Tu1681 Validation of Teixeira Optic Magnifying FICE Vascular Pattern of Colorectal Lesions With Optic Magnifying NBI: A Pilot Study

Abstract

Validation of Teixeira Optic Magnifying FICE Vascular Pattern of Colorectal Lesions With Optic Magnifying NBI: A Pilot Study Victor Bracho*, Jose Soto, Dervis J. Bandres, Claudio R. Teixeira, Nelson Simonovis, Jacobo Dib, Olaya I. Brewer, Sandra Romero Gastroenterology, Centro Medico Docente La Trinidad, Caracas, Venezuela; Internal Medicine, Centro Medico Docente La Trinidad, Caracas, Venezuela; Pathology, Centro Medico Docente La Trinidad, Caracas, Venezuela; Gastroenterology, FUGAST, Porto Alegre, Brazil Olympus Narrow Band Imaging (NBI) and Fuji Intelligent Color Enhancement System (FICE) have proven to be of great value in enhancing the capillary vessels of colorectal polyps, without optical magnification to access absence / presence of vascular network, understanding that a rich vascular network means neoplasia. When applying optical zoom and the morphology of the vascular pattern (VP) can be seen, it is possible to predict with accuracy low grade dysplasia, high grade dysplasia and deeply invasive adenocarcinoma. Several classifications on the vascular pattern of colorectal lesions are actually under intense trial, using both NBI and FICE and magnification. Aim: To achieve by magnifying NBI Teixeira FICE VP classification of colorectal lesions in a pilot study. Materials and Methods: 31 patients and 54 colorectal lesions in a 12 months period, starting on February 2010, were evaluated at the Centro Medico Docente La Trinidad, Department of Gastroenterology, Caracas-Venezuela. Colonoscopies with Olympus magnifying colonoscope and NBI were performed by 3 independent endoscopists, and a fourth endoscopist from Porto AlegreBrazyl at the department of Gastroenterology of FUGAST received the electronic files in a digital image filing system of the 54 cases. All with training in NBI and FICE .Teixeira VP classification was used with magnifying NBI, formerly described with magnifying FICE. Using random numbers, these 54 pictures were arranged randomly for readers 1 to 4. Diagnostic accuracies of the different endoscopic modalities were determined in reference to the histopathological diagnosis, in terms of neoplasia or no neoplasia and adenoma with low/high grade dysplasia vs. deeply invasive adenocarcinoma. Interobserver agreement in reference to Teixeira VP was recorded. Specificity, sensibility, positive (PPV) and negative (PPN) predictive values were determined for assessing the neoplastic or non neoplastic nature of the lesion, as well as for the presence of low/high grade dysplasia adenoma vs invasive adenocarcinoma. Results: The overall agreement provided a kappa value of 0,84259259 (0.63-0.84) Specificity (0,943 0,013) sensibility (0,825 0.126) PPV (0,960 0.029) and PPN (0,765 0.062) demonstrated high accuracy for predicting the histology of the lesion evaluated. Conclusions: This pilot study shows that a former proposed VP, initially designed with Fujinon Fice can be reproduced with Olympus NBI and magnification. Since no VP classification has proven yet to be the paramount in predicting the histology in colorectal lesions, a more large scale trial using both systems could be the best way to reach a more universal classification, and for such aim, the Teixeira VP classification should be taken into consideration.