TY - JOUR
T1 - An alternative option for “resect and discard” strategy, using magnifying narrow-band imaging
T2 - a prospective “proof-of-principle” study
AU - Takeuchi, Yoji
AU - Hanafusa, Masao
AU - Kanzaki, Hiromitsu
AU - Ohta, Takashi
AU - Hanaoka, Noboru
AU - Yamamoto, Sachiko
AU - Higashino, Koji
AU - Tomita, Yasuhiko
AU - Uedo, Noriya
AU - Ishihara, Ryu
AU - Iishi, Hiroyasu
N1 - Funding Information:
This study was supported by a grant-in-aid from the Osaka Foundation for the Prevention of Cancer and Cardiovascular Diseases.
Publisher Copyright:
© 2015, Springer Japan.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Background: The “resect and discard” strategy is beneficial for cost savings on screening and surveillance colonoscopy, but it has the risk to discard lesions with advanced histology or small invasive cancer (small advanced lesion; SALs). The aim of this study was to prove the principle of new “resect and discard” strategy with consideration for SALs using magnifying narrow-band imaging (M-NBI). Methods: Patients undergoing colonoscopy at a tertiary center were involved in this prospective trial. For each detected polyp <10 mm, optical diagnosis (OD) and virtual management (“leave in situ”, “discard” or “send for pathology”) were independently made using non-magnifying NBI (N-NBI) and M-NBI, and next surveillance interval were predicted. Histological and optical diagnosis results of all polyps were compared. Results: While the management could be decided in 82 % of polyps smaller than 10 mm, 24/31 (77 %) SALs including two small invasive cancers were not discarded based on OD using M-NBI. The sensitivity [90 % confidence interval (CI)] of M-NBI for SALs was 0.77 (0.61–0.89). The risk for discarding SALs using N-NBI was significantly higher than that using M-NBI (53 vs. 23 %, p = 0.02). The diagnostic accuracy (95 % CI) of M-NBI in distinguishing neoplastic from non-neoplastic lesions [0.88 (0.86–0.90)] was significantly better than that of N-NBI [0.84 (0.82–0.87)] (p = 0.005). Conclusions: The results of our study indicated that our “resect and discard” strategy using M-NBI could work to reduce the risk for discarding SALs including small invasive cancer (UMIN-CTR, UMIN000003740).
AB - Background: The “resect and discard” strategy is beneficial for cost savings on screening and surveillance colonoscopy, but it has the risk to discard lesions with advanced histology or small invasive cancer (small advanced lesion; SALs). The aim of this study was to prove the principle of new “resect and discard” strategy with consideration for SALs using magnifying narrow-band imaging (M-NBI). Methods: Patients undergoing colonoscopy at a tertiary center were involved in this prospective trial. For each detected polyp <10 mm, optical diagnosis (OD) and virtual management (“leave in situ”, “discard” or “send for pathology”) were independently made using non-magnifying NBI (N-NBI) and M-NBI, and next surveillance interval were predicted. Histological and optical diagnosis results of all polyps were compared. Results: While the management could be decided in 82 % of polyps smaller than 10 mm, 24/31 (77 %) SALs including two small invasive cancers were not discarded based on OD using M-NBI. The sensitivity [90 % confidence interval (CI)] of M-NBI for SALs was 0.77 (0.61–0.89). The risk for discarding SALs using N-NBI was significantly higher than that using M-NBI (53 vs. 23 %, p = 0.02). The diagnostic accuracy (95 % CI) of M-NBI in distinguishing neoplastic from non-neoplastic lesions [0.88 (0.86–0.90)] was significantly better than that of N-NBI [0.84 (0.82–0.87)] (p = 0.005). Conclusions: The results of our study indicated that our “resect and discard” strategy using M-NBI could work to reduce the risk for discarding SALs including small invasive cancer (UMIN-CTR, UMIN000003740).
KW - Colon polyp surveillance
KW - Colonoscopy
KW - Colorectal neoplasm
KW - Magnifying narrow-band imaging
KW - Resect and discard
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U2 - 10.1007/s00535-015-1048-1
DO - 10.1007/s00535-015-1048-1
M3 - Article
C2 - 25689934
AN - SCOPUS:84943201387
VL - 50
SP - 1017
EP - 1026
JO - Journal of Gastroenterology
JF - Journal of Gastroenterology
SN - 0944-1174
IS - 10
ER -