Establishing reference standards for small and diminutive colorectal polyp size: validation of caliper-based size measurement

Abstract Background and Aim Accurate measurement of resected colorectal polyps is essential for clinical management, research, and the development of artificial intelligence-based size estimation systems. Despite widespread use of caliper-based measurement for specimen sizing, formal validation against a reference standard is lacking. This study aimed to validate caliper-based measurement of resected small and diminutive colorectal polyps against high-resolution digital microscopy, a previously validated reference method. Methods At the Centre hospitalier de l’Université de Montréal, 143 polyps from 92 patients were measured immediately after resection using vernier digital calipers in the endoscopy suite. Independent measurements were subsequently obtained using high-resolution digital microscopy under blinded conditions. Agreement between methods was assessed using bias analysis, Bland-Altman limits of agreement, intraclass correlation coefficient (ICC), and categorical size concordance. Results Caliper-based measurements demonstrated a mean bias of −0.22 mm (95% CI: −0.34 to −0.11; P < .001) relative to the reference standard. The noninferiority hypothesis with a 0.5-mm margin was not rejected (lower 95% CI > −0.5 mm). Bland-Altman’s limits of agreement were −1.57 to 1.12 mm, and the ICC was 0.88 (95% CI: 0.82-0.92). Correct categorical classification occurred in 94.4% of cases (95% CI: 0.89-0.97; κ = 0.81). Conclusion Caliper-based measurement provides accurate and reproducible estimates of polyp size when compared with digital microscopy, supporting its use for clinical and research applications requiring direct specimen measurement.