1
|
Kaufman D, Djinbachian R, Taghiakbari M, Popescu Crainic I, Haumesser C, Abou Khalil M, Sidani S, Liu Chen Kiow J, Panzini B, von Renteln D. A Preclinical Blinded Randomized-Controlled Trial Evaluating the Clinical Relevance of Polyp Size Measurement Using a Virtual Scale Endoscope. J Can Assoc Gastroenterol 2024; 7:149-153. [PMID: 38596804 PMCID: PMC10999760 DOI: 10.1093/jcag/gwad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background The virtual scale endoscope (VSE) helps endoscopists measure colorectal polyp size more accurately compared to visual assessment (VA). However, previous studies were not adequately powered to evaluate the sizing of polyps at clinically relevant size thresholds and relative accuracy for size subgroups. Methods We created 64 artificial polyps of varied sizes and Paris class morphology, randomly assigned 1:1 to be measured (383 total measurement datapoints with VSE and VA by 6 endoscopists blinded to true size) in a colon model. We added data from two previous trials (480 measurement datapoints). We evaluated for correct classification of polyps into size groups at 3 mm, 5 mm, 10 mm, and 20 mm size thresholds and the relative size measurement accuracy for diminutive polyps (≤5 mm), small polyps (5-9 mm), large polyps at 10-19 mm, and polyps (≥20). Results VSE had significantly less size group misclassifications at the 5 mm, and 10 mm thresholds (28 percent vs. 45 percent, P = 0.0159 and 26 percent vs. 44 percent, P = 0.0135, respectively). For the 3 mm and 20 mm thresholds, VSE had lower misclassifications; however, this was not statistically significant (36 percent vs. 46 percent, P = 0.3853 and 38 percent vs. 41 percent, P = 0.2705, respectively). The relative size measurement accuracy was significantly higher for VSE compared to VA for all size subgroups (diminutive (P < 0.01), small polyps (P < 0.01), 10-19 mm (P < 0.01), and ≥20 mm (P < 0.01)). Conclusion VSE outperforms VA in categorizing polyps into size groups at the clinically relevant size thresholds of 5 mm and 10 mm. Using VSE resulted in significantly higher relative measurement accuracy for all size subgroups.
Collapse
Affiliation(s)
- Daniel Kaufman
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- University of Montreal Medical School, Montreal, QC, Canada
| | - Roupen Djinbachian
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- Department of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, QC, Canada
| | - Mahsa Taghiakbari
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- Department of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, QC, Canada
| | - Ioana Popescu Crainic
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- University of Montreal Medical School, Montreal, QC, Canada
- Department of Internal Medicine, Montreal University Hospital Center (CHUM), Montreal, QC, Canada
| | - Claire Haumesser
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- University of Montreal Medical School, Montreal, QC, Canada
| | - Maria Abou Khalil
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- Department of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, QC, Canada
| | - Sacha Sidani
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- Department of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, QC, Canada
| | - Jeremy Liu Chen Kiow
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- Department of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, QC, Canada
| | - Benoit Panzini
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- Department of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, QC, Canada
| | - Daniel von Renteln
- Montreal University Hospital Research Center (CRCHUM), Departement of Gastroenterology, Montreal, QC, Canada
- Department of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, QC, Canada
| |
Collapse
|
2
|
Taghiakbari M, Djinbachian R, Haumesser C, Sidani S, Chen Kiow JL, Panzini B, von Renteln D. Measuring Size of Colorectal Polyps Using a Virtual Scale Endoscope or Visual Assessment: A Randomized Controlled Trial. Am J Gastroenterol 2024:00000434-990000000-00955. [PMID: 38084850 DOI: 10.14309/ajg.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION This study aimed to compare the accuracy of polyp size measurements using a virtual scale endoscope (VSE) with an integrated laser-based adaptive scale function and visual assessment (VA) during colonoscopies. METHODS We conducted a single-blinded, prospective randomized controlled trial. Eligible patients (aged 45-80 years) undergoing screening, surveillance, or diagnostic colonoscopies were randomly assigned (1:1) into 2 groups. In the intervention group, all detected polyps were measured for size using VSE; in the control group, all polyps were measured using VA. Size measurements were compared with a reference standard of digital caliper measurement immediately post polypectomy. The primary outcome was the relative accuracy of real-time VSE measurement compared with VA. Secondary outcomes included the mean differences and the correlations between VSE or VA sizes and the reference standard of measurement. RESULTS Overall, 230 patients were enrolled and randomized. The relative size measurement accuracy of VSE was 84% in 118 polyps, which was significantly higher than that of VA (105 polyps; 68.4%, P < 0.001). VSE resulted in a significantly higher percentage of size measurements within 25% of true size compared with VA (81.4% vs 41%, P < 0.001). VSE had a significantly lower percentage for >5-mm polyps incorrectly sized as 1-5 mm compared with VA (13.5% vs 57.1%; P < 0.001) and a significantly lower percentage for >3-mm polyps incorrectly sized as 1-3 mm compared with VA (11.3% vs 56.5%; P < 0.001). DISCUSSION VSE significantly improves the size measurement accuracy of colorectal polyps during colonoscopies compared with VA and results in fewer misclassifications at relevant decision-making size thresholds.
