Rondonotti E1, Paggi S1, Amato A1, Mogavero G1,2, Andrealli A1, Conforti FS1,3, Conte D1, Spinzi G1, Radaelli F1.
Gastrointest Endosc. 2018 Sep 28. pii: S0016-5107(18)33137-7. doi: 10.1016/j.gie.2018.09.027. [Epub ahead of print]
Background and aims: Blue light imaging (BLI) is a new chromoendoscopy technology, potentially useful for differentiating neoplastic from non-neoplastic lesions. Present study was aimed at comparing BLI with high-definition white light (HDWL) in the real-time histology prediction of subcentimetric (<10 mm) colonic polyps.
Methods: Consecutive outpatients undergoing colonoscopy with ELUXEO 7000 endoscopy platform and 760 series videocolonscopes (Fujifilm Co, Tokyo, Japan) having at least one polyp <10 mm, were randomized to BLI or HDWL for polyp characterization. The accuracy of high-confidence real-time histology prediction (adenoma vs. non-adenoma) by either BLI or HDWL for subcentrimentic (primary end-point) and diminutive (<5mm) polyps was calculated, along with sensitivity, specificity, positive and negative predictive values, with histopathology as the reference standard.
Results: A total of 483 polyps were detected in 245 randomized patients (125 and 120 in the BLI and HDWL arms, respectively); 358 were diminutive and 283 adenomas. Overall, 222 (85.7%) and 193 (86.1%) polyps were characterized with high-confidence by BLI and HDWL, respectively (p=0.887), with an overall accuracy of 92% and 84%, respectively (p=0.011). The accuracy was significantly higher by BLI than HDWL also for diminutive polyps (92% vs. 83%; p=0.008). When BLI was used, the negative predictive value for diminutive rectosigmoid polyps was 88% and the post-polypectomy surveillance interval was correctly attributed in 85.7% and 93.7% of patients, according to U.S. and European guidelines respectively.
Conclusions: The BLI was superior to HDWL for the real-time prediction of subcentimetric polyp histology. A BLI-dedicated classification might further improve the endoscopists’ performances.
1 Gastroenterology Unit, Valduce Hospital, Como, Italy.
2 Gastroenterology Unit, Biomedical Department of Internal and Specialized Medicine (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy.
3 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.