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Suboptimal endoscopic cancer recognition in colorectal lesions in a national bowel screening programme
  1. Jasper L A Vleugels1,
  2. Lianne Koens2,
  3. Marcel G W Dijkgraaf3,
  4. Britt Houwen1,
  5. Yark Hazewinkel1,
  6. Paul Fockens1,
  7. Evelien Dekker1
  8. on behalf of the DISCOUNT study group
    1. 1 Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
    2. 2 Department of Pathology, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
    3. 3 Clinical Research Unit, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
    1. Correspondence to Prof. dr. Evelien Dekker, Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam 1105 AZ, The Netherlands; e.dekker{at}amsterdamumc.nl

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    The worldwide implementation of bowel cancer screening programmes (BCSPs) results in a growing number of early T1 colorectal cancers (T1 CRCs). Successful treatment of T1 CRCs starts with accurately recognising these lesions during endoscopy. This study performed in the Dutch BCSP showed that endoscopists correctly diagnosed T1 CRCs in only 39% of 92 cases (95% CI 30 to 49) and that this limited diagnostic accuracy of optical diagnosis resulted in different treatment outcomes. In patients with T1 CRCs that were optically not diagnosed as cancer and treated locally, adjuvant surgery was performed in 41% of cases, compared with 11% of patients with T1 CRCs that were correctly optically diagnosed (p=0.02).

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    In this prospective multicentre study (trial registration number: NTR4635, NCT02407925), endoscopists accredited for fecal immunochemical test (FIT)-positive colonoscopies within the Dutch BCSP were trained in optical diagnosis with our validated National Institute for Health and Care Excellence (NICE)-WASP (Workgroup serrAted polypS and Polyposis) module (online supplementary material 1 for full methods).1 2 A total of 27 endoscopists completed the training successfully and entered the prospective study, in which the endoscopists as well as pathologists reported their findings in a predefined structure. This facilitated high-quality data collection and ensured collection of exact data on all aspects of each detected lesion as location, size, Paris morphology, optical diagnosis (colorectal cancer (CRC), adenoma, hyperplastic polyp, sessile serrated lesion or other), endoscopic treatment method (biopsy, cold or hot snare polypectomy, endoscopic mucosal resection, biopsy for diagnosis or no treatment), completeness of resection and whether a tattoo was placed. Participating endoscopists recorded optical diagnosis using narrow band imaging in all consecutive FIT-positive colonoscopies for the Dutch BCSP during 1 year. Local treatment was defined as endoscopic resection or transanal endoscopic microsurgery. For all patients initially diagnosed with T1 CRCs, the original H&E staining slides were collected …

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