Reliability and accuracy of the endoscopic appearance in the identification of aberrant crypt foci.
BACKGROUND
Aberrant crypt foci (ACF) have emerged as a putative precursor to colorectal adenoma, with potential use as a biomarker of colorectal cancer. However, there are wide differences in ACF prevalence, dysplasia, and histologic confirmation rates across studies. These differences may, in part, be because of variability in identification of endoscopic criteria.


OBJECTIVE
To systematically evaluate the accuracy and reliability of various endoscopic criteria used to identify ACF when using magnification chromoendoscopy (MCE).


METHODS
Images obtained via MCE were shown to participating endoscopists who diagnosed them as ACF or not and who assessed them for the endoscopic characteristics used to identify ACF in the literature.


METHODS
The predictive ability of the endoscopic criteria (crypt number, staining, margin, crypt size, epithelial thickness, and lumen shape) for histologic confirmation of ACF, and their reliability across endoscopists. The accuracy of the examiners in identifying ACF that were histologically confirmed was also assessed.


RESULTS
The interrater agreement rate for all except one of the endoscopic criteria (crypt number) was low and did not improve with training. None of the criteria could significantly predict histologic confirmation of ACF. Despite training exercises, accuracy of endoscopists to correctly identify a histologically proven ACF remained low.


CONCLUSIONS
Still images with x40 optical magnification were analyzed rather than real-time endoscopy. All ACF samples were hyperplastic; none were dysplastic.


CONCLUSIONS
No endoscopic criteria evaluated by our study predicted histologic confirmation of ACF. MCE had low accuracy and poor reliability.
Gupta
Akshay K
AK
Department of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
Pinsky
Paul
P
Rall
Christopher
C
Mutch
Matthew
M
Dry
Sarah
S
Seligson
David
D
Schoen
Robert E
RE
D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D006801:Humans; D015588:Observer Variation; D011230:Precancerous Conditions / Q000473:pathology*; D015203:Reproducibility of Results