Video-autofluorescence imaging, and narrow band imaging are new endoscopic techniques that may improve the detection of high-grade intraepithelial neoplasia in Barrett's esophagus.
Autofluorescence imaging improves the detection of lesions but may give false-positive findings.
Narrow band imaging allows for detailed inspection of the mucosal and microvascular patterns, which are related to high-grade intraepithelial neoplasia.
Dr Jacques Bergman and colleagues from Illinois assessed whether combining the 2 techniques would improve the detection of high-grade intraepithelial neoplasia.
The research team also assessed whether the combination of the techniques reduced false-positive findings.
The team conducted a cross-sectional single-center study of consecutive eligible patients.
The researchers investigated 20 patients with Barrett's Esophagus with suspected or endoscopically treated high-grade intraepithelial neoplasia.
|All 28 lesions with neoplasia were identified using autofluorescence imaging|
The team used 2 prototype imaging systems.
High-resolution videoendoscopy and autofluorescence imaging was used for detection of lesions.
The team used narrow band imaging for detailed inspection of mucosal and vascular patterns of identified lesions.
Lesions were sampled for histopathologic evaluation.
The team's main outcome was the positive predictive value of autofluorescence imaging alone and combined with narrow band imaging for detecting high-grade intraepithelial neoplasia.
The reduction of false-positive findings because of the use of narrow band imaging was also one of the main outcomes.
All of the 28 lesions with high-grade intraepithelial neoplasia were identified with autofluorescence imaging.
The team identified 17 with white light.
Autofluorescence imaging detected 47 suspicious lesions.
Of these, 28 contained high-grade intraepithelial neoplasia, and 19 were false positive.
With narrow band imaging, 25 of the true-positive lesions had definitely suspicious patterns, and 3 had dubiously suspicious patterns.
Of the 19 false positives, the team found that 14 were not suspicious on narrow band imaging.
The false-positive rate, therefore, was reduced from 40% to 10%.
The researchers found low-grade dysplasia in 4 of the remaining 5 false positives.
All of the 14 patients with high-grade intraepithelial neoplasia were identified by autofluorescence imaging-narrow band imaging, a sensitivity of 100%.
Dr Bergman's team concludes, “This proof-of-principle study confirms that autofluorescence imaging can be used as a red-flag technique to detect suspicious lesions.”
“With narrow band imaging, detailed inspection of the surface patterns can be performed.”
“This combination may increase the accuracy of detecting high-grade intraepithelial neoplasia in Barrett's Esophagus.”