We compared detection of invisible flat intraepithelial neoplasia with protoporphyrin IX fluorescence and standard 4-quadrant biopsies.
Prospective, crossover design without randomization of the order of procedures.
Gastroenterology Department, Humboldt University, Charité, Berlin, Germany.
Forty-two patients with extensive ulcerative colitis of more than 10 years' duration were included.
Colonoscopy with 4-quadrant biopsies and targeted biopsies of macroscopic lesions and time-gated fluorescence–guided colonoscopy were performed 2 weeks apart by 2 blinded endoscopists. Three independent pathologists examined the biopsy specimens.
The primary outcome criterion was detection rate of invisible flat intraepithelial neoplasia.
Invisible flat intraepithelial neoplasia was detected in 3 (7 % ) patients by white light 4-quadrant biopsies and in 10 (24 % ) patients by fluorescence-guided endoscopy (P = .02). The sensitivity and specificity for differentiating patients with and without dysplasia were 100 % and 81 % , respectively. Dysplastic and nondysplastic mucosa could be discriminated with a sensitivity and specificity of 73 % and 81 % , respectively.
The trial was not randomized.
The detection rate of intraepithelial neoplasia in patients with ulcerative colitis can be improved by fluorescence-guided colonoscopy.