Comparative effectiveness of i-SCAN^(TM) and high-definition white light characterizing small colonic polyps  

作　　者：Johanna L Chan Li Lin Michael Feiler Andrew I Wolf Diana M Cardona Ziad F Gellad 

机构地区：[1]Department of Medicine, Duke University Medical Center,Durham, NC 27705, United States [2]Duke Clinical Research Institute, Durham,NC 27705, United States [3]Department of Pathology, Duke UniversityMedical Center, Durham, NC 27705, United States [4]Durham VA Medical Center, Durham, NC 27705,United States

出　　处：《World Journal of Gastroenterology》2012年第41期5905-5911,共7页世界胃肠病学杂志（英文版）

基　　金：Supported by An Unrestricted Educational Grant from PENTAX Medical Company;A Career Development Research Awardfrom the American Society for Gastrointestinal Endoscopy,to Dr.Gellad

摘　　要：AIM： To evaluate accuracy of in vivo diagnosis of ad- enomatous vs non-adenomatous polyps using/-SCAN digital chromoendoscopy compared with high-definition white light. METHODS： This is a single-center comparative effec- tiveness pilot study. Polyps （n = 103） from 75 average- risk adult outpatients undergoing screening or surveil- lance colonoscopy between December 1, 2010 and April 1, 2011 were evaluated by two participating en- doscopists in an academic outpatient endoscopy center. Polyps were evaluated both with high-definition white light and with/-SCAN to make an/n vivo prediction of adenomatous vs non-adenomatous pathology. We de- termined diagnostic characteristics of/-SCAN and high- definition white light, including sensitivity, specificity, and accuracy, with regards to identifying adenomatous vs non-adenomatous polyps. Histopathologic diagnosis was the gold standard comparison. RESULTS： One hundred and three small polyps, de- tected from forty-three patients, were included in the analysis. The average size of the polyps evaluated in the analysis was 3.7 mm （SD 1.3 mm, range 2 mm to 8 mm）. Formal histopathology revealed that 54/103 （52.4%） were adenomas, 26/103 （25.2%） were hyper- plastic, and 23/103 （22.3%） were other diagnoses in- clude ＂lymphoid aggregates＂, ＂non-specific colitis,＂ and ＂no pathologic diagnosis.＂ Overall, the combined accu- racy of endoscopists for predicting adenomas was iden- tical between/-SCAN （71.8%, 95%CI： 62.1%-80.3%） and high-definition white light （71.8%, 95%CI： 62.1%-80.3%）. However, the accuracy of each endosco- pist differed substantially, where endoscopist A demon- strated 63.0% overall accuracy （95%CI： 50.9%-74.0%） as compared with endoscopist B demonstrating 93.3% overall accuracy （95%CI： 77.9%-99.2%）, irrespective of imaging modality. Neither endoscopist demonstrated a significant learning effect with i-SCAN during the study. Though endoscopist A increased accuracy using/-SCAN from 59% （95%CI： 42.1%-74.4%AIM:To evaluate accuracy of in vivo diagnosis of adenomatous vs non-adenomatous polyps using i-SCAN digital chromoendoscopy compared with high-definition white light.METHODS:This is a single-center comparative effectiveness pilot study.Polyps(n = 103) from 75 averagerisk adult outpatients undergoing screening or surveillance colonoscopy between December 1,2010 and April 1,2011 were evaluated by two participating endoscopists in an academic outpatient endoscopy center.Polyps were evaluated both with high-definition white light and with i-SCAN to make an in vivo prediction of adenomatous vs non-adenomatous pathology.We determined diagnostic characteristics of i-SCAN and highdefinition white light,including sensitivity,specificity,and accuracy,with regards to identifying adenomatous vs non-adenomatous polyps.Histopathologic diagnosis was the gold standard comparison.RESULTS:One hundred and three small polyps,detected from forty-three patients,were included in the analysis.The average size of the polyps evaluated in the analysis was 3.7 mm(SD 1.3 mm,range 2 mm to 8 mm).Formal histopathology revealed that 54/103(52.4%) were adenomas,26/103(25.2%) were hyperplastic,and 23/103(22.3%) were other diagnoses include "lymphoid aggregates","non-specific colitis," and "no pathologic diagnosis." Overall,the combined accuracy of endoscopists for predicting adenomas was identical between i-SCAN(71.8%,95%CI:62.1%-80.3%) and high-definition white light(71.8%,95%CI:62.1%-80.3%).However,the accuracy of each endoscopist differed substantially,where endoscopist A demonstrated 63.0% overall accuracy(95%CI:50.9%-74.0%) as compared with endoscopist B demonstrating 93.3% overall accuracy(95%CI:77.9%-99.2%),irrespective of imaging modality.Neither endoscopist demonstrated a significant learning effect with i-SCAN during the study.Though endoscopist A increased accuracy using i-SCAN from 59%(95%CI:42.1%-74.4%) in the first half to 67.6%(95%CI:49.5%-82.6%) in the second half,and endoscopist B decreased accuracy using i-SCAN from 100%(95%CI:80

关 键 词：COLONOSCOPY ADENOMA Virtual chromoendoscopy Colonic polyps Comparative effectiveness 

分 类 号：R735.3[医药卫生—肿瘤]