Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study
- Author:
Dong-Hoon YANG
1
;
Sneha JOHN
;
Fujishiro MITSUHIRO
;
Jae Myung CHA
;
Jeong-Sik BYEON
;
Hyung Wook KIM
;
Hyun Gun KIM
;
Shai FRIEDLAND
;
Yon Xian KOH
;
Jin-Young YOON
;
Min-Seob KWAK
;
Byong Duk YE
;
Jihun KIM
;
Suk-Kyun YANG
Author Information
- Publication Type:Original Article
- From:Gut and Liver 2020;14(5):611-618
- CountryRepublic of Korea
- Language:0
-
Abstract:
Background/Aims:Endoscopic diagnosis of dysplasia or colitic cancer in patients with ulcerative colitis (UC) is more challenging than that of colorectal neoplasia in non-colitic patients. We aimed to evaluate the accuracy of the endo-scopic diagnosis of “nonpedunculated” dysplasia or colitic cancer in UC patients.
Methods:Ten endoscopists from four countries were surveyed using photographs of 61 histologi-cally confirmed dysplastic or non-dysplastic lesions retrieved from the UC registry database of Asan Medical Center. The participants provided their assessment based on the given photographs and their intention to perform biopsy.
Results:The overall diagnostic performance of the 10 participants is summarized as follows: sensitivity of 88.2% (95% confidence interval [CI], 84.3% to 91.5%), specificity of 34.8% (95% CI, 29.1% to 40.8%), positive predictive value of 63.0% (95% CI, 60.8% to 65.2%), negative predictive value of 70.2% (95% CI, 62.7% to 76.6%), and accuracy of 64.6% (95% CI, 60.7% to 68.4%). The interobserver agreement on the inten-tion to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, includ-ing ulceration, distinctness of the borders, and pit patterns, only neoplastic pit patterns were significantly predictive of dysplasia (odds ratio, 3.710; 95% CI, 2.001 to 6.881). The diagnostic sensitivity and specificity of neoplastic pit patterns were 68.2% (95% CI, 63.0% to 73.2%) and 63.3% (95% CI,57.3% to 69.1%), respectively.
Conclusions:Diagnostic per-formance based on the endoscopist’s intention to perform a biopsy for nonpedunculated potentially dysplastic lesions in UC patients was suboptimal according to this survey-based study.
