title: Time-gated fluorescence spectroscopy improves endoscopic detection of low-grade dysplasia in ulcerative colitis.
abstract: 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.
authors.affiliation: Department of Gastroenterology, University Hospital for Visceral Surgery and Medicine, University Hospital Inselspital, Bern, Switzerland. ma.ortner@bluewin.ch
authors.forename: Maria-Anna
authors.initials: MA
authors.lastname: Ortner
authors.forename: Virginia
authors.initials: V
authors.lastname: Fusco
authors.forename: Bernd
authors.initials: B
authors.lastname: Ebert
authors.forename: Uwe
authors.initials: U
authors.lastname: Sukowski
authors.forename: Jutta
authors.initials: J
authors.lastname: Weber-Eibel
authors.forename: Barbara
authors.initials: B
authors.lastname: Fleige
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.forename: Georg
authors.initials: G
authors.lastname: Oberhuber
authors.forename: Herbert
authors.initials: H
authors.lastname: Rinneberg
authors.forename: Herbert
authors.initials: H
authors.lastname: Lochs
mesh_terms: 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