FICE in Predicting Colorectal Flat Lesion Histology

Abstract

Background and Objectives:Colonoscopy is the gold standard for detection of polyps and is preventive against colorectal cancers. Flat adenomas are small, superficial lesions and have a high rate of going undetected during conventional white-light endoscopy. This article adds to the scant body of literature in English regarding in vivo detection and diagnosis of flat adenomas using Fujinon intelligent color enhancement (FICE) system. In this study, we investigated the diagnosis of flat lesions via the FICE endoscopy system and in vivo histologic diagnostic estimations of flat lesions.Methods:This prospective study was conducted in patients who underwent colonoscopy that found flat adenomas. Lesions were classified morphologically with regard to the Paris Classification and sent for histopathologic examination after in vivo histologic diagnostic estimations were made according to Kudo's pit pattern classification. The positive predictive value (PPV), negative predictive value (NPV), specificity, sensitivity, and accuracy of in vivo endoscopic diagnostic estimations of flat lesions with the FICE system were analyzed.Results:A total of 217 flat lesions were identified in 137 patients. Of the lesions, 85.7% were Paris type 0-IIa, and 59.4% were Kudo pit pattern type III. When the FICE diagnostic estimations of flat lesions and final pathology results were considered, PPV was 68.5%, NPV value was 89.6%, sensitivity was 94.7%, specificity was 50.9%, and accuracy was 74.2%.Conclusions:Biologic importance of flat lesions is obscure, as they are usually missed during colonoscopy. The use of novel endoscopic techniques may improve their detection and diagnosis rates.

Improving Diagnostic Yield of Capsule Endoscopy in Coeliac Disease: Can Flexible Spectral Imaging Colour Enhancement Play a Role?

“…Dye chromoendoscopy has been utilised in the context of IBD surveillance to help the visualisation of subtle lesions and to define surface staining patterns enabling targeted biopsies to be taken [23]. Virtual chromoendoscopy has been applied to identifying adenomatous polyps and areas of dysplasia during upper GI endoscopy and in helping the identification of polyps during colonoscopy [24,25]. It has also been shown to be useful in detecting high-grade dysplasia in Barrett's epithelium [26].…”

“…In the first part of the study, the reviewers were asked to examine a set of 50 images consisting of both normal (25) In the second part of the study, reviewers were asked to go through 55 abnormal images (11 questions) and to compare between conventional white light, different FICE (I, II, III) settings and blue light as the best modality to delineate changes of CD on SBCE. Each question consisted of abnormal images in conventional white light, different FICE settings or blue light ( Fig.…”