Background: Autofluorescence imaging is a novel imaging technique that may improve the detection of early neoplasia in Barrett's esophagus. Autofluorescence imaging is, however, associated with a 40% to 81% false-positive rate.
Objective: Our purpose was to identify endoscopic features that may predict the presence of early neoplasia in autofluorescence-positive areas.
Design: Descriptive and prospective cohort study.
Setting: Tertiary referral centers for the detection and treatment of early Barrett's neoplasia.
Patients and methods: Patients undergoing autofluorescence endoscopy. High-quality images with autofluorescence imaging and white-light endoscopy were obtained with corresponding histologic study. A systematic image evaluation process was performed, including an unblinded orientation phase (10 areas), a blinded derivation phase, and a blinded validation phase by 5 international experts in autofluorescence imaging (80 areas). Subsequently the identified features were validated in a prospective pilot study.
Main outcome measurements: Association between endoscopic features and presence of early neoplasia in autofluorescence-positive areas.
Results: Autofluorescence intensity, proximity of gastric folds <1 cm, and different appearance on white-light endoscopy were independently associated with early neoplasia in autofluorescence-positive areas on multivariate analysis. The kappa values for interobserver agreement of these factors were moderate, ranging between 0.49 to 0.56. The association with autofluorescence intensity and different appearance on white-light endoscopy was confirmed in a prospective pilot study.
Limitation: Selected set of images from a high-risk population (tertiary referral center).
Conclusion: We found specific endoscopic features that were associated with early neoplasia in autofluorescence-positive areas. These findings can be used in future prospective studies to improve the accuracy of autofluorescence imaging without performing magnification endoscopy for detailed inspection of suspicious areas.