title: Effects of autofluorescence imaging on detection and treatment of early neoplasia in patients with Barrett's esophagus.
abstract: OBJECTIVE
  Studies have reported that autofluorescence imaging (AFI) increases targeted detection of high-grade intraepithelial neoplasia (HGIN) and intramucosal cancer (IMC) in patients with Barrett's esophagus (BE). We analyzed data from trials to assess the clinical relevance of AFI-detected lesions.
  
  
  METHODS
  We collected information on 371 patients with BE, along with endoscopy and histology findings, from databases of 5 prospective studies of AFI (mean age, 65 years; 305 male). We compared these data with outcomes of treatment and follow-up. Study end points included the diagnostic value of AFI (proportion of surveillance patients with HGIN or IMC detected only by AFI-targeted biopsies) and value of AFI in selection of therapy (the proportion of patients for which detection of an HGIN or IMC lesion by AFI changed the treatment strategy based on white-light endoscopy or random biopsy analysis).
  
  
  RESULTS
  Of study participants, 211 were referred for surveillance and 160 were referred for early stage neoplasia; HGIN or IMC were diagnosed in 147 patients. In 211 patients undergoing surveillance, 39 had HGIN or IMC (23 detected by white-light endoscopy, 11 detected by random biopsies, 5 detected by AFI). So, the diagnostic value of AFI was 5 (2%) of 211. In 24 patients, HGIN or IMC was diagnosed using only AFI. In 33 patients, AFI detected additional HGINs or IMCs next to lesions detected by primary white-light endoscopy. Lesions detected by AFI were treated in 57 patients: 26 patients underwent radiofrequency ablation and showed full remission of neoplasia, whereas 31 underwent endoscopic resection and 6 were found to have IMC. The value of AFI in selection of therapy was 6 (2%) of 371.
  
  
  CONCLUSIONS
  Based on an analysis of data from clinical trials of patients with BE, detection of lesions by AFI has little effect on the diagnosis of early stage neoplasia or therapeutic decision making. AFI therefore has a limited role in routine surveillance or management of patients with BE.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: David F
authors.initials: DF
authors.lastname: Boerwinkel
authors.affiliation: Department of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Jasmin A
authors.initials: JA
authors.lastname: Holz
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Kara
authors.affiliation: Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Sybren L
authors.initials: SL
authors.lastname: Meijer
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Louis-Michel
authors.initials: LM
authors.lastname: Wong Kee Song
authors.affiliation: Wolfson Digestive Disease Centre, Queen's Medical Centre, Nottingham, United Kingdom.
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Wolfsen
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Bas L
authors.initials: BL
authors.lastname: Weusten
authors.affiliation: Department of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Maurice C
authors.initials: MC
authors.lastname: Aalders
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Wouter L
authors.initials: WL
authors.lastname: Curvers
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: j.j.bergman@amc.uva.nl.
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000150:complications*; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000628:therapy*; D002986:Clinical Trials as Topic; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D012680:Sensitivity and Specificity
keywords: Cancer Detection; Esophageal; Screening; Tumor