Collapse
Affiliation(s)
- Mahsa Taghiakbari
- Montreal University Hospital Research Center, Montreal, Quebec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Roupen Djinbachian
- Montreal University Hospital Research Center, Montreal, Quebec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Quebec, Canada
| | | | - Sacha Sidani
- Montreal University Hospital Research Center, Montreal, Quebec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Jeremy Liu Chen Kiow
- Montreal University Hospital Research Center, Montreal, Quebec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Benoit Panzini
- Montreal University Hospital Research Center, Montreal, Quebec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Daniel von Renteln
- Montreal University Hospital Research Center, Montreal, Quebec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Quebec, Canada
| |
Collapse
|
3
|
von Renteln D, Djinbachian R, Zarandi-Nowroozi M, Taghiakbari M. Measuring size of smaller colorectal polyps using a virtual scale function during endoscopies. Gut 2023; 72:417-420. [PMID: 36411028 DOI: 10.1136/gutjnl-2022-328654] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Daniel von Renteln
- University of Montreal, Montreal, Quebec, Canada .,Department of Medicine, Division of Gastroenterology, CHUM, Montreal, Quebec, Canada
| | - Roupen Djinbachian
- Department of Medicine, Division of Gastroenterology, CHUM, Montreal, Quebec, Canada
| | | | - Mahsa Taghiakbari
- University of Montreal, Montreal, Quebec, Canada.,CRCHUM, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Shimoda R, Akutagawa T, Tomonaga M, Murano T, Shinmura K, Yoshioka M, Teramura Y, Kiyomi F, Ikematsu H. Estimating colorectal polyp size with a virtual scale endoscope and visual estimation during colonoscopy: Prospective, preliminary comparison of accuracy. Dig Endosc 2022; 34:1471-1477. [PMID: 35594177 DOI: 10.1111/den.14351] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/15/2022] [Indexed: 01/11/2023]
Abstract
The virtual scale endoscope (VSE) is a new endoscope that helps estimate the size of neoplasms in the gastrointestinal tract. We compared the accuracy of polyp size estimation by VSE with that of visual estimation. A dual center prospective study was conducted in two Japanese academic endoscopy units. Ten endoscopists (five trainees and five experts) estimated the size of 20 simulated polyps in four colon phantoms during colonoscopy by two methods: conventional visual estimation and estimation by VSE. The primary endpoint was the relative accuracy in relation to true polyp size according to visual estimation and VSE estimation during colonoscopy. The secondary endpoint was the required time (the time needed to measure in each procedure). The mean values of the primary end-point were 62.5% for visual estimation and 84.0% for VSE estimation; hence the result differed significantly (95% confidence interval 18.3-24.7; P < 0.001). The mean of required times was significantly longer for estimation by VSE (6.4 min) than that by visual estimation (2.9 min; P < 0.001). The accuracy of colorectal polyp size estimation was superior with VSE than with visual estimation during colonoscopy. In the future, VSE should be evaluated in actual clinical settings, including the time required for size estimation.
Collapse
Affiliation(s)
- Ryo Shimoda
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
| | - Takashi Akutagawa
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
| | - Michito Tomonaga
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center East, Chiba, Japan
| | | | | | - Fumiaki Kiyomi
- Department of Statistics and Data Center, Clinical Research Support Center Kyushu, Fukuoka, Japan
| | - Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy, National Cancer Center East, Chiba, Japan
| |
Collapse
|
5
|
Yoshioka M, Sakaguchi Y, Utsunomiya D, Sonoda S, Tatsuta T, Ozawa S, Teramura Y, Harada K, Kinugasa H, Okada H. Virtual scale function of gastrointestinal endoscopy for accurate polyp size estimation in real-time: a preliminary study. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210162R. [PMID: 34472242 PMCID: PMC8408764 DOI: 10.1117/1.jbo.26.9.096002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
SIGNIFICANCE Polyp size is important for selecting the surveillance interval or treatment policy. Nevertheless, it is challenging to accurately estimate the polyp size during endoscopy. An easy and cost-effective function to assist in polyp size estimation is required. AIM To propose a virtual scale function for endoscopy and evaluate its performance and expected accuracy. APPROACH An adaptive virtual scale behavior was demonstrated. The measurement error of the virtual scale along the distance between the tip of the endoscope and the object plane was evaluated using graph paper. The accuracy of polyp size estimation by an expert endoscopist was compared with the accuracy of the biopsy forceps method using phantom images. RESULTS The measurement errors of the virtual scale were ≤ 0.7 mm when the distance to the graph paper, which faced the tip of the endoscope, varied from 4 to 30 mm. The accuracy with the virtual scale was significantly higher than that obtained with biopsy forceps (5.3 ± 5.5 % versus 11.9 ± 9.4 % , P < 0.001). CONCLUSIONS The virtual scale function, which operates in real-time without any additional device, can be used to estimate polyp sizes easily and accurately with endoscopy.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Yuichi Teramura
