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Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study

Gut and Liver 2020년 14권 5호 p.611 ~ 618
양동훈, John Sneha, Mitsuhiro Fujishiro, 차재명, 변정식, 김형욱, 김현건, Friedland Shai, Koh Yon Xian, 윤진영, 곽민섭, 예병덕, 김지헌, 양석균,
소속 상세정보
양동훈 ( Yang Dong-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
 ( John Sneha ) - Gold Coast University Hospital Department of Gastroenterology
 ( Mitsuhiro Fujishiro ) - Nagoya University Graduate School of Medicine Department of Gastroenterology
차재명 ( Cha Jae-Myung ) - Kyung Hee University School of Medicine Kyung Hee University Hospital at Gangdong Department of Internal Medicine
변정식 ( Byeon Jeong-Sik ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
김형욱 ( Kim Hyung-Wook ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Internal Medicine
김현건 ( Kim Hyun-Gun ) - Soonchunhyang University College of Medicine Department of Internal Medicine
 ( Friedland Shai ) - Stanford University School of Medicine Department of Gastroenterology and Hepatology
 ( Koh Yon Xian ) - Gold Coast University Hospital Department of Gastroenterology
윤진영 ( Yoon Jin-Young ) - Kyung Hee University School of Medicine Kyung Hee University Hospital at Gangdong Department of Internal Medicine
곽민섭 ( Kwak Min-Seob ) - Kyung Hee University School of Medicine Kyung Hee University Hospital at Gangdong Department of Internal Medicine
예병덕 ( Ye Byong-Duk ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
김지헌 ( Kim Ji-Hun ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
양석균 ( Yang Suk-Kyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology

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 endoscopic diagnosis of “nonpedunculated” dysplasia or colitic cancer in UC patients.

Methods: Ten endoscopists from four countries were surveyed using photographs of 61 histologically 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 intention to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, including 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 performance 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.

키워드

Colitis, ulcerative; Dysplasia; Neoplasm, colonic; Colonoscopy; Diagnosis

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