Virtual Chromoendoscopy With FICE for the Classification of Polypoid and Nonpolypoid Raised Lesions in Ulcerative Colitis

Cassinotti, A.; Buffoli, Federico; Fociani, Paolo; Staiano, Teresa; Villanacci, Vincenzo; Nebuloni, Manuela; Duca, Piergiorgio; Fichera, Maria; Grassia, Roberto; Manes, Gianpiero; Salemme, Marianna; Molteni, Paola; Sampietro, Gianluca; Foschi, Diego; Franchis, Roberto de; Ardizzone, Sandro

doi:10.1097/mcg.0000000000000974

Cited by 15 publications

(56 citation statements)

References 49 publications

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“…(1) irregular brown/bluish visible capillary vessels, defined according to a Teixeira III-V vascular pattern, which were previously described in studies with FICE in the general population and were related to higher risk of neoplasia [3,12]; and (2) pits heterogeneity, defined as variable density or size of pits in the context of low-risk (type I and II) patterns, which was previously associated with higher risk of neoplasia [3,13,14].…”

Section: Classification Of Lesionsmentioning

confidence: 95%

“…In the FICE arm, virtual chromoendoscopy was performed with the high-definition, magnified, Fujinon EG-590ZW colonoscope (Fujinon Corp, Saitama, Japan), equipped with the EPX4400 processor. The FICE set number 4 was used exclusively, according to previous validation studies [3,10]. Magnification was activated according to the endoscopist's need, based on his confidence to assess the mucosal and vascular patterns of each lesion in supporting his differential diagnosis.…”

Section: Endoscopic Protocolmentioning

confidence: 99%

“…In the FICE arm, neoplasia was first suspected according to the conventional Kudo classification (FICE-KUDO), and then according to the modified Kudo classification for FICE in IBD (FICE-KUDO/IBD) which was developed in our previous pilot study adding three specific endoscopic modifiers for risk of neoplasia [3]. In particular, as shown in ▶ Fig.…”

Section: Classification Of Lesionsmentioning

confidence: 99%

“…Recent availability of powered endoscopy, such as high-definition equipment and dye-based chromoendoscopy, has improved detection of neoplastic lesions in IBD, including the flat and non-polypoid forms [4,5]. Moreover, dye-based chromoendoscopy, when added to magnification endoscopy to better define the mucosal crypt architecture according to the pit-pattern classification of Kudo [6], has been used to differentiate neoplastic and non-neoplastic lesions, although the accuracy of this classification in the specific setting of IBD is still controversial due to inflammatory and regenerative artifacts [3].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, we published the first experience with FICE in IBD, which focused only on visible polypoid and non-polypoid lesions found during surveillance in UC [3]. Through a post-hoc, retrospective analysis of endoscopic predictors of neoplasia, that study showed the need to develop and validate a more accurate endoscopic classification system for characterization of raised lesions in IBD, based not only on pit-pattern visualization but also on inflammatory markers.…”

Section: Introductionmentioning

confidence: 99%

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Modified Kudo classification can improve accuracy of virtual chromoendoscopy with FICE in endoscopic surveillance of ulcerative colitis

et al. 2020

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Background and study aims Virtual chromoendoscopy with Fuji Intelligent Color Enhancement (FICE) has never been studied in prospective trials of endoscopic surveillance for ulcerative colitis (UC). We compared FICE and white light endoscopy (WLE) in differentiation of visible lesions in UC. Patients and methods In a prospective parallel study, we compared consecutive outpatients with UC submitted to surveillance colonoscopy with FICE or WLE. At least one visible polypoid or non-polypoid lesion for each patient was required. Random biopsies from normal mucosa, targeted biopsies or removal of suspected neoplastic lesions and targeted biopsies of unsuspected lesions were performed. In the FICE arm, neoplasia was suspected according to a modified Kudo classification (FICE-KUDO/inflammatory bowel disease [IBD]). Sensitivity (SE), specificity (SP), positive and negative likelihood ratios (LR) and negative predictive value (NPV) were analyzed. Results One hundred patients were submitted to FICE (n = 46) or WLE (n = 54). Twenty-two patients (11 in WLE, 11 in FICE) had a least one neoplastic lesion. No neoplasia was found in random biopsies. Among 275 lesions, 17 of 136 by FICE and 27 of 139 by WLE were suspected neoplasia, but 28 (14 in each arm) were true neoplastic lesions. The accuracy of FICE-KUDO/IBD vs WLE (per lesion) was: SE 93 % vs 64 % (P = 0.065), SP 97 % vs 86 % (P = 0.002), positive-LR 28.3 vs 4.5 (P = 0.001), negative-LR 0.07 vs 0.42 (P = 0.092), NPV 99 % vs 96 % (P = 0.083). FICE-KUDO/IBD detected more non-polypoid lesions than WLE (P = 0.016). Conclusions Targeted biopsies of polypoid and non-polypoid lesions, using the modified Kudo classification with FICE are more accurate than WLE in UC surveillance.