- FUJIFILM Corporation, Tokyo, Japan
- Address all correspondence to Yuichi Teramura,
| | - Keita Harada
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Gastroenterology and Hepatology, Okayama, Japan
| | - Hideaki Kinugasa
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Gastroenterology and Hepatology, Okayama, Japan
| | - Hiroyuki Okada
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Gastroenterology and Hepatology, Okayama, Japan
| |
Collapse
|
6
|
Tang L, Di Re A, El-Khoury T. Accuracy of estimation of polyp size at colonoscopy. ANZ J Surg 2020; 90:1125-1129. [PMID: 32395884 DOI: 10.1111/ans.15958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/02/2020] [Accepted: 04/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Cancer Council posits that the size of adenomas is a more robust marker of risk than histological characteristics. The purpose of our study is to assess the accuracy of estimation of polyp size at colonoscopy amongst different levels of endoscopists and compare this with histopathological size. METHODS A retrospective review of prospectively collected data was performed. Specimens were included if they were (i) from patients aged 18 years or older, (ii) polyp obtained at colonoscopy, (iii) measured in quantitative units and (iv) the largest eligible polyp per patient. RESULTS A total of 92 patients were included. Our results demonstrate that the relationship between the histological size of a polyp and an endoscopist's estimate depended upon seniority level (P = 0.001). Senior consultants tended to overestimate lesion size (P < 0.001), fellows/junior consultants tended to underestimate size (P = 0.010), whilst registrars' estimates demonstrated no systematic difference from histological size (P = 0.518). The ratio of a senior consultant's estimate of polyp size to histological size was on average 74% with their estimates ranging from 31% to 173%. The corresponding estimates are 123% (32-470%) for fellows/junior consultants and 107% (35-334%) for registrars. CONCLUSION Our study demonstrates that senior consultants are more precise with more junior endoscopists having a great degree of variability in their practice. It is evident that there is a relationship between proceduralist experience and polyp size estimation. It is, therefore, important to consider the ways in which we can mitigate this learning curve and continue to develop technology to improve our accuracy.
Collapse
Affiliation(s)
- Linda Tang
- Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Angelina Di Re
- Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Toufic El-Khoury
- Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Polyp Characteristics of Nonsyndromic and Potentially Syndromic Juvenile Polyps: A Retrospective Cohort Analysis. J Pediatr Gastroenterol Nutr 2019; 69:668-672. [PMID: 31765335 PMCID: PMC6882539 DOI: 10.1097/mpg.0000000000002477] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Juvenile polyps (JPs) are the most common gastrointestinal polyps diagnosed in children. There is paucity of evidence differentiating polyp burden groups and the presence and significance of neoplastic changes. METHODS A retrospective chart review of patients, ages birth through 18 years with nonsyndromic JPs was performed from 2003 to 2017. Abstracted data included basic demographics, age, clinical presentation, colonoscopy findings, and pathology report. Slides of polyps with neoplasia were reviewed by a pathologist. RESULTS A total of 213 subjects underwent 326 procedures and 435 polypectomies. Subjects with positive family history, positive gene mutations, or numerous (>10) polyps were excluded. Groups were defined by polyp number (1, 2-4, 5-10). Polyp recurrence on repeat colonoscopy was significantly related to polyp burden (1 polyp: 1.5%/2-4 polyps 19.2%/5-10 polyps 82.6%: P < 0.001). Polyp distribution was significantly different amongst different groups with isolated polyps favoring a distal distribution. JPs harboring adenomatous foci were reported in 26 (12%) patients. JPs harboring adenomatous foci were significantly more likely to be proximally distributed but the presence of adenomatous transformation within the polyps did not correlate with polyp number or the likelihood of polyp recurrence on repeat colonoscopy. CONCLUSIONS JP recurrence is positively and significantly related to polyp burden. JP harbored adenomatous changes independent of polyp number, underscoring a possible malignant potential in JPs. In the absence of a consistent genotype or pedigree, the presence of adenomatous transformation within JPs cannot be construed as a biomarker for syndromic juvenile polyposis.
Collapse
|
8
|
Koo HS, Huh KC. Importance of the Size of Adenomatous Polyps in Determining Appropriate Colonoscopic Surveillance Intervals. Clin Endosc 2018; 51:404-406. [PMID: 30257543 PMCID: PMC6182287 DOI: 10.5946/ce.2018.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 09/12/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hoon Sup Koo
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Kyu Chan Huh
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| |
Collapse
|