Yoji Takeuchi1, Masao Hanafusa2, Hiromitsu Kanzaki3, Takashi Ohta4, Noboru Hanaoka5, Sachiko Yamamoto6, Koji Higashino7, Yasuhiko Tomita8, Noriya Uedo9, Ryu Ishihara10, Hiroyasu Iishi11. 1. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. takeuti-yo@mc.pref.osaka.jp. 2. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. m-hanafusa@nyc.odn.ne.jp. 3. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. kanzaki@qc4.so-net.ne.jp. 4. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. tks.ohta@gmail.com. 5. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. hanaoka-no@mc.pref.osaka.jp. 6. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. yamamoto-sa@mc.pref.osaka.jp. 7. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. higasino-ko@mc.pref.osaka.jp. 8. Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, 537-8511, Japan. yasuhiko-tomita@umin.ac.jp. 9. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. uedou-no@mc.pref.osaka.jp. 10. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. isihara-ry@mc.pref.osaka.jp. 11. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. iisi-hi@mc.pref.osaka.jp.
Abstract
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).
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).
Authors: René Lambert; Shin Ei Kudo; Michael Vieth; John I Allen; Hiroaki Fujii; Takahiro Fujii; Hiroshi Kashida; Takahisa Matsuda; Masaki Mori; Hiroshi Saito; Tadakazu Shimoda; Shinji Tanaka; Hidenobu Watanabe; Joseph J Sung; Andrew D Feld; John M Inadomi; Michael J O'Brien; David A Lieberman; David F Ransohoff; Roy M Soetikno; Ann Zauber; Claudio Rolim Teixeira; Jean Francois Rey; Edgar Jaramillo; Carlos A Rubio; Andre Van Gossum; Michael Jung; Jeremy R Jass; George Triadafilopoulos Journal: Gastrointest Endosc Date: 2009-10-31 Impact factor: 9.427
Authors: Bernard Levin; David A Lieberman; Beth McFarland; Kimberly S Andrews; Durado Brooks; John Bond; Chiranjeev Dash; Francis M Giardiello; Seth Glick; David Johnson; C Daniel Johnson; Theodore R Levin; Perry J Pickhardt; Douglas K Rex; Robert A Smith; Alan Thorson; Sidney J Winawer Journal: Gastroenterology Date: 2008-02-08 Impact factor: 22.682