Paul Fockens

Identification of predictive factors for early neoplasia in Barrett's esophagus after autofluorescence imaging: a stepwise multicenter structured assessment.

BACKGROUNDnAutofluorescence imaging is a novel imaging technique that may improve the detection of early neoplasia in Barretts esophagus. Autofluorescence imaging is, however, associated with a 40% to 81% false-positive rate.nnnOBJECTIVEnOur purpose was to identify endoscopic features that may predict the presence of early neoplasia in autofluorescence-positive areas.nnnDESIGNnDescriptive and prospective cohort study.nnnSETTINGnTertiary referral centers for the detection and treatment of early Barretts neoplasia.nnnPATIENTS AND METHODSnPatients undergoing autofluorescence endoscopy. High-quality images with autofluorescence imaging and white-light endoscopy were obtained with corresponding histologic study. A systematic image evaluation process was performed, including an unblinded orientation phase (10 areas), a blinded derivation phase, and a blinded validation phase by 5 international experts in autofluorescence imaging (80 areas). Subsequently the identified features were validated in a prospective pilot study.nnnMAIN OUTCOME MEASUREMENTSnAssociation between endoscopic features and presence of early neoplasia in autofluorescence-positive areas.nnnRESULTSnAutofluorescence intensity, proximity of gastric folds <1 cm, and different appearance on white-light endoscopy were independently associated with early neoplasia in autofluorescence-positive areas on multivariate analysis. The kappa values for interobserver agreement of these factors were moderate, ranging between 0.49 to 0.56. The association with autofluorescence intensity and different appearance on white-light endoscopy was confirmed in a prospective pilot study.nnnLIMITATIONnSelected set of images from a high-risk population (tertiary referral center).nnnCONCLUSIONnWe found specific endoscopic features that were associated with early neoplasia in autofluorescence-positive areas. These findings can be used in future prospective studies to improve the accuracy of autofluorescence imaging without performing magnification endoscopy for detailed inspection of suspicious areas.