Endoscopy 2019; 51(02): 133-141
DOI: 10.1055/a-0757-7759
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A multimodal (FACILE) classification for optical diagnosis of inflammatory bowel disease associated neoplasia

Marietta Iacucci
1   Division of Gastroenterology, University of Calgary, Calgary, Canada
2   Institute Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
,
Kenneth McQuaid
3   Division of Gastroenterology, University of California, San Francisco, United States
,
X. Sean Gui
1   Division of Gastroenterology, University of Calgary, Calgary, Canada
,
Yasushi Iwao
4   Center for Preventive Medicine, Keio University l, Tokyo, Japan
,
Brendan C. Lethebe
5   Clinical Research Unit, University of Calgary, Canada
,
Mark Lowerison
5   Clinical Research Unit, University of Calgary, Canada
,
Takayuki Matsumoto
6   Division of Gastroenterology, Iwate Medical University, Japan
,
Uday N. Shivaji
2   Institute Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
,
Samuel C. L. Smith
2   Institute Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
,
Venkataraman Subramanian
7   Division of Gastroenterology, University of Leeds, Leeds, United Kingdom
,
Toshio Uraoka
8   Division of Gastroenterology, Tokyo Medical Center, Tokyo, Japan
,
Silvia Sanduleanu
9   Division of Gastroenterology and Hepatology, Maastricht University Medical Center, The Netherlands
,
Subrata Ghosh
1   Division of Gastroenterology, University of Calgary, Calgary, Canada
2   Institute Translational of Medicine, Institute of immunology and immunotherapy and NIHR Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
,
Ralf Kiesslich
10   Division of Gastroenterology, HSK Hospital, Wiesbaden, Germany
› Author Affiliations
Further Information

Publication History

submitted 28 January 2018

accepted after revision 31 August 2018

Publication Date:
12 December 2018 (online)

Abstract

Background Characterization of colonic lesions in inflammatory bowel disease (IBD) remains challenging. We developed an endoscopic classification of visual characteristics to identify colitis-associated neoplasia using multimodal advanced endoscopic imaging (Frankfurt Advanced Chromoendoscopic IBD LEsions [FACILE] classification).

Methods The study was conducted in three phases: 1) development – an expert panel defined endoscopic signs and predictors of dysplasia in IBD and, using multivariable logistic regression created the FACILE classification; 2) validation – using 60 IBD lesions from an image library, two assessments of diagnostic accuracy for neoplasia were performed and interobserver agreement between experts using FACILE was determined; 3) reproducibility – the reproducibility of the FACILE classification was tested in gastroenterologists, trainees, and junior doctors after completion of a training module.

Results The experts initially selected criteria such as morphology, color, surface, vessel architecture, signs of inflammation, and lesion border. Multivariable logistic regression confirmed that nonpolypoid lesion, irregular vessel architecture, irregular surface pattern, and signs of inflammation within the lesion were predictors of dysplasia. Area under the curve of this logistic model using a bootstrapped estimate was 0.76 (0.73 – 0.78). The training module resulted in improved accuracy and kappa agreement in all nonexperts, though in trainees and junior doctors the kappa agreement was still moderate and poor, respectively.

Conclusion We developed, validated, and demonstrated reproducibility of a new endoscopic classification (FACILE) for the diagnosis of dysplasia in IBD using all imaging modalities. Flat shape, irregular surface and vascular patterns, and signs of inflammation predicted dysplasia. The diagnostic performance of all nonexpert participants improved after a training module.

 
  • References

  • 1 Laine L, Kaltenbach T, Barkun A. et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015; 148: 639-651
  • 2 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-43
  • 3 Kudo S, Rubio CA, Teixeira CR. et al. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 2001; 33: 367-373
  • 4 Hazewinkel Y, López-Cerón M, East JE. et al. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc 2013; 77: 916-924
  • 5 IJspeert JE, Bastiaansen BA, van Leerdam ME. et al. Development and validation of the WASP classification system for optical diagnosis of adenoma, hyperplastic polyps and sessile serrated adenoma/polyps. Gut 2016; 65: 963-970
  • 6 Bisschops R, Bessissow T, Dekker E. et al. Pit pattern analysis with high-definition chromoendoscopy and narrow-band imaging for optical diagnosis of dysplasia in patients with ulcerative colitis. Gastrointest Endosc 2017; 86: 1100-1106
  • 7 Carballal S, Maisterra S, López-Serrano A. et al. Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD. Gut 2018; 67: 70-78
  • 8 Iacucci M, Kaplan GG, Panaccione R. et al. A randomized trial comparing high definition colonoscopy alone with high definition dye spraying and electronic virtual chromoendoscopy for detection of colonic neoplastic lesions during IBD surveillance colonoscopy. Am J Gastroenterol 2018; 113: 225-234
  • 9 Hata K, Watanabe T, Motoi T. et al. Pitfalls of pit pattern diagnosis in ulcerative colitis-associated dysplasia. Gastroenterology 2004; 126: 374-376
  • 10 Oka S, Tanaka S, Chayama K. Detection of nonpolypoid colorectal neoplasia using magnifying endoscopy in colonic inflammatory bowel disease. Gastrointest Endosc Clin North Am 2014; 24: 405-417
  • 11 Rubin DT, Rothe JA, Hetzel JT. et al. Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis?. Gastrointest Endosc 2007; 65: 998-1004
  • 12 Matsumoto T, Iwao Y, Igarashi M. et al. Endoscopic and chromoendoscopic atlas featuring dysplastic lesions in surveillance colonoscopy for patients with long-standing ulcerative colitis. Inflamm Bowel Dis 2008; 14: 259-264
  • 13 Sussman DA, Barkin JA, Martin AM. et al. Development of advanced imaging criteria for the endoscopic identification of inflammatory polyps. Clin Transl Gastroenterol 2015; 6: e128
  • 14 Sugimoto S, Naganuma M, Iwao Y. et al. Endoscopic morphologic features of ulcerative colitis-associated dysplasia classified according to the SCENIC consensus statement. Gastrointest Endosc 2017; 85: 639-646
  • 15 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
  • 16 Fleiss JL, Nee JC, Landis JR. Large sample variance of kappa in the case of different sets of raters. Psychol Bull 1979; 86: 974
  • 17 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
  • 18 Iacucci M, Hassan C, Fort GasiaM. et al. Serrated adenoma prevalence in inflammatory bowel disease surveillance colonoscopy, and characteristics revealed by chromoendoscopy and virtual chromoendoscopy. Can J Gastroenterol Hepatol 2014; 28: 589-594
  • 19 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599-607
  • 20 Raghavendra M, Hewett DG, Rex DK. Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes. Gastrointest Endosc 2010; 72: 572-576
  • 21 Rastogi A, Rao DS, Gupta N. et al. Impact of a computer-based teaching module on characterization of diminutive colon polyps by using narrow-band imaging by non-experts in academic and community practice: a video-based study. Gastrointest Endosc 2014; 79: 390-398
  • 22 Patel SG, Schoenfeld P, Kim HM. et al. Real-time characterization of diminutive colorectal polyp histology using narrow-band imaging: implications for the resect and discard strategy. Gastroenterology 2016; 150: 406-418
  • 23 van Doorn SC, Hazewinkel Y, East JE. et al. Polyp morphology: an interobserver evaluation for the Paris classification among international experts. Am J Gastroenterol 2015; 110: 180-187