title: External Validation of the Endoscopic Features of Sessile Serrated Adenomas in Expert and Trainee Colonoscopists.
abstract: OBJECTIVE
  It is unclear whether the endoscopic features of sessile serrated adenomas (SSAs) would be useful to trainee colonoscopists to predict SSA. Therefore, the present study aimed to identify features that expert and trainee colonoscopists can use to independently and reliably predict SSA by using high-resolution white-light endoscopy.
  
  
  METHODS
  Endoscopic images of 81 polyps (39 SSAs, 22 hyperplastic polyps, and 20 tubular adenomas) from 43 patients were retrospectively evaluated by 10 colonoscopists (four experts and six trainees). Eight endoscopic features of SSAs were assessed for each polyp.
  
  
  RESULTS
  According to multivariable analysis, a mucous cap (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.72 to 19.07), indistinctive borders (OR, 4.21; 95% CI, 2.74 to 7.16), dark spots (OR, 3.64; 95% CI, 1.89 to 7.00), and cloud-like surface (OR, 2.43; 95% CI, 1.27 to 4.668) were independent predictors of SSAs. Among these, a mucous cap, indistinctive borders, and cloud-like surface showed moderate interobserver agreement (mean κ >0.40) among experts and trainees. When ≥1 of the three predictors was observed, the sensitivity and specificity for diagnosing SSAs were 79.0% and 81.4%, respectively.
  
  
  CONCLUSIONS
  Colonoscopy trainees and experts can use several specific endoscopic features to independently and reliably predict SSAs.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyo-Joon
authors.initials: HJ
authors.lastname: Yang
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jeong In
authors.initials: JI
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Soo-Kyung
authors.initials: SK
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yoon Suk
authors.initials: YS
authors.lastname: Jung
authors.affiliation: Department of Pathology, Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Sohn
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kyu Yong
authors.initials: KY
authors.lastname: Choi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Park
keywords: Colonoscopy; Colorectal neoplasms; Education, medical, graduate; Observer variation; Sensitivity and specificity