title: Development of a novel index to discriminate bulge from mass on small-bowel capsule endoscopy.
abstract: BACKGROUND
  Submucosal malignant masses (SMMs) and innocent bulges look similar on small-bowel capsule endoscopy (SBCE). In a previous observational study, 4 criteria associated with innocent bulges were recognized.
  
  
  OBJECTIVE
  To devise and validate an index based on these criteria (smooth, protruding lesion index on capsule endoscopy [SPICE]) to discriminate SMMs from innocent bulges.
  
  
  METHODS
  Single-center, prospective study.
  
  
  METHODS
  General hospital in Busto Arsizio, Italy.
  
  
  METHODS
  This study involved 25 of 424 consecutive SBCEs performed on as many patients having SBCE findings of smooth, round, protruding lesions.
  
  
  METHODS
  Patients' evaluation up to the final diagnosis. At study entry, a short video clip of the lesion was obtained and deidentified for blind SPICE calculation.
  
  
  METHODS
  SPICE accuracy, using the final diagnosis of each patient as the criterion standard.
  
  
  RESULTS
  Six patients had SMMs (4 GI stromal tumors, 2 neuroendocrine tumors), and 19 had innocent bulges. SPICE scores ranged from 0 to 4; they discriminated SMMs from innocent bulges (P = .002). A SPICE value >2 had 83.3% sensitivity and 89.4% specificity, and the area under the curve was 0.90 (95% confidence interval, 0.72-0.98; P < .001) for the detection of SMMs.
  
  
  CONCLUSIONS
  Single-center study; small sample size; no invasive ascertainment in 36% of patients.
  
  
  CONCLUSIONS
  SPICE is easy to calculate and useful for distinguishing SMMs from innocent bulges. An index >2 is predictive of SMM.
authors: First Division of Internal Medicine, Service of Gastroenterology and Digestive Endoscopy, Hospital of Busto Arsizio, Busto Arsizio (VA), Italy. cargirel@vodafone.it
authors: Carlo M
authors: CM
authors: Girelli
authors: Paola
authors: P
authors: Porta
authors: Elisabetta
authors: E
authors: Colombo
authors: Enrico
authors: E
authors: Lesinigo
authors: Giordano
authors: G
authors: Bernasconi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001165:Arteriovenous Malformations / Q000473:pathology; D053704:Capsule Endoscopy; D003661:Decision Support Techniques; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology*; D006801:Humans; D007077:Ileal Diseases / Q000473:pathology; D007078:Ileal Neoplasms / Q000473:pathology*; D043183:Irritable Bowel Syndrome / Q000473:pathology; D007579:Jejunal Diseases / Q000473:pathology; D007580:Jejunal Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D015588:Observer Variation; D011446:Prospective Studies; D012372:ROC Curve; D018709:Statistics, Nonparametric; D000267:Tissue Adhesions / Q000473:pathology