title: Autofluorescence imaging endoscopy for screening of esophageal squamous mucosal high-grade neoplasia: a phase II study.
abstract: OBJECTIVE
  Few prospective studies examining the efficacy of autofluorescence imaging (AFI) screening for esophageal cancer have been reported. This study aimed to investigate the diagnostic value of AFI endoscopy for the screening of squamous mucosal high-grade neoplasia of the esophagus, performed by experienced and less-experienced endoscopists.
  
  
  METHODS
  Patients with a history of esophageal neoplasia or head and neck cancer underwent AFI endoscopic screening, followed by chromoendoscopy using iodine staining as the reference standard. The primary outcome was the sensitivity of AFI for detecting new squamous mucosal high-grade neoplasias. The secondary outcome was the positive predictive value (PPV) of AFI.
  
  
  RESULTS
  Of a total 364 patients who underwent endoscopic examination, 43 new mucosal high-grade neoplasias were detected. The sensitivities of AFI in the experienced and less-experienced endoscopist groups were 71% (95% confidence interval [CI]: 55-87%) and 50% (95% CI: 32-68%), respectively. The PPV of AFI in the experienced and the less-experienced endoscopist groups were 25% (95% CI: 16-34%) and 26% (95% CI: 15-37%), respectively. The sensitivity of AFI in lesions ≤ 10 mm (31%, 5/16 lesions) was significantly lower than that in lesions > 10 mm (78%, 21/27 lesions) (P = 0.003).
  
  
  CONCLUSIONS
  The sensitivity of AFI for the detection of new squamous mucosal high-grade neoplasias, and its PPV, were both low. Based on these results, a randomized study to compare AFI with standard techniques is not justified.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. isihara-ry@mc.pref.osaka.jp
authors.forename: Ryu
authors.initials: R
authors.lastname: Ishihara
authors.forename: Takuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Noboru
authors.initials: N
authors.lastname: Hanaoka
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Tsujii
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kanzaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Oota
authors.forename: Masao
authors.initials: M
authors.lastname: Hanafusa
authors.forename: Sachiko
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Kengo
authors.initials: K
authors.lastname: Nagai
authors.forename: Fumi
authors.initials: F
authors.lastname: Matsui
authors.forename: Natsuko
authors.initials: N
authors.lastname: Kawada
authors.forename: Koji
authors.initials: K
authors.lastname: Higashino
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005453:Fluorescence; D006801:Humans; D007564:Japan; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D013194:Staining and Labeling