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

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.

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).…”

“…In all studies, Kudo pit patterns III–V were considered suspicious for neoplasia, whereas Kudo pit patterns I–II were combined and considered non-neoplastic as previously described in the non-IBD literature. 55 When the frequency of these groups of pit patterns was clearly reported (2296 lesions – 19% neoplastic, from 13 studies; Table 2), 6,7,12,13,15,16,20,22,23,28,34,40,42 most lesions (65%) had non-neoplastic type I–II pits, whereas 26% were suspicious for neoplasia (Kudo III–V patterns). However, when the Kudo patterns were compared to histology (1645 lesions from 12 studies clearly reporting the rates of true and false positives/negatives), 6,7,12,13,15,16,20,22,23,28,40,42 4% of Kudo I–II patterns were neoplastic, whereas only 44% of Kudo III–V were neoplastic.…”

Use of advanced endoscopic technology for optical characterization of neoplasia in patients with ulcerative colitis: Systematic review

“…Two studies conducted by the same research group reported the usefulness of FICE for differentiating neoplasia from non-neoplasia. 25,40 Their recently modified Kudo's pit pattern under FICE for adaptation to lesions in patients with UC and prospective evaluation of the new classification, which they termed FICE-KUDO/inflammatory bowel disease (IBD), showed a sensitivity of 93% and specificity of 97% in comparison with those of white light endoscopy (86% and 64%, respectively). 40 Iacucci et al 38 developed a multimodal classification (including CE, NBI, and i-scan OE) for optical diagnosis of IBD-associated neoplasia using advanced endoscopic imaging.…”

“…25,40 Their recently modified Kudo's pit pattern under FICE for adaptation to lesions in patients with UC and prospective evaluation of the new classification, which they termed FICE-KUDO/inflammatory bowel disease (IBD), showed a sensitivity of 93% and specificity of 97% in comparison with those of white light endoscopy (86% and 64%, respectively). 40 Iacucci et al 38 developed a multimodal classification (including CE, NBI, and i-scan OE) for optical diagnosis of IBD-associated neoplasia using advanced endoscopic imaging. The classification consisted of four criteria: morphology, surface architecture, vessel architecture, and inflammation within the lesion (Fig.…”

Questions to consider when caring for patients with ulcerative colitis

“…Alternatively, random quadrant biopsies every 10 cm and targeted biopsies of any visible lesion should be performed if conventional, and not if HD-WLE is used. The combination of virtual CE with targeted biopsies is superior to a combination of white light endoscopy with random biopsies [110]. With regard to the increased tumor risk, additional random quadrant biopsies should always be taken every 10 cm in PSC patients [2].…”