A94 PRE-RESECTION OPTICAL EVALUATION RELIABLY DIFFERENTIATES BETWEEN SERRATED AND ADENOMATOUS LARGE NON-PEDUNCULATED COLORECTAL POLYPS

Journal of the Canadian Association of Gastroenterology Pub Date : 2024-02-14 DOI:10.1093/jcag/gwad061.094

S. Jiang, A. Zarrin, A. Walia, C. Galorport, W Xiong, R. Enns, E. Lam, N. Shahidi

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Abstract

Abstract Background Modality selection between cold snare resection (CSR) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is largely predicated on the ability to differentiate between serrated and adenomatous histopathology. While optical evaluation has modest accuracy for diminutive polyps, performance has not been evaluated for large non-pedunculated colorectal polyps (LNPCPs). Aims To evaluate the performance of pre-resection optical evaluation to differentiate between serrated and adenomatous LNPCPs. Methods Consecutive patients ampersand:003E 18 years of age who underwent endoscopic resection for a LNPCP were enrolled in a prospective single center observation cohort study (clinicaltrials.gov ID: NCT05402696). Pre-resection optical evaluation was performed using high-definition white-light and narrow-band imaging (NBI) with or without near-focus. The Japanese NBI Expert Team (JNET) classification was used to differentiate between serrated (JNET I) vs. adenomatous (JNET IIA, IIB) LNPCPs. Traditional serrated adenomas (TSAs) and cancers were excluded from analysis. Sensitivity, specificity, and accuracy were used to evaluate optical evaluation performance. Results From 06/2022-09/2023, 266 patients underwent 282 procedures for a total of 335 LNPCPs. Median size was 30mm (IQR 20-40mm). Histopathology identified 215 (64.2%) adenomatous, 91 (27.2%) serrated, 16 (4.8%) cancerous, and 13 (3.9%) other LNPCPs; including 5 TSAs. Of the 91 serrated lesions, 90 (98.9%) were predicted as serrated; sensitivity, specificity, and accuracy were 98.90% (95% CI 94.03-99.97), 99.53% (95% CI 97.44-99.99), 99.35% (95% CI 97.66-99.92), respectively. Of the 215 adenomatous lesions, 213 (99.1%) were predicted as adenomatous; sensitivity, specificity, and accuracy were 99.07% (95% CI 96.68-99.89), 98.90% (95% CI 94.03-99.97), 99.02% (95% CI 97.16-99.80), respectively. Conclusions Optical evaluation demonstrates excellent performance characteristics to differentiate between serrated and adenomatous LNPCPs; therefore, empowering endoscopists to reliably apply a selective resection algorithm between CSR, EMR and ESD. Funding Agencies None

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A94 切片前光学评估能可靠地区分锯齿状和腺瘤性大块非梗阻性大肠息肉

摘要背景在冷套管切除术（CSR）和内镜下粘膜切除术（EMR）或内镜下粘膜下剥离术（ESD）之间选择手术方式，主要取决于区分锯齿状组织病理学和腺瘤组织病理学的能力。虽然光学评估对微小息肉有一定的准确性，但尚未对大的非梗阻性结直肠息肉（LNPCPs）的性能进行评估。目的评估切除前光学评估区分锯齿状和腺瘤性 LNPCP 的性能。方法在一项前瞻性单中心观察队列研究（clinicaltrials.gov ID：NCT05402696）中纳入了因 LNPCP 而接受内镜切除术的 18 岁连续患者。切除术前的光学评估是通过高清白光和窄带成像（NBI）（带或不带近焦）进行的。日本窄带成像专家组（JNET）的分类用于区分锯齿状（JNET I）和腺瘤状（JNET IIA、IIB）LNPCP。传统锯齿状腺瘤（TSA）和癌症不在分析之列。敏感性、特异性和准确性用于评估光学评估性能。结果在 2022 年 6 月至 2023 年 9 月期间，266 名患者接受了 282 次手术，共发现 335 个 LNPCP。中位尺寸为 30 毫米（IQR 20-40毫米）。组织病理学确定了 215 个（64.2%）腺瘤型、91 个（27.2%）锯齿型、16 个（4.8%）癌型和 13 个（3.9%）其他 LNPCP，包括 5 个 TSA。在 91 个锯齿状病变中，90 个（98.9%）被预测为锯齿状；敏感性、特异性和准确性分别为 98.90% (95% CI 94.03-99.97)、99.53% (95% CI 97.44-99.99)、99.35% (95% CI 97.66-99.92)。在 215 个腺瘤病灶中，213 个（99.1%）被预测为腺瘤病灶；敏感性、特异性和准确性分别为 99.07% (95% CI 96.68-99.89)、98.90% (95% CI 94.03-99.97)、99.02% (95% CI 97.16-99.80)。结论光学评估在区分锯齿状和腺瘤状 LNPCP 方面表现出卓越的性能特征；因此，内镜医师有能力在 CSR、EMR 和 ESD 之间可靠地应用选择性切除算法。无

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Journal of the Canadian Association of Gastroenterology

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