Impact of Magnification Endoscopy on Diagnostic Accuracy and Confidence in Real-Time Histological Prediction of...

Accurate endoscopic diagnosis of colorectal lesions is essential for clinical management. This prospective multicenter study assessed the impact of magnification endoscopy on real-time decision-making for colorectal lesions.

We included 419 patients with 876 colorectal polyps and assessed using three approaches: single (white light endoscopy, WLE), dual (WLE + narrow-band imaging with magnification endoscopy, NBIME), and triple (WLE + NBIME + pit pattern analysis using magnification chromoendoscopy or acetic acid-enhanced NBIME). Expert endoscopists provided histological predictions and confidence. Predictions were further classified into three management categories: surveillance (hyperplastic polyps), endoscopic resection (conventional adenomas, sessile serrated lesions [SSLs], traditional serrated adenomas [TSAs], T1a carcinoma), and surgical resection (T1b carcinoma).

Lesions included 24 hyperplastic polyps, 654 conventional adenomas, 85 SSL/TSAs, 90 T1a carcinomas, and 23 T1b carcinomas. Histological prediction accuracy was 84.9%, 85.3%, and 87.4% (p = 0.35), and clinical diagnosis accuracy was 94.6%, 95.5%, and 96.5% (p = 0.17) for single, dual, and triple modalities, respectively, showing numerically higher values with additional modalities. High-confidence rates significantly increased with additional modalities (73.4%, 80.0%, 83.6%; p < 0.05), correlating with improved accuracy. In high-confidence cases, histological prediction accuracy was 93.3%, 92.7%, and 93.2%, compared to 66.5%, 60.6%, and 67.4% in low-confidence cases (p < 0.05). A similar trend was observed for clinical diagnosis, with accuracy of 98.3%, 97.9%, and 97.8% versus 85.0%, 85.7%, and 89.6% (p < 0.05). Confidence gain was associated with larger size in both single-dual and dual-triple transitions (p < 0.05), particularly ≥ 10 mm lesions.

Magnification endoscopy has minimal impact on diagnostic accuracy but significantly enhances diagnostic confidence, aiding clinical decisions.