title: In vivo classification of colorectal neoplasia using high-resolution microendoscopy: Improvement with experience.
abstract: OBJECTIVE
  High-resolution microendoscopy (HRME) is a novel, low-cost "optical biopsy" technology that allows for subcellular imaging. The study aim was to evaluate the learning curve of HRME for the differentiation of neoplastic from non-neoplastic colorectal polyps.
  
  
  METHODS
  In a prospective cohort fashion, a total of 162 polyps from 97 patients at a single tertiary care center were imaged by HRME and classified in real time as neoplastic (adenomatous, cancer) or non-neoplastic (normal, hyperplastic, inflammatory). Histopathology was the gold standard for comparison. Diagnostic accuracy was examined at three intervals over time throughout the study; the initial interval included the first 40 polyps, the middle interval included the next 40 polyps examined, and the final interval included the last 82 polyps examined.
  
  
  RESULTS
  Sensitivity increased significantly from the initial interval (50%) to the middle interval (94%, P = 0.02) and the last interval (97%, P = 0.01). Similarly, specificity was 69% for the initial interval but increased to 92% (P = 0.07) in the middle interval and 96% (P = 0.02) in the last interval. Overall accuracy was 63% for the initial interval and then improved to 93% (P = 0.003) in the middle interval and 96% (P = 0.0007) in the last interval.
  
  
  CONCLUSIONS
  In conclusion, this in vivo study demonstrates that an endoscopist without prior colon HRME experience can achieve greater than 90% accuracy for identifying neoplastic colorectal polyps after 40 polyps imaged. HRME is a promising modality to complement white light endoscopy in differentiating neoplastic from non-neoplastic colorectal polyps.
authors.affiliation: Division of Digestive Diseases, Yale New Haven Hospital, New Haven, Connecticut, USA.
authors.forename: Neil D
authors.identifier: http://orcid.org/0000-0003-4850-8316
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, New York University Langone Medical Center, New York, New York, USA.
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Chang
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: D001706:Biopsy / Q000379:methods*; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000473:pathology*; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D007417:Intestinal Polyps / Q000175:diagnosis / Q000473:pathology; D008856:Microscopy, Fluorescence / Q000379:methods*; D061848:Optical Imaging / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: adenoma classification; colorectal polyps; microendoscopy