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

World Journal of Gastroenterology 2012年第41期18卷 5905-5911页

作者： Johanna L Chan Li Lin michael feiler Andrew I Wolf Diana M Cardona Ziad F Gellad Department of Medicine Duke University Medical CenterDurham NC 27705 United States Duke Clinical Research Institute DurhamNC 27705 United States Department of Pathology Duke UniversityMedical Center Durham NC 27705 United States Durham VA Medical Center Durham NC 27705United States

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%） in the first hal

关键词： Colonoscopy Adenoma Virtual chromoendoscopy Colonic polyps Comparative effectiveness

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