title: In vivo diagnostic accuracy of high-resolution microendoscopy in differentiating neoplastic from non-neoplastic colorectal polyps: a prospective study.
abstract: OBJECTIVE
  High-resolution microendoscopy (HRME) is a low-cost, "optical biopsy" technology that allows for subcellular imaging. The purpose of this study was to determine the in vivo diagnostic accuracy of the HRME for the differentiation of neoplastic from non-neoplastic colorectal polyps and compare it to that of high-definition white-light endoscopy (WLE) with histopathology as the gold standard.
  
  
  METHODS
  Three endoscopists prospectively detected a total of 171 polyps from 94 patients that were then imaged by HRME and classified in real-time as neoplastic (adenomatous, cancer) or non-neoplastic (normal, hyperplastic, inflammatory).
  
  
  RESULTS
  HRME had a significantly higher accuracy (94%), specificity (95%), and positive predictive value (PPV, 87%) for the determination of neoplastic colorectal polyps compared with WLE (65%, 39%, and 55%, respectively). When looking at small colorectal polyps (less than 10 mm), HRME continued to significantly outperform WLE in terms of accuracy (95% vs. 64%), specificity (98% vs. 40%) and PPV (92% vs. 55%). These trends continued when evaluating diminutive polyps (less than 5 mm) as HRME's accuracy (95%), specificity (98%), and PPV (93%) were all significantly greater than their WLE counterparts (62%, 41%, and 53%, respectively).
  
  
  CONCLUSIONS
  In conclusion, this in vivo study demonstrates that HRME can be a very effective modality in the differentiation of neoplastic and non-neoplastic colorectal polyps. A combination of standard white-light colonoscopy for polyp detection and HRME for polyp classification has the potential to truly allow the endoscopist to selectively determine which lesions can be left in situ, which lesions can simply be discarded, and which lesions need formal histopathologic analysis.
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Neil D
authors.initials: ND
authors.lastname: Parikh
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Perl
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Brijen
authors.initials: B
authors.lastname: Shah
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Young
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Richa
authors.initials: R
authors.lastname: Shukla
authors.affiliation: Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Alexandros D
authors.initials: AD
authors.lastname: Polydorides
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Moshier
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: James
authors.initials: J
authors.lastname: Godbold
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Elinor
authors.initials: E
authors.lastname: Zhou
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Josephine
authors.initials: J
authors.lastname: Mitcham
authors.affiliation: Department of Bioengineering, Rice University, Houston, Texas, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Richards-Kortum
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Anandasabapathy
mesh_terms: D000236:Adenoma / Q000473:pathology*; D000368:Aged; D003110:Colonic Neoplasms / Q000473:pathology*; D003111:Colonic Polyps / Q000473:pathology*; D020685:Colonoscopes; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods; D057186:Comparative Effectiveness Research; D003937:Diagnosis, Differential; D005336:Fiber Optic Technology; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008853:Microscopy / Q000379:methods; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011237:Predictive Value of Tests; D020700:Proctoscopes; D011351:Proctoscopy / Q000295:instrumentation / Q000379:methods; D012004:Rectal Neoplasms / Q000473:pathology*