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Quantification of autofluorescence imaging can accurately and objectively assess the severity of ulcerative colitis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

No endoscopic examination has been able to evaluate severity of ulcerative colitis (UC) by quantification. This prospective study investigated the efficacy of quantifying autofluorescence imaging (AFI) to assess the severity of UC, which captures the fluorescence emitted from intestinal tissue and then quantifies the intensity using an image-analytical software program.

Materials and methods

Eleven endoscopists separately evaluated 135 images of conventional endoscopy (CE) and AFI from a same lesion. A CE image corresponding to Mayo endoscopic subscore 0 or 1 was defined as being inactive. The fluorescence intensities of AFI were quantified using an image-analytical software program (F index; FI). Active inflammation was defined when Matts’ histological grade was 2 or more. A cut-off value of the FI for active inflammation was determined using a receiver operating characteristic (ROC) analysis. The inter-observer consistency was calculated by unweighted kappa statistics.

Results

The correlation coefficient for the FI was inversely related to the histological severity (r = −0.558, p < 0.0001). The ROC analysis showed that the optimal cut-off value for the FI for active inflammation was 0.906. The average diagnostic accuracy of the FI was significantly higher than those of the CE (84.7 vs 78.5 %, p < 0.01). The kappa values for the inter-observer consistency of CE and the FI were 0.60 and 0.95 in all participants, 0.53 and 0.97 in the less-experienced endoscopists group and 0.67 and 0.93 in the expert group, respectively.

Conclusions

The quantified AFI is considered to be an accurate and objective indicator that can be used to assess the activity of ulcerative colitis, particularly for less-experienced endoscopists.

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References

  1. Rogler G (2012) Inflammatory bowel disease cancer risk, detection and surveillance. Dig Dis 30(suppl 2):48–54

    Article  PubMed  Google Scholar 

  2. Truelove SC, Richards WC (1956) Biopsy studies in ulcerative colitis. Br Med J 1:1315–8

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Matts SG (1961) The value of rectal biopsy in the diagnosis of ulcerative colitis. Q J Med 30:393–407

    CAS  PubMed  Google Scholar 

  4. Dick AP, Holt LP, Dalton ER (1966) Persistence of mucosal abnormality in ulcerative colitis. Gut 7:355–60

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. D’Haens G, Sandborn WJ, Feagan BG et al (2007) A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology 132:763–86

    Article  PubMed  Google Scholar 

  6. Riley SA (1991) Microscopic activity in ulcerative colitis: what does it mean? Gut 32:174–8

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Dick AP (1966) Persistence of mucosal abnormality in ulcerative colitis. Gut 7:355–60

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Florén CH (1987) Histologic and colonoscopic assessment of disease extension in ulcerative colitis. Scand J Gastroenterol 22:459–62

    Article  PubMed  Google Scholar 

  9. Gomes P (1986) Relationship between disease activity indices and colonoscopic findings in patients with colonic inflammatory bowel disease. Gut 27:92–5

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Lemmens B (2013) Correlation between the endoscopic and histologic score in assessing the activity of ulcerative colitis. Inflamm Bowel Dis 19:1194–201

    Article  PubMed  Google Scholar 

  11. Thia KT, Loftus EV Jr, Pardi DS et al (2011) Measurement of disease activity in ulcerative colitis: interobserver agreement and predictors of severity. Inflamm Bowel Dis 17:1257–64

    Article  PubMed  Google Scholar 

  12. Osada T, Ohkusa T, Yokoyama T et al (2010) Comparison of several activity indices for the evaluation of endoscopic activity in UC: inter- and intraobserver consistency. Inflamm Bowel Dis 16:192–7

    Article  PubMed  Google Scholar 

  13. Sato R, Fujiya M, Watari J et al (2011) The diagnostic accuracy of high-resolution endoscopy, autofluorescence imaging and narrow-band imaging for differentially diagnosing colon adenoma. Endoscopy 43:862–8

    Article  CAS  PubMed  Google Scholar 

  14. Moriichi K, Fujiya M, Sato R et al (2012) Autofluorescence imaging and the quantitative intensity of fluorescence for evaluating the dysplastic grade of colonic neoplasms. Int J Colorectal Dis 27:325–30

    Article  PubMed  Google Scholar 

  15. Ueno N, Fujiya M, Moriichi K et al (2011) Endosopic autofluorescence imaging is useful for the differential diagnosis of intestinal lymphomas resembling lymphoid hyperplasia. J Clin Gastroenterol 45:507–13

