| Backgroud:The estimated incidence of colorectal cancer in China is 36.21/100 000,and is still increasing these years.The incidence of colorectal cancer has undergone a low-grade intraepithelial neoplasia-a high-grade intraepithelial neoplasia-colorectal cancer process.Removal of polyps can block progression from adenoma to colorectal cancer and has been proved to significantly reduce the incidence of colorectal cancer.Hyperplastic polyps and inflammatory polyps at rectum and sigmoid colon are benign lesions,and there are no need for endoscopic treatment.The removal of hyperplasia or inflammatory polyp waste valuable medical Resources as well as increasing the economic burden on patients.The appearance of electronic-dyed endoscopy allows real-time optical diagnosis of the colorectal polyps so that the pathologic type of polyps can be obtained directly.I-scan OE system is a new type of optical-enhancement endoscopy,which can improve the observation of blood vessels on the surface of polyps by filtering the light of the corresponding wavelength.There is still no relevant study on evaluating the value of diagnosis of the pathological type of colorectal polyps.Aims:(1)To evaluated the accuracy of i-scan OE system with magnification endoscopy on real-time predicting the pathology types of colorectal polyps.(2)To evaluate whether the diagnostic value of OE with magnification can meet the thresholds of "resect-and-discard" and "diagnose-and-leave" strategies outlined by Preservation and Incorporation of Valuable Endoscopic Innovations(PIVI)document.(3)To assess the diagnostic value and inter-observer agreement of OE on post-hoc differentiating pathology of colorectal polyps.Methods:Patients were recruited from Aug,2016 to Feb,2017 in Qilu Hospital.After bowel cleansing with 2L polyethylene glycol,patients received colonoscopy under propofol intravenous anesthesia.When a polyp was found,we began to wash it and record the video.OE mode 1 with magnification was first used with near focus the polyp and an endoscopist made a prediction of polyp pathology.After that,high-definition mode and OE mode 1 without magnification were used to observe polyp sequencely.Biopsy of the polyps were taken after observation,and the size of polyps was estimated by the biopsy forceps.The information of patient age,gender polyp morphology and location were recorded.After a video transcoding and clipping,the pathology type of each video clip was predicted by an endoscopist.The sensitivity,specificity,positive predicting value(PPV),negative predicting value(NPV)and accuracy were calculated.The pathology types of polyps were classified by non-neoplastic polyps and neoplastic polyps according to Vienna Classification.Statistics were performed by NCSS 11 and R software(Version 3.3.2).Results:Fifty-eight patients were included at last.The average age was 58.17,and the ration of male and female was 37:21.Eighty-eight polyps were included,and the average size was 0.38cm.The sensitivity,specificity,accuracy,PPV and NPV of OE with magnification endoscopy on real-time assessing polyps' pathology were 0.97,0.50,0.76,0.95 and 0.71.The NPV of diminutive polyps was 0.92 and agreement between endoscopy based interval and pathology-based interval was 92.11%.After video clipping,54 high-definition video clips,45 OE without magnification video clips and 88 OE with magnification video clips were got.The sensitivity,specificity and accuracy of high-definition endoscopy were 0.61,0.51 and 0.58.The sensitivity,specificity and accuracy of OE without magnification were 0.73,0.60 and 0.68 while these of OE with magnification were 0.87,0.59 and 0.75.The accuracy of OE was significantly higher than high-definition endoscopy.The accuracy of expert group is higher than trainee group of OE with magnification(P<0.001),but not of high-definition endoscopy and OE without magnification(P = 0.06,P= 1.00).The kappa value of four observers were 0.23,0.52 and 0.76 in high-definition endoscopy group,OE without and with magnification groups.Conclusion:The diagnostic value of i-scan OE system with magnification can meet the threshold of PIVI guideline for "resect-and-discard" and "diagnose-and-leave"strategies.The sensitivity and specificity of OE on differentiating colorectal polyps'pathology is significantly higher than high-definition endoscopy.Large-scale studies are still needed to explore the accuracy of i-scan OE system with magnification for predicting pathology type of colorectal polyps. |
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