External Validation of the Endoscopic Features of Sessile Serrated Adenomas in Expert and Trainee Colonoscopists
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Background/Aims: It is unclear whether the endoscopic features of sessile serrated adenomas (SSAs) would be useful to trainee colonoscopists to predict SSA. Therefore, the present study aimed to identify features that expert and trainee colonoscopists can use to independently and reliably predict SSA by using high-resolution white-light endoscopy. Methods: Endoscopic images of 81 polyps (39 SSAs, 22 hyperplastic polyps, and 20 tubular adenomas) from 43 patients were retrospectively evaluated by 10 colonoscopists (four experts and six trainees). Eight endoscopic features of SSAs were assessed for each polyp. Results: According to multivariable analysis, a mucous cap (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.72 to 19.07), indistinctive borders (OR, 4.21; 95% CI, 2.74 to 7.16), dark spots (OR, 3.64; 95% CI, 1.89 to 7.00), and cloud-like surface (OR, 2.43; 95% CI, 1.27 to 4.668) were independent predictors of SSAs. Among these, a mucous cap, indistinctive borders, and cloud-like surface showed moderate interobserver agreement (mean κ >0.40) among experts and trainees. When ≥1 of the three predictors was observed, the sensitivity and specificity for diagnosing SSAs were 79.0% and 81.4%, respectively. Conclusions: Colonoscopy trainees and experts can use several specific endoscopic features to independently and reliably predict SSAs.
Abstract
Background/Aims: It is unclear whether the endoscopic features of sessile serrated adenomas (SSAs) would be useful to trainee colonoscopists to predict SSA. Therefore, the present study aimed to identify features that expert and trainee colonoscopists can use to independently and reliably predict SSA by using high-resolution white-light endoscopy. Methods: Endoscopic images of 81 polyps (39 SSAs, 22 hyperplastic polyps, and 20 tubular adenomas) from 43 patients were retrospectively evaluated by 10 colonoscopists (four experts and six trainees). Eight endoscopic features of SSAs were assessed for each polyp. Results: According to multivariable analysis, a mucous cap (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.72 to 19.07), indistinctive borders (OR, 4.21; 95% CI, 2.74 to 7.16), dark spots (OR, 3.64; 95% CI, 1.89 to 7.00), and cloud-like surface (OR, 2.43; 95% CI, 1.27 to 4.668) were independent predictors of SSAs. Among these, a mucous cap, indistinctive borders, and cloud-like surface showed moderate interobserver agreement (mean κ >0.40) among experts and trainees. When ≥1 of the three predictors was observed, the sensitivity and specificity for diagnosing SSAs were 79.0% and 81.4%, respectively. Conclusions: Colonoscopy trainees and experts can use several specific endoscopic features to independently and reliably predict SSAs.
참고문헌 (27)
- Ferlay J, "Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012", Int J Cancer, 136, pp.E359~E386 (2015)
- Vleugels JL, "Colorectal cancer screening by colonoscopy: putting it into perspective", Dig Endosc, 28, pp.250~259 (2016)
- Brenner H, "Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality:systematic review and meta-analysis of randomised controlled trials and observational studies", BMJ, 348, pp.g2467~ (2014)
- Nishihara R, "Long-term colorectal-cancer incidence and mortality after lower endoscopy", N Engl J Med, 369, pp.1095~1105 (2013)
- Zauber AG, "Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths", N Engl J Med, 366, pp.687~696 (2012)
- Otto S. Lin, "Impact of Sigmoidoscopy and Colonoscopy on Colorectal Cancer Incidence and Mortality: An Evidence-Based Review of Published Prospective and Retrospective Studies", Intestinal research, 12(4), pp.268~274 (2014), 대한장연구학회
- Brenner H, "Risk of colorectal cancer after detection and removal of adenomas at colonoscopy: population-based case-control study", J Clin Oncol, 30, pp.2969~2976 (2012)
- 김창준, "한국인 중간암의 유병률, 임상병리학적 특징과 예측인자", Intestinal research, 11(3), pp.178~183 (2013), 대한장연구학회
- 차재명, "Colonoscopy Quality is the Answer for the Emerging Issue of Interval Cancer", Intestinal research, 12(2), pp.110~116 (2014), 대한장연구학회
- le Clercq CM, "Postcolonoscopy colorectal cancers are preventable: a population-based study", Gut, 63, pp.957~963 (2014)
- Snover DC, "Update on the serrated pathway to colorectal carcinoma", Hum Pathol, 42, pp.1~10 (2011)
- Holme O, "Long-term risk of colorectal cancer in individuals with serrated polyps", Gut, 64, pp.929~936 (2015)
- Leggett B, "Role of the serrated pathway in colorectal cancer pathogenesis", Gastroenterology, 138, pp.2088~2100 (2010)
- Tadepalli US, "A morphologic analysis of sessile serrated polyps observed during routine colonoscopy", Gastrointest Endosc, 74, pp.1360~1368 (2011)
- Hazewinkel Y, "Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging", Gastrointest Endosc, 77, pp.916~924 (2013)
- JE IJ, "Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas", polyps, 2016, pp.65, 963~970
- Yamashina T, "Diagnostic features of ses sile serrated adenoma", polyps on magnifying narrow band imaging:a prospective study of diagnostic accuracy, 2015, pp.30, 117~123
- Yamada M, "Investigating endoscopic features of sessile serrated adenomas", polyps by using narrow-band imaging with optical magnification, 2015, pp.82, 108~117
- Ignjatovic A, "Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps", Gastrointest Endosc, 73, pp.128~133 (2011)
- Raghavendra M, "Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes", Gastrointest Endosc, 72, pp.572~576 (2010)
- Ng SC, "Narrow-band imaging in the colon: limitations and potentials", J Gastroenterol Hepatol, 26, pp.1589~1596 (2011)
- Snover DC, "WHO Classification of Tumours of the Digestive System", pp.160~165 (2010), International Agency for Research on Cancer
- Landis JR, "The measurement of observer agreement for categorical data", Biometrics, 33, pp.159~174 (1977)
- Hosmer DW, "Applied Logistic Regression", pp.392~ (2000), Wiley
- Yamada A, "Endoscopic features of sessile serrated adenoma and other serrated colorectal polyps", Hepatogastroenterology, 58, pp.45~51 (2011)
- Jaramillo E, "Endoscopic appearance of serrated adenomas in the colon", Endoscopy, 37, pp.254~260 (2005)
- Bordacahar B, "Sessile serrated adenoma: from identification to resection", Dig Liver Dis, 47, pp.95~102 (2015)