High resolution microendoscopy for classification of colorectal polyps

S. S. Chang; R. Shukla; A. D. Polydorides; P. M. Vila; M. Lee; H. Han; P. Kedia; J. Lewis; S. Gonzalez; M. K. Kim; N. Harpaz; J. Godbold; R. Richards-Kortum; S. Anandasabapathy

doi:10.1055/s-0032-1326502

Endoscopy, Table of Contents

Endoscopy 2013; 45(07): 553-559
DOI: 10.1055/s-0032-1326502

Original article

High resolution microendoscopy for classification of colorectal polyps

S. S. Chang

¹Department of Internal Medicine, Mount Sinai Hospital, New York, USA

,

R. Shukla

¹Department of Internal Medicine, Mount Sinai Hospital, New York, USA

,

A. D. Polydorides

²Department of Pathology, Mount Sinai Hospital, New York, USA

,

P. M. Vila

³Department of Gastroenterology, Mount Sinai Hospital, New York, USA

,

M. Lee

³Department of Gastroenterology, Mount Sinai Hospital, New York, USA

,

H. Han

³Department of Gastroenterology, Mount Sinai Hospital, New York, USA

,

P. Kedia

³Department of Gastroenterology, Mount Sinai Hospital, New York, USA

,

J. Lewis

³Department of Gastroenterology, Mount Sinai Hospital, New York, USA

,

S. Gonzalez

³Department of Gastroenterology, Mount Sinai Hospital, New York, USA

,

M. K. Kim

³Department of Gastroenterology, Mount Sinai Hospital, New York, USA

,

N. Harpaz

²Department of Pathology, Mount Sinai Hospital, New York, USA

,

J. Godbold

⁴Department of Preventive Medicine, Mount Sinai Hospital, New York, USA

,

R. Richards-Kortum

⁵Department of Bioengineering, Rice University, Houston, Texas, USA

,

S. Anandasabapathy

³Department of Gastroenterology, Mount Sinai Hospital, New York, USA

› Author Affiliations

Abstract

Background and study aims: It can be difficult to distinguish adenomas from benign polyps during routine colonoscopy. High resolution microendoscopy (HRME) is a novel method for imaging colorectal mucosa with subcellular detail. HRME criteria for the classification of colorectal neoplasia have not been previously described. Study goals were to develop criteria to characterize HRME images of colorectal mucosa (normal, hyperplastic polyps, adenomas, cancer) and to determine the accuracy and interobserver variability for the discrimination of neoplastic from non-neoplastic polyps when these criteria were applied by novice and expert microendoscopists.

Methods: Two expert pathologists created consensus HRME image criteria using images from 68 patients with polyps who had undergone colonoscopy plus HRME. Using these criteria, HRME expert and novice microendoscopists were shown a set of training images and then tested to determine accuracy and interobserver variability.

Results: Expert microendoscopists identified neoplasia with sensitivity, specificity, and accuracy of 67 % (95 % confidence interval [CI] 58 % – 75 %), 97 % (94 % – 100 %), and 87 %, respectively. Nonexperts achieved sensitivity, specificity, and accuracy of 73 % (66 % – 80 %), 91 % (80 % – 100 %), and 85 %, respectively. Overall, neoplasia were identified with sensitivity 70 % (65 % – 76 %), specificity 94 % (87 % – 100 %), and accuracy 85 %. Kappa values were: experts 0.86; nonexperts 0.72; and overall 0.78.

Conclusions: Using the new criteria, observers achieved high specificity and substantial interobserver agreement for distinguishing benign polyps from neoplasia. Increased expertise in HRME imaging improves accuracy. This low-cost microendoscopic platform may be an alternative to confocal microendoscopy in lower-resource or community-based settings.

Clinical trial registration no. NCT01384240

Full Text

References

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