Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study
Dong-Hoon Yang,
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
Affiliations
Dong-Hoon Yang
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Sneha John
Department of Gastroenterology, Gold Coast University Hospital, Southport, Australia
Fujishiro Mitsuhiro
Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Jae Myung Cha
Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
Jeong-Sik Byeon
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Hyung Wook Kim
Division of Gastroenterology, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea
Hyun Gun Kim
Department of Gastroenterology, Soonchunhyang University College of Medicine, Seoul, Korea
Shai Friedland
Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
Yon Xian Koh
Department of Gastroenterology, Gold Coast University Hospital, Southport, Australia
Jin-Young Yoon
Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
Min-Seob Kwak
Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
Byong Duk Ye
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Jihun Kim
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Suk-Kyun Yang
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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.
