A Non-optical Resect-and-Discard Strategy Achieves a Similar Colonoscopy Surveillance Agreement Compared to the Optical Resect-and-Discard Strategy
Bibliographic record
Abstract
Introduction: The current resect-and-discard strategy requires training, credentialing, and monitoring, and is contingent on high-confidence optical diagnosis. Moreover, pathology is often required for concomitant polyps. The complexity of this strategy may challenge widespread adoption. Our objective was to evaluate alternative and less complex resect-and-discard strategies. Methods: Real time optical diagnosis using narrow band imaging was applied to all diminutive polyps found in 1,100 study subjects. In this post hoc analysis of a previous study on optical diagnosis we examined three different resect-and-discard strategies for diminutive polyps: A) The currently proposed optical strategy; B) A simplified optical strategy, in which all rectosigmoid polyps were considered hyperplastic unless confidently diagnosed as adenomas, and all polyps proximal to the rectosigmoid colon as neoplastic. C) A non-optical strategy, in which all rectosigmoid polyps were considered hyperplastic and all polyps proximal to the rectosigmoid as neoplastic. Primary outcome was the agreement of the surveillance interval determined for each strategy with the pathology based surveillance interval. Results: A total of 1311 diminutive polyps were found among 566 patients. Applying the optical strategy, surveillance recommendations agreed with the pathology based recommendations in 93% of patients. The agreement was lower for the simplified strategy (87%), but similar for the non-optical strategy (89%, p < 0.01, Figure 1). When applying a 10-year surveillance interval for 1-2 small adenomas, all strategies surpassed the 90% quality benchmark for surveillance agreement (96%, 93%, and 93%, respectively). Pathology examination could be saved for 960 of 1650 polyps in the cohort (58%) with the optical strategy, and for 1311 polyps (79%) with either the simplified or the non-optical strategy (p < 0.01). More patients could be given recommendations immediately following the colonoscopy when applying the simplified or non-optical strategy (69%) compared to the optical strategy (44%, p < 0.01).Figure 1Conclusion: A non-optical resect-and-discard strategy may achieve similar surveillance recommendation agreements compared to the currently proposed optical strategy. While lessen the complexity of optical diagnosis, alternative strategies would also reduce the number of required pathology examinations and provide more patients with immediate surveillance recommendations following the colonoscopy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".