Background and Aims
Developments in image-enhancing endoscopy and polyp classification systems have led
to a number of gastroenterology societies endorsing an optical diagnosis (OD) approach
for small polyps at colonoscopy. In this study we performed a root-cause analysis
of ODs to determine the most likely causes of OD error.
Methods
As part of a prospective feasibility study, DISCARD3 (Detect InSpect ChAracterise
Resect and Discard 3), evaluating implementation and quality assurance of a “resect
and discard” strategy for consecutive small polyps <10 mm, a root-cause analysis of
184 cases of high-confidence OD error was performed. In all cases, histopathology
underwent a second blinded review and, where discrepancy persisted, further review
with deeper levels.
Results
After a root-cause analysis, 133 of 184 true OD errors were identified and classified
into 4 types: A (OD, adenoma; histology, serrated), 45/133 (33.8%); B (OD, serrated;
histology, adenoma), 55/133 (41.4%); C (OD, adenoma; histology, normal), 19/133 (14.3%);
and D (OD, serrated; histology, normal), 14/133 (10.5%). The remaining 51 of 184 errors
were because of a pathology error requiring deeper levels (43/184), pathology observer
or laboratory error (7/184), or other error (1/184).
Conclusions
OD errors can be related to endoscopist-related factors such as poor photodocumentation,
failures of current classification systems, and incomplete histology. We identified
a subset of serrated polyps frequently misdiagnosed as adenomas (“pseudoadenomas”)
using the NBI International Colorectal Endoscopic (NICE) classification. An enhanced
algorithm for OD is proposed based on the NICE classification including morphologic
and adjunct polyp features.
Abbreviations:
AI (artificial intelligence), DISCARD3 (Detect InSpect ChAracterise Resect and Discard 3), ESGE (European Society of Gastrointestinal Endoscopy), NBI (narrow-band imaging), NICE (NBI International Colorectal Endoscopic), OD (optical diagnosis), PIVI (Preservation and Incorporation of Valuable endoscopic Innovations)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 23, 2022
Accepted:
August 19,
2022
Received:
March 10,
2022
Footnotes
DISCLOSURE: The following authors received research support for this study from Olympus: A. Ahmad, B. P. Saunders. In addition, the following author disclosed financial relationships: B. P. Saunders: Consultant and speaker for Olympus; speaker for and research support from Fujifilm. All other authors disclosed no financial relationships.
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© 2023 by the American Society for Gastrointestinal Endoscopy
