Endoscopic Characterisation of Colorectal Neoplasia with the Different Published Classifications: A Multicentre Comparative Study Involving Gastroenterologists from Trainees to Experts

Aims Validate the COlorectal NEoplasia Classification to Choose the Treatment (CONECCT) classification that groups all published criteria (including covert signs of carcinoma) in a single table.

Methods For this multicentre comparative study an expert endoscopist created a picture library (n = 206 lesions; from hyperplastic to deep invasive cancers) with at least White Light Imaging and chromoendoscopy images. Lesions were resected/biopsied to assess histology. Participants characterised lesions using the Paris, Laterally Spreading Tumours, Kudo, Sano, NBI International Colorectal Endoscopic Classification (NICE), Workgroup serrAted polypS and Polyposis (WASP), and CONECCT classifications, and assessed the quality of pictures on a web-based platform. Krippendorff alpha and Cohen’s Kappa were used to assess inter- and intra-observer agreement, respectively. Answers were cross-referenced with histology.

Results Eleven experts, 19 non-expert gastroenterologists, and 10 interns participated. The CONECCT classification had a higher inter-observer agreement (Krippendorff alpha=0.738) than for all the other classifications and increased with expertise and with quality of pictures. CONECCT classification had a higher intra-observer agreement than all other existing classifications except WASP (only describing Sessile Serrated Adenoma Polyp). The sensitivity of CONECCT IIC (79.0 %) to detect adenocarcinoma within the lesion was higher than that of Kudo Vi (31.2 %). Specificity of CONECCT IIA (89.0 %) to diagnose pure adenomas (without adenocarcinoma) was higher than the NICE2 category (71.0 %; p=0.001).

Conclusions The CONECCT classification currently offers the best inter and intra-observer agreement, including between experts and non-experts. The sensitivity to detect a superficial adenocarcinoma in CONECCT IIC lesions and to avoid it in lesions classified CONECCT IIA is higher than current published classifications.

Citation: Bonniaud P, Rivory J, Ponchon T et al. eP175ENDOSCOPIC CHARACTERISATION OF COLORECTAL NEOPLASIA WITH THE DIFFERENT PUBLISHED CLASSIFICATIONS: A MULTICENTRE COMPARATIVE STUDY INVOLVING GASTROENTEROLOGISTS FROM TRAINEES TO EXPERTS. Endoscopy 2021; 53: S153.

Publication History

Article published online:
19 March 2021