title: Trimodal endoscopic imaging for the detection and differentiation of colorectal adenomas: a prospective single-centre clinical evaluation.
abstract: OBJECTIVE
  The purpose of this study is to evaluate an endoscopic trimodal imaging (ETMI) system (high resolution, autofluorescence, and NBI) in the detection and differentiation of colorectal adenomas.
  
  
  METHODS
  A prospective randomised trial of tandem colonoscopies was carried out using the Olympus XCF-FH260AZI system. Each colonic segment was examined twice for lesions, once with HRE and once with AFI, in random order per patient. All detected lesions were assessed with NBI for pit pattern and with AFI for colour. All lesions were removed and sent for histology. Any lesion identified on the second examination was considered as missed by the first examination. Outcome measures are adenoma miss rates of AFI and HRE, and diagnostic accuracy of NBI and AFI for differentiating neoplastic from non-neoplastic lesions.
  
  
  RESULTS
  Ninety-four patients underwent colonoscopy with ETMI (47 in each group). Among 47 patients examined with AFI first, 31 adenomas in 15 patients were detected initially [detection rate 0.66 (0.52-0.75)]. Subsequent HRE inspection identified six additional adenomas. Among 47 patients examined with HRE first, 29 adenomas in 14 patients were detected initially [detection rate 0.62 (0.53-0.79)]. Successive AFI yielded seven additional adenomas. Adenoma miss rates of AFI and HRE were 14% and 16.2%, respectively (p = 0.29). Accuracy of AFI alone for differentiation was lower than NBI (63% vs. 80%, p < 0.001). Combined use of AFI and NBI achieved improved accuracy for differentiation (84%), showing a trend for superiority compared with NBI alone (p = 0.064).
  
  
  CONCLUSIONS
  AFI did not significantly reduce the adenoma miss rate compared with HRE. AFI alone had a disappointing accuracy for adenoma differentiation, which could be improved by combination of AFI and NBI.
authors: Division of Gastroenterology, ASL NA3sud-Ospedale Maresca, Torre del Greco, Italy. gianluca.rotondano@virgilio.it
authors: Gianluca
authors: G
authors: Rotondano
authors: Maria Antonia
authors: MA
authors: Bianco
authors: Stefano
authors: S
authors: Sansone
authors: Antonio
authors: A
authors: Prisco
authors: Costantino
authors: C
authors: Meucci
authors: Maria Lucia
authors: ML
authors: Garofano
authors: Livio
authors: L
authors: Cipolletta
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005188:False Negative Reactions; D005260:Female; D005453:Fluorescence; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric