HISTOLOGICAL PREDICTION OF ADENOMATOSOUS AND NON-ADENOMATOSOUS POLYPS IN CHILDREN WITH APPLICATION OF THE I-SCAN SYSTEM

Abstract

Introduction: Virtual chromoendoscopy, including i-Scans, has increased the detection of adenomas in adults, with limited pediatric experience. Objective: Predict histological result of adenomatous and non-adenomatous polyp in children applying i-Scan. Methods: Prospective, descriptive, cross-sectional study, applying i-Scan during colonoscopy in pediatric patients with polyposis, period 2020-2021. Variables: age, sex, symptoms, polyp morphology, color characteristics, surface and vessels with i-Scan (ICE classification) and histology. Results: 26 patients with 44 polyps, preschool 61.54%, male 20/26 (76.92%); rectal bleeding symptoms 21/26 (80.77%). By Paris classification; polyps 0-Ip 25/44 (56.82%); rectal location 20/44 (45.45%) and 9/44 (20.46%) in other colonic segments. Solitary polyps 73.08%, size 1-2cm 61.54%. With ICE (i-Scan) classification, 2/44 (4.55%) adenomatous polyps characterized with a pattern of surface and vessels, and 42/44 (95.45%) non-adenomatous. With color 5/44 (11.36%) adenomatous and 39/44 (88.64%) non-adenomatous. Individual predictive capacity of the surface and vessel pattern was sensitivity 66.7%, specificity and PPV 100% and NPV 97.6%. With color, 100% sensitivity and NPV, 95% specificity and 60% PPV were obtained. With the sum of the patterns, 2/44 (4.55%) were identified as adenomatous polyps and 42/44 (95.45%) as non-adenomatous, achieving 67% sensitivity, specificity and PPV 100% and NPV 98%, due to the histological detection of 3/44 (6.82%) adenomatous polyps. When comparing the chromoendoscopy findings with histology, a 0.788 Kappa index was obtained, indicating good agreement between both methods. Conclusions: i-Scan is a safe diagnostic tool for histological prediction of adenomatous polyps in real time, with a fast learning curve, and its routine use can be implemented in pediatric gastroenterology.