What size cutoff level should be used to implement optical polyp diagnosis?

Area of Science:

• Gastroenterology
• Endoscopy
• Pathology

Background:

• Risk of advanced pathology and mismanagement increases with polyp size.
• Optical diagnosis (OD) aids in real-time polyp assessment during colonoscopy.
• Accurate surveillance intervals are crucial for effective colorectal cancer prevention.

Purpose of the Study:

• To evaluate the proportion of patients receiving inadequate surveillance intervals based on different optical diagnosis size cutoffs.
• To assess the impact of varying polyp size thresholds for optical diagnosis on patient management.
• To determine optimal size cutoffs for implementing optical diagnosis in colonoscopy surveillance.

Main Methods:

• Post hoc analysis of three prospective colonoscopy studies.
• Evaluation of optical diagnosis for polyp size groups: 1-3 mm, 1-5 mm, and 1-10 mm.
• Primary outcome: proportion of patients with advanced adenomas and delayed surveillance due to OD.

Main Results:

• A 3-mm cutoff for optical diagnosis showed a 3.8% rate of delayed surveillance for advanced adenomas.
• Larger cutoffs (5 mm and 10 mm) resulted in significantly higher rates of delayed surveillance (15.2% and 25.3%).
• A 3-mm cutoff achieved 97.2% agreement with pathology for surveillance intervals and reduced pathology examinations by 33.5%.

Conclusions:

• Implementing optical diagnosis with a 3-mm size cutoff minimizes the risk of delayed management for advanced neoplasia.
• This strategy maintains high agreement with pathological findings for surveillance recommendations.
• A 3-mm cutoff offers a substantial reduction in the need for histopathological examinations, improving efficiency.