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Section: Classification Of Lesionsmentioning

confidence: 95%

Section: Endoscopic Protocolmentioning

confidence: 99%

Section: Classification Of Lesionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Modified Kudo classification can improve accuracy of virtual chromoendoscopy with FICE in endoscopic surveillance of ulcerative colitis

et al. 2020

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New endoscopic tools in inflammatory bowel disease

et al. 2022

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Endoscopic remission is now considered the ultimate long‐term goal for treating inflammatory bowel disease (IBD). Recent advances in endoscopic techniques have progressively added new tools to the armamentarium of endoscopists for a deeper assessment and characterisation of the intestinal mucosa. Virtual Electronic chromoendoscopy is widely available in the endoscopic units, leading to a more accurate evaluation of the vascular and mucosal architecture of the colon, reducing the gap with histology, which is considered a favourable long‐term measure. In addition, advanced, sophisticated techniques such as endocytoscope and confocal laser endomicroscopy provide insights into individualised and personalised IBD therapy. Finally, high expectations are placed on the advent of Artificial Intelligence (AI) with promising applications that have the potential to revolutionise IBD diagnosis and management. Here, we discuss state‐of‐the‐art of endoscopic techniques and their applicability to accurate assess endoscopic and histological remission, predict response to therapy and detect, characterise and guide treatment of colonic dysplastic lesions. We are seeing the dawn of a new era wherein the applications of these new endoscopic tools, hand in hand with AI, offer the most incredible opportunity to deliver precision medicine to patients with IBD.

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Accuracy of optical diagnosis with narrow band imaging in the surveillance of ulcerative colitis: a prospective study comparing Kudo, Kudo-IBD and NICE classifications

Cassinotti,

Duca,

Maconi

et al. 2024

Int J Colorectal Dis

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Purpose The diagnostic accuracy of Narrow Band Imaging (NBI) in the endoscopic surveillance of ulcerative colitis (UC) has been disappointing in most trials which used the Kudo classification. We aim to compare the performance of NBI in the lesion characterization of UC, when applied according to three different classifications (NICE, Kudo, Kudo-IBD). Methods In a prospective, real-life study, all visible lesions found during consecutive surveillance colonoscopies with NBI (Exera-II CV-180) for UC were classified as suspected or non-suspected for neoplasia according to the NICE, Kudo and Kudo-IBD criteria. The sensitivity (SE), specificity (SP), positive (+LR) and negative (-LR) likelihood ratios of the three classifications were calculated, using histology as the reference standard. Results 394 lesions (mean size 6 mm, range 2–40 mm) from 84 patients were analysed. Twenty-one neoplastic (5%), 49 hyperplastic (12%), and 324 inflammatory (82%) lesions were found. The diagnostic accuracy of the NICE, Kudo and Kudo-IBD classifications were, respectively: SE 76%-71%-86%; SP 55-69%-79% (p < 0.05 Kudo-IBD vs. both Kudo and NICE); +LR 1.69-2.34-4.15 (p < 0.05 Kudo-IBD vs. both Kudo and NICE); -LR 0.43-0.41-0.18. Conclusion The diagnostic accuracy of NBI in the differentiation of neoplastic and non-neoplastic lesions in UC is low if used with conventional classifications of the general population, but it is significantly better with the modified Kudo classification specific for UC.

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Virtual Chromoendoscopy With FICE for the Classification of Polypoid and Nonpolypoid Raised Lesions in Ulcerative Colitis

Abstract: FICE can help to predict the histology of raised lesions in UC. A new classification of pit patterns, based on inflammatory markers, should be developed in the setting of UC to improve the diagnostic performance.

Cited by 15 publications

References 49 publications

Modified Kudo classification can improve accuracy of virtual chromoendoscopy with FICE in endoscopic surveillance of ulcerative colitis

Modified Kudo classification can improve accuracy of virtual chromoendoscopy with FICE in endoscopic surveillance of ulcerative colitis

New endoscopic tools in inflammatory bowel disease

Accuracy of optical diagnosis with narrow band imaging in the surveillance of ulcerative colitis: a prospective study comparing Kudo, Kudo-IBD and NICE classifications

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