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P260 Virtual chromoendoscopy with FICE is superior to standard colonoscopic surveillaillance for flat visibile dysplasic lesions and raised lesions (polyps and pseudopolyps) evaluation in long-standing ulcerative colitis: a prospective, randomized, trial.

A. Cassinotti*1, S. Ardizzone1, F. Buffoli2, P. Fociani3, V. Villanacci4, M. Nebuloni3, M. Fichera1, M. Salemme4, M. Lombardini1, P. Molteni1, G. Sampietro5, F. Furfaro1, A. Dell'Era1, P. Gambitta6, D. Foschi5, P. Duca7, R. de Franchis1, G. Maconi1

1Luigi Sacco University Hospital, Gastroenterology Unit, Milan, Italy, 2Istituti Ospitalieri Cremona, Endoscopy Unit, Cremona, Italy, 3Luigi Sacco University Hospital, Pathology Unit, Milan, Italy, 4Spedali Civili, Pathology Unit, Brescia, Italy, 5Luigi Sacco University Hospital, General Surgery, Milan, Italy, 6Luigi Sacco University Hospital, Endoscopy Unit, Milan, Italy, 7Luigi Sacco University Hospital, Chair of Statistics, Milan, Italy

Background

Conventional surveillance colonoscopy in long-standing ulcerative colitis (UC) is based on multiple random biopsies and targeted biopsies of suspicious lesions, but its diagnostic yield has been criticized in favor of dye-based, targeted chromoendoscopy. No studies have analyzed the performance of the Fuji Intelligent Colour Enhancement (FICE) in this setting. We compared FICE with standard white light endoscopy (WLE) for the surveillance of long-standing UC in a prospective, randomized, single-operator, parallel study.

Methods

Consecutive patients with long-standing ( ≥ 8 years) UC, scheduled for surveillance colonoscopy, were randomized to withdrawal with FICE or WLE. All procedures were performed by a single operator. At least one raised lesion for each patient was required for inclusion, as a sample size of at least 100 raised lesion in each arm. In both arms, four types of histological samples were obtained for dysplasia detection: 1) quadrantic every 10 cm, random, biopsies from otherwise normal flat mucosa, 2) targeted biopsies of flat visible lesions, 3) targeted biopsies or removal of suspicious raised lesions, and 4) targeted biopsies of unsuspicious raised lesions. True and false positive lesions, false negatives as well as sensitivity, specificity, positive- and negative-predictive value and accuracy were compared between FICE and WLE, overall and for each type of histological sample collection.

Results

91 patients were randomized to FICE (n=41) or WLE (n=50). No dysplasia was found in each arm from random biopsies of "normal" flat mucosa (0/879 FICE, 0/888 WLE), while flat visible lesions were found only by FICE (6 suspicious lesions, of whom 5 true dysplasic lesions). 132 raised lesions were analyzed in each arm: 19 and 12 were judged suspicious by FICE and WLE, respectively, but true positives were higher using FICE than WLE (15/19 vs 5/12; p=0.0346). Among unsuspicious raised lesions, a not significant higher rate of false negatives for dysplasia were found using WLE (3/120; 2.5%) than FICE (1/123; 1%).

Sensitivity of FICE was higher than WLE, both overall and after exclusion of random biopsies (95% vs 63% in both cases; p=0.0000). Specificity was significantly higher using targeted biopsies of flat visible and raised suspicious lesions than when including also random biopsies, both with FICE (96% vs 11%) than with WLE (94% vs 12%), as was accuracy (96% vs 13% and 92% vs 12%, respectively; p=0.0000).

Conclusion

Virtual chromoendoscopy with FICE can support the detection of dysplasia in flat mucosa and the characterization of polyps and pseudopolyps in long-standing UC, thus making less important the role of random quadrantic biopsies.