title: Observer agreement for diagnosis of colorectal lesions with analysis of the vascular pattern by image-enhanced endoscopy.
abstract: OBJECTIVE
  Image-enhanced endoscopy (IEE) can differentiate neoplastic from non-neoplastic colorectal lesions through indirect analysis of pit patterns and microvascular architecture. We evaluated the accuracy of Flexible Spectral Imaging Color Enhancement (FICE) in differentiating neoplastic from non-neoplastic lesions and observer agreement in the analysis of capillary pattern of colorectal lesions.
  
  
  METHODS
  A prospective double-blind trial was conducted in two referral endoscopy centers. Vascular pattern was analyzed by IEE with magnification. Lesions were divided into two groups and examined separately by two experts. Examiners, blinded to each other's interpretations, switched groups and the lesions were reviewed. After 60 days, lesions were reevaluated.
  
  
  RESULTS
  In total, 76 patients were referred to colonoscopy for colon cancer screening. Of 100 colorectal lesions, 88 were neoplastic (73 tubular adenomas, 10 tubulovillous adenomas, 1 villous adenoma, 2 serrated adenomas, 2 adenocarcinomas) and 12 were non-neoplastic (hyperplastic polyps). Mean diameter of the lesions was 6.7 mm. Examiners 1 and 2 had 95 % accuracy. The interobserver kappa coefficient was 0.80 and the intraobserver kappa coefficient was 0.88 for examiner 1 and 0.73 for examiner 2.
  
  
  CONCLUSIONS
  IEE with magnification is effective for real-time predictive histological diagnosis of colorectal lesions, with inter- and intraobserver agreement ranging from good to excellent.
authors.affiliation: Department of Digestive Endoscopy and Gastroenterology, Santa Casa Hospital, Bagé, Brazil.
authors.forename: Carlos Eduardo Oliveira
authors.initials: CE
authors.lastname: Dos Santos
authors.affiliation: Department of Digestive Endoscopy, Universidade Federal de Santa Catarina, Florianópolis, Brazil.
authors.forename: Horácio Joaquin
authors.initials: HJ
authors.lastname: Perez
authors.affiliation: Basil Hirschowitz Endoscopic Center of Excellence, University of Alabama, Birmingham, USA.
authors.forename: Klaus
authors.initials: K
authors.lastname: Mönkemüller
authors.affiliation: Department of Digestive Endoscopy and Gastroenterology, Santa Casa Hospital, Bagé, Brazil.
authors.forename: Daniele
authors.initials: D
authors.lastname: Malaman
authors.affiliation: Department of Gastroenterology, Santa Casa Hospital, Porto Alegre, Brazil.
authors.forename: César Vivian
authors.initials: CV
authors.lastname: Lopes
authors.affiliation: Department of Gastroenterology, Santa Casa Hospital, Porto Alegre, Brazil.
authors.forename: Júlio Carlos
authors.initials: JC
authors.lastname: Pereira-Lima