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

Andrea Cassinotti; Paolo Fociani; Piergiorgio Duca; Manuela Nebuloni; Sophia Elizabeth Campbell Davies; Gianluca Sampietro; Federico Buffoli; Alberto Corona; Giovanni Maconi; Sandro Ardizzone

doi:10.1055/a-1165-0169

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

Endosc Int Open. 2020 Oct;8(10):E1414-E1422. doi: 10.1055/a-1165-0169. Epub 2020 Sep 22.

Authors

Affiliations

¹ Gastroenterology Unit, ASST Fatebenefratelli Sacco, Milan, Italy.
² ASST Sette Laghi, Varese (Italy).
³ Pathology Unit, ASST Fatebenefratelli Sacco, Milan, Italy.
⁴ Chair of Statistics, University of Milan, Milan, Italy.
⁵ Pharmacy Service - Fatebenefratelli e Oftalmico Hospital, Milan, Italy.
⁶ IBD Surgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy.
⁷ Endoscopy Unit, ASST Cremona, Cremona, Italy.
⁸ Intensive Care Unit, ASST Fatebenefratelli Sacco, Milan, Italy.

Abstract

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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