Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Clin Gastroenterol Hepatol. 2014 May;12(5):774-81. doi: 10.1016/j.cgh.2013.10.013. Epub 2013 Oct 24.

Effects of autofluorescence imaging on detection and treatment of early neoplasia in patients with Barrett's esophagus.

Author information

  • 1Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
  • 2Department of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, The Netherlands.
  • 3Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands.
  • 4Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.
  • 5Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
  • 6Wolfson Digestive Disease Centre, Queen's Medical Centre, Nottingham, United Kingdom.
  • 7Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.
  • 8Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: j.j.bergman@amc.uva.nl.

Abstract

BACKGROUND & AIMS:

Studies have reported that autofluorescence imaging (AFI) increases targeted detection of high-grade intraepithelial neoplasia (HGIN) and intramucosal cancer (IMC) in patients with Barrett's esophagus (BE). We analyzed data from trials to assess the clinical relevance of AFI-detected lesions.

METHODS:

We collected information on 371 patients with BE, along with endoscopy and histology findings, from databases of 5 prospective studies of AFI (mean age, 65 years; 305 male). We compared these data with outcomes of treatment and follow-up. Study end points included the diagnostic value of AFI (proportion of surveillance patients with HGIN or IMC detected only by AFI-targeted biopsies) and value of AFI in selection of therapy (the proportion of patients for which detection of an HGIN or IMC lesion by AFI changed the treatment strategy based on white-light endoscopy or random biopsy analysis).

RESULTS:

Of study participants, 211 were referred for surveillance and 160 were referred for early stage neoplasia; HGIN or IMC were diagnosed in 147 patients. In 211 patients undergoing surveillance, 39 had HGIN or IMC (23 detected by white-light endoscopy, 11 detected by random biopsies, 5 detected by AFI). So, the diagnostic value of AFI was 5 (2%) of 211. In 24 patients, HGIN or IMC was diagnosed using only AFI. In 33 patients, AFI detected additional HGINs or IMCs next to lesions detected by primary white-light endoscopy. Lesions detected by AFI were treated in 57 patients: 26 patients underwent radiofrequency ablation and showed full remission of neoplasia, whereas 31 underwent endoscopic resection and 6 were found to have IMC. The value of AFI in selection of therapy was 6 (2%) of 371.

CONCLUSIONS:

Based on an analysis of data from clinical trials of patients with BE, detection of lesions by AFI has little effect on the diagnosis of early stage neoplasia or therapeutic decision making. AFI therefore has a limited role in routine surveillance or management of patients with BE.

Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Cancer Detection; Esophageal; Screening; Tumor

Comment in

PMID:
24161353
[PubMed - in process]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk