Time-gated fluorescence spectroscopy improves endoscopic detection of low-grade dysplasia in ulcerative colitis.
BACKGROUND
Dysplasia in ulcerative colitis is frequently missed with 4-quadrant biopsies. An experimental setup recording delayed fluorescence spectra simultaneously with white light endoscopy was recently developed.


OBJECTIVE
We compared detection of invisible flat intraepithelial neoplasia with protoporphyrin IX fluorescence and standard 4-quadrant biopsies.


METHODS
Prospective, crossover design without randomization of the order of procedures.


METHODS
Gastroenterology Department, Humboldt University, Charité, Berlin, Germany.


METHODS
Forty-two patients with extensive ulcerative colitis of more than 10 years' duration were included.


METHODS
Colonoscopy with 4-quadrant biopsies and targeted biopsies of macroscopic lesions and time-gated fluorescence-guided colonoscopy were performed 2 weeks apart by 2 blinded endoscopists. Three independent pathologists examined the biopsy specimens.


METHODS
The primary outcome criterion was detection rate of invisible flat intraepithelial neoplasia.


RESULTS
Invisible flat intraepithelial neoplasia was detected in 3 (7%) patients by white light 4-quadrant biopsies and in 10 (24%) patients by fluorescence-guided endoscopy (P = .02). The sensitivity and specificity for differentiating patients with and without dysplasia were 100% and 81%, respectively. Dysplastic and nondysplastic mucosa could be discriminated with a sensitivity and specificity of 73% and 81%, respectively.


CONCLUSIONS
The trial was not randomized.


CONCLUSIONS
The detection rate of intraepithelial neoplasia in patients with ulcerative colitis can be improved by fluorescence-guided colonoscopy.
Ortner
Maria-Anna
MA
Department of Gastroenterology, University Hospital for Visceral Surgery and Medicine, University Hospital Inselspital, Bern, Switzerland. ma.ortner@bluewin.ch
Fusco
Virginia
V
Ebert
Bernd
B
Sukowski
Uwe
U
Weber-Eibel
Jutta
J
Fleige
Barbara
B
Stolte
Manfred
M
Oberhuber
Georg
G
Rinneberg
Herbert
H
Lochs
Herbert
H
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002278:Carcinoma in Situ / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D003093:Colitis, Ulcerative / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013050:Spectrometry, Fluorescence / Q000379:methods*; D055815:Young Adult