Gut Liver.  2020 Sep;14(5):611-618. 10.5009/gnl19237.

Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study

  • 1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 2Department of Gastroenterology, Gold Coast University Hospital, Southport, Australia.
  • 3Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
  • 4Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
  • 5Division of Gastroenterology, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 6Department of Gastroenterology, Soonchunhyang University College of Medicine, Seoul, Korea.
  • 7Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA.
  • 8Department of Gastroenterology, VA Palo Alto Health Care System, Palo Alto, CA, USA.
  • 9Inflammatory Bowel Disease Center,Seoul, Korea
  • 10Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea


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 endo-scopic diagnosis of “nonpedunculated” dysplasia or colitic cancer in UC patients.
Ten endoscopists from four countries were surveyed using photographs of 61 histologi-cally 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.
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 inten-tion to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, includ-ing 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.
Diagnostic per-formance 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.


Colitis; ulcerative; Dysplasia; Neoplasm; colonic; Colonoscopy; Diagnosis
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