title: Optical diagnosis of colorectal polyps using high-definition i-scan: an educational experience.
abstract: OBJECTIVE
  To examine performances regarding prediction of polyp histology using high-definition (HD) i-scan in a group of endoscopists with varying levels of experience.
  
  
  METHODS
  We used a digital library of HD i-scan still images, comprising twin pictures (surface enhancement and tone enhancement), collected at our university hospital. We defined endoscopic features of adenomatous and non-adenomatous polyps, according to the following parameters: color, surface pattern and vascular pattern. We familiarized the participating endoscopists on optical diagnosis of colorectal polyps using a 20-min didactic training session. All endoscopists were asked to evaluate an image set of 50 colorectal polyps with regard to polyp histology. We classified the diagnoses into high confidence (i.e., cases in which the endoscopist could assign a diagnosis with certainty) and low confidence diagnoses (i.e., cases in which the endoscopist preferred to send the polyp for formal histology). Mean sensitivity, specificity and accuracy per endoscopist/image were computed and differences between groups tested using independent-samples t tests. High vs low confidence diagnoses were compared using the paired-samples t test.
  
  
  RESULTS
  Eleven endoscopists without previous experience on optical diagnosis evaluated a total of 550 images (396 adenomatous, 154 non-adenomatous). Mean sensitivity, specificity and accuracy for diagnosing adenomas were 79.3%, 85.7% and 81.1%, respectively. No significant differences were found between gastroenterologists and trainees regarding performances of optical diagnosis (mean accuracy 78.0% vs 82.9%, P = 0.098). Diminutive lesions were predicted with a lower mean accuracy as compared to non-diminutive lesions (74.2% vs 93.1%, P = 0.008). A total of 446 (81.1%) diagnoses were made with high confidence. High confidence diagnoses corresponded to a significantly higher mean accuracy than low confidence diagnoses (84.0% vs 64.3%, P = 0.008). A total of 319 (58.0%) images were evaluated as having excellent quality. Considering excellent quality images in conjunction with high confidence diagnosis, overall accuracy increased to 92.8%.
  
  
  CONCLUSIONS
  After a single training session, endoscopists with varying levels of experience can already provide optical diagnosis with an accuracy of 84.0%.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands.
authors.forename: Mariëlle W E
authors.initials: MW
authors.lastname: Bouwens
authors.forename: Rogier
authors.initials: R
authors.lastname: de Ridder
authors.forename: Ad A M
authors.initials: AA
authors.lastname: Masclee
authors.forename: Ann
authors.initials: A
authors.lastname: Driessen
authors.forename: Robert G
authors.initials: RG
authors.lastname: Riedl
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanduleanu
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D019723:Endoscopes; D005762:Gastroenterology / Q000193:education / Q000379:methods; D006801:Humans; D015588:Observer Variation; D010364:Pattern Recognition, Visual; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors
keywords: Colonoscopy; Colorectal polyps; High-definition i-scan; Optical diagnosis; Training