DOP081. Outcomes of colitis-associated dysplasia after referral from the community to a tertiary centre
Why this work is in the frame
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Bibliographic record
Abstract
Background: Dye chromoendoscopy (DCE) is considered the standard of practice for IBD surveillance colonoscopy. However, the most appropriate procedure for optimum detection of neoplastic lesions (NL) is still unclear. The resolution of high-definition (HD) and virtual chromoendoscopy (VCE) colonoscopy has improved substantially, and further studies are needed to determine the optimal endoscopic technique. We aimed to conduct a randomised study comparing 3 different techniques for surveillance colonoscopy to detect colonic NL in IBD: HD, DCE, and VCE. Methods: A randomised study (NCT02098798) was conducted to determine the detection rates of NL with HD alone, HD with DCE or HD with VCE in patients with long standing colitis (8 years from diagnosis, both UC and CD, or PSC with IBD from diagnosis). Consecutive patients with inactive disease were enrolled in 1:1:1 ratio into 3 arms of the study. Colonoscopy was performed using a Pentax EPKi processor and HD video colonoscope (EC-3490Fi; Pentax, Tokyo). Endoscopic colonic lesions were classified by the Paris classification as polypoid/non-polypoid and Kudo pit pattern The NL were histologically categorised by the modified Vienna classification as dysplasia (ALM and DALM), sessile serrated adenomas (SSAs), and adenoma-like polyps (ALP). Chi squared test was used for comparison between the 3 arms. Sensitivity, specificity, PPV, NPV, and accuracy were calculated for each technique. The study was powered to detect an absolute difference in detection of neoplastic lesion of 15% between the HD and VCE groups, with the DSC group being a reference arm. Results: In the study, 225 consecutive patients (122 = M, median age 49 y, range 20-77 y) were assessed by HD (n = 75), VCE (n = 75) or DCE (n = 75). Further, 31 SSAs were found in 17 patients (7.5%); 45 ALPs were found in 39 patients (17.3%); 7 dysplastic lesions were found in 6 patients (2.7%); adenocarcinoma was found in 1 patient (0.4%). The colonic neoplastic lesions found in each surveillance arm are detailed in Table Neoplasia detection rates were similar amongst the 3 arms of the study (HD: 28%, DCE 22.6%, VCE 17.3%, p = NS). The 3 techniques had similar sensitivity and specificity in detecting DL. HD had a sensitivity of 93.6%, specificity of 85%, PPV 93.6%, NPV 85%, and accuracy 93.85%. DCE had a sensitivity of 86.6%, specificity of 89.6%, PPV 88%, NPV 86.7%, accuracy 87.3%, and VCE had a sensitivity of 92%, specificity of 73.3%, PPV 85.2%, NPV 84.6%, and accuracy 86%.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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 it