Pit pattern analysis with high-definition chromoendoscopy and narrow-band imaging for optical diagnosis of dysplasia in patients with ulcerative colitis - 22/11/17
Abstract |
Background and Aims |
Patients with longstanding ulcerative colitis (UC) are at increased risk of developing colorectal neoplasia. Chromoendoscopy (CE) increases detection of lesions, and Kudo pit pattern classification I and II have been suggested to be predictive of benign polyps in UC. Little is known on the use of this classification in nonmagnified high-definition (HD) (virtual) CE and narrow-band Imaging (NBI) or on the interobserver agreement. The aim of this pilot study was to assess the diagnostic accuracy and the interobserver agreement of the Kudo pit pattern classification in UC patients undergoing surveillance with methylene blue CE or NBI in a multicenter study.
Methods |
Fifty images of lesions identified in 27 UC patients (13 neoplastic) either with classical CE (methylene blue .1%; n = 24) or NBI (n = 26) were selected by an independent investigator. Images were selected from a randomized controlled trial to compare CE and NBI. All nonmagnified images were obtained with a processor and mounted in a PowerPoint file in a standardized way (same size; black background). Ten endoscopists with extensive experience in NBI/CE were asked to assess the lesions for the predominant Kudo pit pattern (I, II, IIIL, IIIS, IV, and V) to indicate if they believed the lesion was neoplastic and how confident they were about the diagnosis. Histology was used as the criterion standard.
Results |
Median sensitivity, specificity, negative predictive value, and positive predictive value for diagnosing neoplasia based on the presence of pit pattern other than I or II was 77%, 68%, 88%, and 46%, respectively. Diagnostic accuracy was significantly higher when a diagnosis was made with a high level of confidence (77% vs 21%, P < .001). The overall interobserver agreement for any pit pattern was only fair (κ = .282), with CE being significantly better than NBI (.322 vs .224, P < .001). From a clinical viewpoint the difference between neoplastic and non-neoplastic lesions is important. The agreement for differentiation between non-neoplastic patterns (I, II) and neoplastic patterns (IIIL, IIIS, IV, or V) was moderate (κ = .587) and even significantly better for NBI in comparison with CE (κ = .653 vs .495, P < .001).
Conclusions |
Differentiation between non-neoplastic and neoplastic pit patterns in UC lesions shows a moderate to substantial agreement among expert endoscopists. The agreement for differentiating neoplastic from non-neoplastic lesions is significantly better for NBI in comparison with HD CE. The assessment of pit pattern I or II with nonmagnified HD CE or NBI has a high negative predictive value to rule out neoplasia. (Clinical trial registration number: NCT01882205.)
Le texte complet de cet article est disponible en PDF.Abbreviations : CE, CRC, HD, NBI, NPV, PPV, UC
Plan
| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: R. Bisschops: Speaker for Pentax, Fujifilm, Olympus, Covidien, Boston Scientific, Ferring, and Norgine; consultant for Pentax, Fujifilm, CDx Diagnostics, Covidien, Boston Scientific, and Norgine; research support recipient from Pentax, Fujifilm, Covidien, and Cook. T. Bessissow: Speaker and consultant for Janssen, Abbvie, Shire, Takeda, and Ferring. M. Ferrante: Research grant recipient from Takeda; speaker for Takeda, Abbvie, Boehringer-Ingelheim, Chiesi, Falk, Ferring, Janssen, Mitsubishi Tanabe, MSD, Tilotts, and Zeria; consultant for Abbvie, Boehringer-Ingelheim, Ferring, Janssen, and MDS. E. Dekker: Research support recipient from Olympus and Fujifilm. J. E. East: Research support and advisory board member for Olympus, Cosmo Pharmaceuticals, and Lumendi. K. Ragunath: Consultant and research support recipient from Olympus, Pentax, Cook, Boston Scientific, Erbe, Astra Zeneca, and Ferring. P. Bhandari: Research support recipient from Olympus, Pentax, and Fujifilm. M. Rutter: Honoraria from Pentax; research support recipient from Olympus. E. Schoon: Speaker for Medtronic and Boston Scientific; equipment loan from Fujifilm. F. Baert: Research support recipient from Abbott, Chiesi, Roche, and MSD; speaker and consultant for Abbvie, Boehringer-Ingelheim, MSD, Mundipharma, Falk, Ferring, Takeda, and Vifor. All other authors disclosed no financial relationships relevant to this publication. |
Vol 86 - N° 6
P. 1100 - décembre 2017 Retour au numéro
Article précédent
- Surgery versus surveillance in ulcerative colitis patients with endoscopically invisible low-grade dysplasia: a cost-effectiveness analysis
- Ben Parker, James Buchanan, Sarah Wordsworth, Satish Keshav, Bruce George, James E. East
- Optimizing the quality of endoscopy in inflammatory bowel disease: focus on surveillance and management of colorectal dysplasia using interactive image- and video-based teaching
- Tonya R. Kaltenbach, Roy M. Soetikno, Rebecca DeVivo, Loren A. Laine, Alan Barkun, Kenneth R. McQuaid
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