Even non-experts identify non-dysplastic lesions in inflammatory bowel disease via chromoendoscopy: results of a screening program in real-life

Abstract

Background and study aims Chromoendoscopy with targeted biopsy is the technique of choice for colorectal cancer screening in longstanding inflammatory bowel disease. We aimed to analyze results of a chromoendoscopy screening program and to assess the possibility of identifying low-risk dysplastic lesions by their endoscopic appearance in order to avoid histological analysis. Materials and methods We retrospectively reviewed chromoendoscopies performed between February 2011 and June 2017 in seven Spanish hospitals in a standardized fashion. We analyzed the findings and the diagnostic yield of the Kudo pit pattern for predicting dysplasia. Results A total of 709 chromoendoscopies (569 patients) were reviewed. Median duration of disease was 16.7 years (SD 8.1); 80.4 % had ulcerative colitis. A total of 2025 lesions (3.56 lesions per patient) were found; two hundred and thirty-two lesions were neoplastic (11.5 %) (223 were LGD (96.1 %), eight were HGD (3.4 %), and one was colorectal cancer (0.5 %). The correlation between dysplasia and Kudo pit patterns predictors of dysplasia (≥ III) was low, with an area under the curve of 0.649. Kudo I and II lesions were correctly identified with a high negative predictive value (92 %), even by non-experts. Endoscopic activity, Paris 0-Is classification, and right colon localization were risk factors for dysplasia detection, while rectum or sigmoid localization were protective against dysplasia. Conclusions Chromoendoscopy in the real-life setting detected 11 % of dysplastic lesions with a low correlation with Kudo pit pattern. A high negative predictive value would prevent Kudo I and, probably, Kudo II biopsies in the left colon, reducing procedure time and avoiding complications.

Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

“…Sensitivity, specificity, positive and negative likelihood ratios with the Kudo classification were 91 %, 76 %, 3.8, and 0.12, respectively. Recently Aladrén et al aimed to analyze results of a CE screening program in Spain and to assess the possibility of identifying low risk dysplastic lesions by their endoscopic appearance, in order to avoid histological analysis [100]. Correlation between dysplasia and Kudo pit pattern predictors of dysplasia (Kudo ≥ III) was low while Kudo I and II lesions were correctly identified with a high negative predictive value of 92 %, even by nonexperts.…”

Endoscopic characterization of neoplastic and non-neoplastic lesions in inflammatory bowel disease: systematic review in the era of advanced endoscopic imaging

“…Twenty-four studies reported the use of Kudo classification for lesion characterization in IBD (predominantly patients with UC). 6,7,12–16,20,22,23,28,31,33–38,40–42,44–46 Eighteen studies used DCE (IC: 13, MB: 5, CV: 6), whereas 11 studies used VCE (NBI: 7, FICE: 2, i-SCAN: 2); magnification was used in 17 studies, and HD in 19 studies (Table 1).…”

Evolving roles of magnifying endoscopy and endoscopic resection for neoplasia in inflammatory bowel diseases

“…Another study using 769 stereomicroscopic pictures (509 neoplastic and 260 non-neoplastic) obtained from surgically resected specimens showed that pit pattern types III-V were significantly associated with the presence of neoplasia (sensitivity 77.4% and specificity 89.5%)[ 12 ]. Further, previous studies also demonstrated that pit pattern types I-II had a high negative predictive value to rule out the diagnosis of neoplasia (Table 1 )[ 13 , 14 ]. The findings in all of these studies suggest that magnifying endoscopy assessing Kudo pit patterns may be useful to differentiate between neoplastic lesions and non-neoplastic lesions in IBD patients.…”

“…Indeed, histopathological findings of regenerative mucosa can masquerade as dysplastic findings and make the diagnosis of dysplasia equivocal[ 16 ]. Several studies have also suggested that the correlation between dysplasia and pit pattern types III-V was low (Table 1 )[ 13 , 14 ]. Moreover, Kudo’s pit patterns cannot necessarily classify all of the findings which are observed in the neoplastic lesions in UC patients.…”