BASIC (BLI Adenoma Serrated International Classification) classification for colorectal polyp characterization with...

Area of Science:

• Gastroenterology
• Endoscopic Imaging
• Oncology

Background:

• Advanced endoscopic imaging, including blue-light imaging (BLI), aids in characterizing colon lesions.
• Accurate differentiation of subcentimetric polyps and invasive cancers is crucial for patient management.
• Existing classification systems may benefit from enhancements for improved diagnostic precision.

Purpose of the Study:

• To develop and validate a novel classification system for subcentimetric hyperplastic and adenomatous polyps, and deeply invasive malignant lesions.
• To assess the interobserver agreement of the new classification using BLI with and without optical magnification.
• To enhance diagnostic accuracy in colonoscopy through standardized lesion characterization.

Main Methods:

• A video library of 48 BLI recordings (with/without optical magnification) from 24 histologically verified lesions was created.
• Seven endoscopists participated in a modified Delphi process to identify and refine key descriptors.
• Interobserver agreement was assessed using Gwet's AC1 statistic for the proposed classification domains.

Main Results:

• The new BASIC classification incorporates polyp surface, pit appearance, and vessel characteristics.
• High interobserver agreement was achieved for most descriptors, particularly for mucus presence and vessel patterns.
• Optical magnification generally improved interobserver agreement across various classification domains.

Conclusions:

• The BASIC classification, utilizing BLI features, shows high concordance among observers for differentiating colorectal lesions.
• This classification system offers a standardized approach to enhance diagnostic accuracy during colonoscopy.
• Optical magnification is a valuable tool for improving the reliability of endoscopic lesion characterization.