The accuracy of human detection of submucosal invasive cancer – analysis of 739 individual assessments of large non-pedunculated colorectal polyps using a novel clinical decision tool.

Aims Current tools to detect submucosal invasive cancer (SMI) within large (>=20mm) non-pedunculated colorectal polyps (LNPCPs) are complex. This potentially leads to incorrect decision-making (e.g. piecemeal resection of SMI necessitating surgery or surgery for benign disease). An online decision-support tool was developed using the concept of a demarcated area – where a regular pit/vascular pattern becomes disordered – to search for OVERT (visible on the surface) SMI and 4 morphological characteristics of LNPCPs (Paris classification, size, colonic location, and granularity) to quantify COVERT (hidden) SMI risk. Methods A survey was sent to endoscopists containing an educational video with 20 subsequent randomly-presented standardized videos of LNPCPs. Participants’ first impression was asked before using the tool to classify polyps as low/high (COVERT), or very high (OVERT) risk of SMI. Responses were compared to expert responses and histopathology. Results 739 individual responses were analysed. First impression strongly predicted absence of SMI – negative predictive value (NPV) 97.5% (95% confidence interval (95%CI):95.0-99.0%) and accuracy 72.3% (95%CI:68.9-75.6%). Absence of a demarcated area was predicted with similar NPV – 97.6%(95%CI:96.0-99.0%). Lower accuracy, 78.6%(95%CI:76.5-81.5%), resulted from participant overcalling of a demarcated area. The accuracy of participant size, Paris classification, granularity, and location (provided) determination were 66.3%(95%CI:61.8-70.5%), 66.3%(95%CI:61.8-70.5%), 64.8%(95%CI:60.3-69.1%) and 94.8%(95%CI:92.4-96.6%) respectively. Overall accuracy was 66.2%(95%CI:62.6-69.6%), clinically resulting in correct treatment in 71.3%, undertreatment in 13.1% and overtreatment in 15.6%.

Citation

Debels, L., Schoonjans, C., Anderson, J., Valori, R., Desomer, L., & Tate, D. (2022). The accuracy of human detection of submucosal invasive cancer – Analysis of 739 individual assessments of large non-pedunculated colorectal polyps using a novel clinical decision tool. Endoscopy, 54(S 01), OP179. https://doi.org/10.1055/s-0042-1744742

DOI

10.1055/s-0042-1744742

URI

https://hdl.handle.net/20.500.14709/870

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