NEW YORK (Reuters Health) – Autofluorescence imaging is inferior to chromoendoscopy for detecting neoplasms in patients with long-standing ulcerative colitis (UC), according to results from the FIND-UC trial.
“Chromoendoscopy remains the criterion standard for dysplasia detection for surveillance in inflammatory bowel disease,” said Dr. James E. East from John Radcliffe Hospital, University of Oxford, U.K.
“We need to implement this more widely in clinical practice as recommended in the SCENIC consensus statement to minimize future colorectal cancer risk,” he told Reuters Health by email.
Both autofluorescence imaging and chromoendoscopy are superior to white-light endoscopy for dysplasia detection in patients with long-standing UC, but the two techniques have not been compared in head-to-head studies.
Dr. East and colleagues undertook a phase 2 study with predefined performance thresholds to determine whether autofluorescence imaging could meet clinical criteria to go forward to an appropriately powered noninferiority study in which it would be compared with chromoendoscopy.
To proceed to such a study, autofluorescence imaging would have to achieve a relative dysplasia detection rate above 0.67, compared with chromoendoscopy.
Dysplasia was detected in 19% (20/105) of patients in the chromoendoscopy group and in 12% (13/105) of patients in the autofluorescence imaging group, a relative detection rate of 0.65.
Chromoendoscopy detected a mean 0.37 dysplastic lesions per patient, compared with 0.13 per patient with autofluorescence imaging, a relative detection rate of 0.36, the researchers report in The Lancet Gastroenterology & Hepatology, online March 19. Sensitivity analyses showed similar outcomes.
Moreover, post hoc exploratory analyses suggested significantly better outcomes with chromoendoscopy for the mean number of neoplastic lesions per patient, mean number of targeted biopsies per patient and proportion of patients with one or more targeted biopsy.
“Autofluorescence fell short by a wide margin at both a per-patient and per-lesion basis,” Dr. East said. “If autofluorescence is to go forward, it will need a radical rethink and significant R&D investment. High-definition white-light colonoscopy with chromoendoscopy sets a very high bar to match, let alone overcome.”
Dr. Michael F. Picco from Mayo Clinic, in Jacksonville, Florida, who wrote an accompanying editorial, told Reuters Health by email, “The study clearly shows that chromoendoscopy is better in dysplasia detection for typical dysplastic lesions. For sessile serrated lesions, the optimal technique is not clear, as the study, unfortunately, did not adequately address this issue.”
“Sessile serrated lesions are important pre-cancerous lesions found in UC and non-UC populations,” he said. “Their natural history is not entirely clear in UC. Future studies should also focus on their detection.”
Olympus Europe and Olympus Keymed provided funding and equipment for this study and had various relationships with all of the authors.
SOURCE: https://bit.ly/2q8OdDz and https://bit.ly/2EpwZ94
Lancet Gastroenterol Hepatol 2018.
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