title: High resolution microendoscopy for classification of colorectal polyps.
abstract: OBJECTIVE
  It can be difficult to distinguish adenomas from benign polyps during routine colonoscopy. High resolution microendoscopy (HRME) is a novel method for imaging colorectal mucosa with subcellular detail. HRME criteria for the classification of colorectal neoplasia have not been previously described. Study goals were to develop criteria to characterize HRME images of colorectal mucosa (normal, hyperplastic polyps, adenomas, cancer) and to determine the accuracy and interobserver variability for the discrimination of neoplastic from non-neoplastic polyps when these criteria were applied by novice and expert microendoscopists.
  
  
  METHODS
  Two expert pathologists created consensus HRME image criteria using images from 68 patients with polyps who had undergone colonoscopy plus HRME. Using these criteria, HRME expert and novice microendoscopists were shown a set of training images and then tested to determine accuracy and interobserver variability.
  
  
  RESULTS
  Expert microendoscopists identified neoplasia with sensitivity, specificity, and accuracy of 67 % (95 % confidence interval [CI] 58 % - 75 %), 97 % (94 % - 100 %), and 87 %, respectively. Nonexperts achieved sensitivity, specificity, and accuracy of 73 % (66 % - 80 %), 91 % (80 % - 100 %), and 85 %, respectively. Overall, neoplasia were identified with sensitivity 70 % (65 % - 76 %), specificity 94 % (87 % - 100 %), and accuracy 85 %. Kappa values were: experts 0.86; nonexperts 0.72; and overall 0.78.
  
  
  CONCLUSIONS
  Using the new criteria, observers achieved high specificity and substantial interobserver agreement for distinguishing benign polyps from neoplasia. Increased expertise in HRME imaging improves accuracy. This low-cost microendoscopic platform may be an alternative to confocal microendoscopy in lower-resource or community-based settings.
authors.affiliation: Department of Internal Medicine, Mount Sinai Hospital, New York 10029, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Chang
authors.forename: R
authors.initials: R
authors.lastname: Shukla
authors.forename: A D
authors.initials: AD
authors.lastname: Polydorides
authors.forename: P M
authors.initials: PM
authors.lastname: Vila
authors.forename: M
authors.initials: M
authors.lastname: Lee
authors.forename: H
authors.initials: H
authors.lastname: Han
authors.forename: P
authors.initials: P
authors.lastname: Kedia
authors.forename: J
authors.initials: J
authors.lastname: Lewis
authors.forename: S
authors.initials: S
authors.lastname: Gonzalez
authors.forename: M K
authors.initials: MK
authors.lastname: Kim
authors.forename: N
authors.initials: N
authors.lastname: Harpaz
authors.forename: J
authors.initials: J
authors.lastname: Godbold
authors.forename: R
authors.initials: R
authors.lastname: Richards-Kortum
authors.forename: S
authors.initials: S
authors.lastname: Anandasabapathy
mesh_terms: D018256:Adenomatous Polyps / Q000145:classification* / Q000473:pathology; D003106:Colon / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000145:classification* / Q000473:pathology; D006801:Humans; D006965:Hyperplasia; D007413:Intestinal Mucosa / Q000473:pathology; D007417:Intestinal Polyps / Q000145:classification* / Q000473:pathology; D008856:Microscopy, Fluorescence; D015588:Observer Variation; D012007:Rectum / Q000473:pathology; D012680:Sensitivity and Specificity; D014741:Video Recording