    Article  PubMed  Google Scholar 

  16. Fujiya M, Saitoh Y, Watari J et al (2007) Auto-fluorescence imaging is useful to assess the activity of ulcerative colitis. Dig Endosc 19:145–9

    Article  Google Scholar 

  17. Osada T, Arakawa A, Sakamoto N et al (2011) Autofluorescence imaging endoscopy for identification and assessment of inflammatory ulcerative colitis. World J Gastroenterol 17:5110–6

    Article  PubMed Central  PubMed  Google Scholar 

  18. Takehana S, Kaneko M, Mizuno H (1999) Endoscopic diagnostic system using autofluorescence. Diagnostic and Therapeutic Endoscopy 5:59–63

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Nakashima A, Miwa H, Watanabe H et al (2001) A new technique: light-induced fluorescence endoscopy in combination with pharmacoendoscopy. Gastrointest Endosc 53:343–8

    Article  Google Scholar 

  20. Fujiya M, Saitoh Y, Watari J et al (2007) Auto-fluorescence imaging is useful to assess the activity of ulcerative colitis. Dig Endosc 19:145–9

    Article  Google Scholar 

  21. Ueno N, Fujiya M, Moriichi K et al (2011) Endosopic autofluorescence imaging is useful for the differential diagnosis of intestinal lymphomas resembling lymphoid hyperplasia. J Clin Gastroenterol 45:507–13

    Article  PubMed  Google Scholar 

  22. Kanda Y (2013) Investigation of the freely-available easy-to-use software “EZR” (Easy R) for medical statistics. Bone Marrow Transplant 48:452–458

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Riley SA, Mani V, Goodman MJ et al (1991) Microscopic activity in ulcerative colitis: what does it mean? Gut 32:174–8

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Dick AP, Holt LP, Dalton ER (1966) Persistence of mucosal abnormality in ulcerative colitis. Gut 7:355–60

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Florén CH, Benoni C, Willén R (1987) Histologic and colonoscopic assessment of disease extension in ulcerative colitis. Scand J Gastroenterol 22:459–62

    Article  PubMed  Google Scholar 

  26. Lemmens B, Arijs I, Van Assche G et al (2013) Correlation between the endoscopic and histologic score in assessing the activity of ulcerative colitis. Inflamm Bowel Dis 19:1194–201

    Article  PubMed  Google Scholar 

  27. D’Haens G, Sandborn WJ, Feagan BG et al (2007) A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology 132:763–86

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no competing interests.

Author contributions

MK and MF provided major input into the conceptual development of the studies, wrote the manuscript, and supervised all investigations. KM, MI, KT, AS, TD, SF, KA, YN, and NU performed the endoscopic examinations. YI assessed the histological findings. SK, TG, JS, and TI managed and treated the enrolled patients and collected and analyzed the data. HT, YS, and YK helped design studies, interpret the data, and prepare/review the manuscript.

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Author notes

    Authors and Affiliations

    1. Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-higashi, Asahikawa, Hokkaido, 078-8510, Japan

      Kentaro Moriichi, Mikihiro Fujiya, Masami Ijiri, Kazuyuki Tanaka, Aki Sakatani, Tatsuya Dokoshi, Shugo Fujibayashi, Katsuyoshi Ando, Yoshiki Nomura, Nobuhiro Ueno, Shin Kashima, Takuma Gotoh, Junpei Sasajima, Yuhei Inaba, Takahiro Ito, Hiroki Tanabe & Yutaka Kohgo

    2. Division of Gastroenterology, International University of Health and Wealfare Hospital, Nasushiobara, Tochigi, Japan

      Hiroki Tanabe & Yutaka Kohgo

    3. Digestive Disease Center, Asahikawa City Hospital, Asahikawa, Hokkaido, Japan

      Yuhei Inaba & Yusuke Saitoh

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    1. Kentaro Moriichi
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    Corresponding author

    Correspondence to Mikihiro Fujiya.

    Additional information

    Kentaro Moriichi and Mikihiro Fujiya contributed equally to this work.

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    Cite this article

    Moriichi, K., Fujiya, M., Ijiri, M. et al. Quantification of autofluorescence imaging can accurately and objectively assess the severity of ulcerative colitis. Int J Colorectal Dis 30, 1639–1643 (2015). https://doi.org/10.1007/s00384-015-2332-5

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    • DOI: https://doi.org/10.1007/s00384-015-2332-5

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