The benefit of autofluorescence in the diagnosis of low grade intraepitelial neoplasia in patients with Barrett's esophagus
Abstract
BACKGROUND: Patients with Barrett esopahgus (BE) have an increased risk of esophageal adenocarcinoma. The aim of the surveillance program is an early detection of Barrett's esophagus related neoplasia (BORN).
Enhancement endoscopy such as narow band imaging (NBI), high resolution endoscopy (HRE) and autuoflorescence (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.
AIMS: To evaluate the diagnostic accuracy of AFI in the detection of BORN and especially of low grade intraepithelial neoplasia in patients with barrett esophagus. RESULTS: Among 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 of HGIN were 90%, 93%, 80% and 96%.
The corresponding values for detecting of LGIN were 50%, 77%, 50% and 77%. CONCLUSION: AFI does not seem to be beneficial for the detection of LGIN in patients with Barrett esophagus, principally due to a high rate of false positive results.
AFI seems to be beneficial in patients with HGIN.