Revista do Colégio Brasileiro de Cirurgiões
https://revistadocbc.org.br/article/doi/10.1590/0100-6991e-20253850
Revista do Colégio Brasileiro de Cirurgiões
Artigo Original

Introdução do uso de cromoendoscopia digital como ferramenta de classificação de lesões colônicas e análise do ganho de experiência em serviço terciário

Introduction of digital chromoendoscopy for classification of colonic lesions and assessment of experience gain in a tertiary healthcare hospital

Vitor Couri Blassioli; Luiza Cadaval Rocha; Guilherme Lopes Machado; Lucas Alves Bessa Cardoso; Marina Barbabela Grisolia De Oliveira; Rodrigo Almeida Paiva; Fabio Lopes Queiroz; Antônio Lacerda Filho

http://dx.doi.org/10.1590/0100-6991e-20253850 RCBC, vol.52, e20253850, 2025
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Resumo

Objetivo: A colonoscopia é eficaz para reduzir a mortalidade ao detectar e remover pólipos, mas procedimentos invasivos ainda são comuns. Novas técnicas, como a classificação NICE com Narrow-band Imaging (NBI), ajudam a prever a histologia dos pólipos sem ressecção. O presente estudo avalia o impacto da classificação NICE em colonoscopias em serviço de saúde terciário, analisando a performance dos examinadores ao longo do tempo.

Métodos: Estudo prospectivo observacional unicêntrico. Incluídos pacientes submetidos à colonoscopia com pólipos detectados, que passaram por cromoendoscopia digital para classificação do protocolo NICE comparando com a histopatologia como padrão-ouro. Foi estratificado a análise em 2 períodos e entre os executantes.

Resultados: A acurácia geral foi de 70,2%, sensibilidade de 0,663, especificidade de 0,761, valor preditivo negativo (VPN) de 0,590, valor preditivo positivo (VPP) de 0,813 sem melhora significativa no segundo período. Houve um ganho de performance na sensibilidade (0,606 vs 0,825, p=0,002), não houve diferença nas outras variáveis.

Discussão: Observou melhoria na sensibilidade e melhoria não significativa na acurácia, VPN, VPP. A variabilidade entre os examinadores, demonstrado pelo Kappa 0,403 e o tamanho reduzido da amostra podem ter limitado resultados mais robustos.

Conclusão: A cromoendoscopia digital é eficaz para a classificação de lesões colônicas e identificação histológica pré-ressecção, mas a performance dos examinadores é crucial, não devendo ser a única base para decisões clínicas. A implementação de treinamento formal e prática contínua é fundamental para melhorar o desempenho.

Palavras-chave

Colonoscopia; Educação Continuada; Pólipos Adenomatosos; Pólipos Intestinais

Abstract

Introduction: Colonoscopy is effective in reducing mortality by detecting and removing polyps, but invasive procedures remain common. New techniques, such as the NICE classification with Narrow-band Imaging (NBI), help predict the histology of polyps without resection. This study evaluates the impact of the NICE classification in colonoscopies at a tertiary healthcare service, analyzing examiner performance over time.

Methods: A single-center prospective observational study. Patients who underwent colonoscopy with detected polyps were included, undergoing digital chromoendoscopy for NICE protocol classification, compared with histopathology as the gold standard. The analysis was stratified by two periods and among examiners.

Results: Overall accuracy was 70.2%, with sensitivity of 0.663, specificity of 0.761, negative predictive value (NPV) of 0.590, and positive predictive value (PPV) of 0.813, with no significant improvement in the second period. There was a performance gain in sensitivity (0.606 vs. 0.825, p=0.002), with no difference in other variables.

Discussion: An improvement was observed in sensitivity and a non-significant improvement in accuracy, NPV, and PPV. Variability among examiners, as indicated by a Kappa of 0.403, and the reduced sample size may have limited more robust results.

Conclusion: Digital chromoendoscopy is effective for classifying colonic lesions and pre-resection histological identification; however, examiner performance is crucial and should not be the sole basis for clinical decisions. Implementing formal training and continuous practice is essential for improving performance.

Keywords

Colonoscopy; Continuing Education; Polyps; Adenomatous Polyps; Intestinal Polyps

Referências

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Submetido em:
24/10/2024

Aceito em:
09/07/2025

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