Colorectal surveillance interval assignment based on in vivo prediction of polyp histology: impact of endoscopic quality improvement program.
BACKGROUND
Validated training methods are needed before in vivo optical diagnosis can be used to guide colorectal cancer surveillance interval assignments.


OBJECTIVE
To assess the impact of endoscopist training on accuracy of surveillance intervals based on in vivo optical diagnosis.


METHODS
Prospective, randomized study.


METHODS
Tertiary referral center.


METHODS
A total of 1231 patients with colorectal polyps (before training, n = 577; after training, n = 654).


METHODS
Endoscopists were randomized to either participate or not participate in two 1-hour training sessions. Endoscopists' in vivo pathology predictions were recorded for all resected polyps. The accuracy of in vivo prediction-guided surveillance intervals were compared with pathology-guided intervals as the criterion standard. Surveillance interval accuracy before and after training were analyzed.


METHODS
Surveillance interval accuracy based on in vivo polyp predictions with pathology-guided intervals as criterion standard before and after a training intervention.


RESULTS
Optically predicted surveillance intervals for the trained group of endoscopists had an overall accuracy of 84% (242/287) before training and 82% (261/317) after training. There was little evidence to suggest that training had a meaningful impact on the accuracy of optically predicted surveillance intervals (odds ratio 1.20; 95% CI, 0.76-1.89, P = .44).


CONCLUSIONS
Limitations include small sample size, lack of endoscopist prediction confidence levels, and optional use of narrow-band imaging.


CONCLUSIONS
Surveillance interval accuracy did not meet published thresholds (>90%) to use in vivo optical diagnosis without pathologic confirmation. Larger studies, focused specifically on the impact of training, are needed to validate methods to improve polyp diagnosis and surveillance predication accuracy.
Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida 32224, USA.
Susan G
SG
Coe
Colleen
C
Thomas
Julia
J
Crook
Vivian
V
Ussui
Nancy
N
Diehl
Michael B
MB
Wallace
D000236:Adenoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy / Q000193:education* / Q000592:standards*; D015179:Colorectal Neoplasms / Q000473:pathology*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011237:Predictive Value of Tests; D015397:Program Evaluation; D058996:Quality Improvement; D013997:Time Factors; D055815:Young Adult