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KMID : 1188320200140050611
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Gut and Liver
2020 Volume.14 No. 5 p.611 ~ p.618
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Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study
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Yang Dong-Hoon
John Sneha
Mitsuhiro Fujishiro
Cha Jae-Myung
Byeon Jeong-Sik
Kim Hyung-Wook
Kim Hyun-Gun
Friedland Shai
Koh Yon Xian
Yoon Jin-Young
Kwak Min-Seob
Ye Byong-Duk
Kim Ji-Hun
Yang Suk-Kyun
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Abstract
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Background/Aims: Endoscopic diagnosis of dysplasia or colitic cancer in patients with ulcerative colitis (UC) is more challenging than that of colorectal neoplasia in non-colitic patients. We aimed to evaluate the accuracy of the endoscopic diagnosis of “nonpedunculated” dysplasia or colitic cancer in UC patients.
Methods: Ten endoscopists from four countries were surveyed using photographs of 61 histologically confirmed dysplastic or non-dysplastic lesions retrieved from the UC registry database of Asan Medical Center. The participants provided their assessment based on the given photographs and their intention to perform biopsy.
Results: The overall diagnostic performance of the 10 participants is summarized as follows: sensitivity of 88.2% (95% confidence interval [CI], 84.3% to 91.5%), specificity of 34.8% (95% CI, 29.1% to 40.8%), positive predictive value of 63.0% (95% CI, 60.8% to 65.2%), negative predictive value of 70.2% (95% CI, 62.7% to 76.6%), and accuracy of 64.6% (95% CI, 60.7% to 68.4%). The interobserver agreement on the intention to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, including ulceration, distinctness of the borders, and pit patterns, only neoplastic pit patterns were significantly predictive of dysplasia (odds ratio, 3.710; 95% CI, 2.001 to 6.881). The diagnostic sensitivity and specificity of neoplastic pit patterns were 68.2% (95% CI, 63.0% to 73.2%) and 63.3% (95% CI, 57.3% to 69.1%), respectively.
Conclusions: Diagnostic performance based on the endoscopist's intention to perform a biopsy for nonpedunculated potentially dysplastic lesions in UC patients was suboptimal according to this survey-based study.
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KEYWORD
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Colitis, ulcerative, Dysplasia, Neoplasm, colonic, Colonoscopy, Diagnosis
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