g. below 5 in the Boston Bowel Preparation Scale-according to Lai et al 37 ) decreases the detection of polyps, a slightly suboptimal bowel preparation might have the opposite effect.…”

Comparison of different virtual chromoendoscopy classification systems for the characterization of colorectal lesions

“…This increment was inferred to be slightly lower than what was found in our previous study for the comparison of MS versus NICE. 9 A McNemar test was used for comparison of accuracies for dichotomic classifications in the exploratory phase, two by two. Comparison of proportions was carried out with Chi-squared test in both exploratory and validation phases.…”

“…However, recently, MS was found to outperform the NICE classification. 9 The MS classification was conceived in 2013 and consists of five categories (I, IIo, II, IIIa, and IIIb), while JNET has four (1, 2A, 2B, and 3), and NICE has three. [1][2][3] Of all these classifications, only WASP and MS are able to classify SSA/Ps into a separate category.…”

“…[1][2][3] Of all these classifications, only WASP and MS are able to classify SSA/Ps into a separate category. [8][9][10][11][12][13][14] Other classifications assign SSA/Ps alongside HPs, hence mixing neoplastic with nonneoplastic polyps. As the role of the serrated pathway becomes clearer, the use of an endoscopic classification that could characterize SSA/Ps is important.…”