title: Endoscopists can sustain high performance for the optical diagnosis of colorectal polyps following standardized and continued training.
abstract: OBJECTIVE
  The learning curve for optical diagnosis of colorectal polyps with the narrow-band imaging (NBI) is unknown. To forego histological analysis of diminutive polyps diagnosed optically with high confidence, guidelines recommend ≥ 90 % negative predictive value (NPV) and concordance of ≥ 90 % for surveillance intervals predicted optically and histologically. We aimed to study the learning of optical diagnosis for colorectal polyps.
  
  
  METHODS
  We studied five endoscopists as part of a randomized multisite trial comparing near-focus and standard-focus views for optical diagnosis. They trained using a computer-based module, followed by 10 real-time colonoscopies with pathology correlation. Endoscopists then optically diagnosed and resected all the polyps found during 558 consecutive colonoscopies, and diagnoses were compared with pathology. Endoscopists repeated the training module at the study midpoint. NPV and concordance of surveillance intervals for diminutive polyps diagnosed optically with high confidence were measured over time.
  
  
  RESULTS
  Endoscopists showed high diagnostic performance, with a nonsignificant trend toward higher NPV in the second half of the study. For the 445 polyps in the standard-view arm, the NPV was 88.0 % (95 %CI 75.7 % - 95.5 %) in the first half and 95.8 % (88.3 % - 99.1 %) in the second; P = 0.7. Three endoscopists in the first half and four in the second achieved > 90 % NPV. Concordance of surveillance intervals was identical in the first and second halves at 98.1 % (95 %CI 93.3 % - 99.8 %).
  
  
  CONCLUSIONS
  High NPV for the prediction of non-neoplasms with NBI was achieved and maintained in this group of endoscopists who participated in standardized and continued training. Both NPV and surveillance interval agreement indicated high performance in the optical diagnosis of colorectal polyps and exceeded thresholds.
authors.affiliation: GI Endoscopy Unit, Veterans Affairs Palo Alto, Palo Alto, and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: McGill
authors.affiliation: GI Endoscopy Unit, Veterans Affairs Palo Alto, Palo Alto, and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Soetikno
authors.affiliation: Gastroenterology Section, Veterans Affairs Kansas City, and Department of Medicine, Division of Gastroenterology, University of Kansas, Kansas City, Missouri, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Pathology and Laboratory Medicine Service, Veterans Affairs Palo Alto, USA, and Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Rouse
authors.affiliation: GI Endoscopy Unit, Veterans Affairs Palo Alto, Palo Alto, and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Tohru
authors.initials: T
authors.lastname: Sato
authors.affiliation: Gastroenterology Section, Veterans Affairs Kansas City, and Department of Medicine, Division of Gastroenterology, University of Kansas, Kansas City, Missouri, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.affiliation: Gastrointestinal Diagnostic Unit, Veterans Affairs San Francisco, and Division of Gastroenterology, University California San Francisco, San Francisco, California, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: McQuaid
authors.affiliation: GI Endoscopy Unit, Veterans Affairs Palo Alto, Palo Alto, and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Tonya
authors.initials: T
authors.lastname: Kaltenbach
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003111:Colonic Polyps / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003198:Computer Simulation; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D061212:Memory, Episodic; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods / Q000592:standards*; D011159:Population Surveillance; D011237:Predictive Value of Tests; D016037:Single-Blind Method