No benefit of autofluorescence in a diagnosis of low grade intraepitelial neoplasia in patients with Barrett´s oesophagus

Czech version

Authors: M. Stefanová ¹; M. Zavoral ¹; F. Závada ¹; Š. Suchánek ¹; I. Tučková ²; P. Hrabal ²; J. Martínek ¹
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN Praha ¹; Oddělení patologie, ÚVN Praha ²
Published in: Gastroent Hepatol 2011; 65(5): 249-254
Category: Clinical and Experimental Gastroenterology: Original Article

Overview

Backgrounds:
Patients with Barrett’s oesophagus (BE) have an increased risk of esophageal adenocarcinoma. The aim of the surveillance program is the early detection of Barrett’s oesophagus-related neoplasia (BORN). Enhancement endoscopy such as narrow band imaging (NBI), high resolution endoscopy (HRE) and autofluorescence (AFI) are useful in the early detection of high grade intraepithelial neoplasia (HGIN) or adenocarcinoma (EAC). However, their role in the detection of low grade intraepithelial neoplasia (LGIN) remains unclear.

Design:
To evaluate the diagnostic accuracy of AFI in the detection of BORN and especially of low grade intraepithelial neoplasia in patients with Barrett’s oesophagus.

Methods:
A prospective cohort study. A total of 53 patients with Barrett’s oesophagus (mean age 63 years, range: 22–98) were referred to our tertiary centre with the following diagnoses: 10× HGIN/EAC, 28× LGIN, 15× long segment of BE with possible LGIN. All patients were examined using HRE, NBI and AFI. The targeted biopsies were taken from all visible lesions as well as from all suspect areas (based on AFI and NBI results). If no such areas were present, the standard random biopsies were taken. Results obtained from targeted biopsies are considered the final diagnosis. All slides were examined by two experienced pathologists.

Results:
In 53 patients with BE, we diagnosed 5 patients with an early adenocarcinoma (EAC), 3 patients with HGIN and 14 patients with LGIN. In the remaining 31 patients, we did not confirm any intraepithelial neoplasia. AFI was positive in 7 patients with EAC and HGIN (7/8, 87%) and in 7 patients with LGIN (7/14, 50%). On the other hand, AFI was falsely positive in 7 patients without intraepithelial neoplasia (7/31 23%). The sensitivity, specificity, PPV and NPV of AFI for detecting HGIN were 90%, 93%, 80% and 96%, respectively. The corresponding values for detecting LGIN were 50%, 77%, 50% and 77%.

Conclusion:
AFI does not seem to be beneficial in the detection of LGIN in patients with Barrett’s oesophagus, principally due to the high rate of false positive results. AFI seems to be beneficial in patients with HGIN although the cohort of patients with HGIN in our study is small.

Key words:
Barrett’s oesophagus – autofluorescence imaging – intraepithelial neoplasia

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