Dos Santos CEO1, Malaman D1, Yoshida N2, Pereira-Lima JC3, Onófrio FQ3, Furlan RG1, Tabushi FI4, Malafaia O4 .
Eur J Gastroenterol Hepatol. 2018 Oct 2. doi: 10.1097/MEG.0000000000001278. [Epub ahead of print]
Background: Image-enhanced endoscopy enables real-time differential diagnosis of colorectal lesions through the observation of microvascular architecture.
Purpose: To evaluate the efficacy of using blue laser imaging (BLI) for capillary pattern analysis in the differential diagnosis of neoplastic and non-neoplastic lesions.
Patients and methods: This prospective study included 920 consecutive superficial lesions diagnosed in 457 patients. The capillary pattern was analysed using BLI-bright magnification on the basis of the Teixeira classification. Histopathology was used as the reference standard.
Results: The adenoma detection rate was 42.3%, with a mean of 0.95 adenomas per patient. Neoplastic lesions were predominant (70.3%), of which 33 (5.1%) had advanced histology. Neoplastic progression was significantly increased in patients aged at least 50 years, in lesions at least 10 mm and in lesions located in the right colon (P<0.01). BLI-based capillary pattern analysis showed 95.5% accuracy, 95.7% sensitivity, 95.2% specificity, 97.9% positive predictive value and 90.3% negative predictive value in the diagnosis of neoplastic lesions. For 672 diminutive lesions (≤5 mm), BLI-based capillary pattern analysis showed 95.7% accuracy, 96.6% sensitivity, 93.6% specificity, 97.2% positive predictive value and 92.2% negative predictive value. Analysing only lesions up to 5 mm in the rectum and sigmoid colon, the values were 95.2, 93.9, 96.5, 95.8 and 94.8%, respectively.
Conclusion: BLI associated with magnification yielded excellent results for the real-time predictive histological diagnosis of colorectal lesions.
1 Department of Endoscopy and Gastroenterology, Santa Casa de Caridade hospital, Bagé
2 Department of Gastroenterology and Endoscopy, Santa Casa Hospital, Porto Alegre
3 department of Surgery, Faculdade Evangélica do Paraná, Curitiba, Brazil
4 Department of Molecular Gastroenterology and Hepatology, Graduate School of Mecdical Science, Koyo Prefectural University of Medicine, Kyoto, Japan