Background and Aim: Few prospective studies examining the efficacy of autofluorescence imaging (AFI) screening for esophageal cancer have been reported. This study aimed to investigate the diagnostic value of AFI endoscopy for the screening of squamous mucosal high-grade neoplasia of the esophagus, performed by experienced and less-experienced endoscopists.
Methods: Patients with a history of esophageal neoplasia or head and neck cancer underwent AEI endoscopic screening, followed by chromoendoscopy using iodine staining as the reference standard. The primary outcome was the sensitivity of API for detecting new squamous mucosa] high-grade neoplasias. The secondary outcome was the positive predictive value (PPV) of AFI.
Results: Of a total 364 patients who underwent endoscopic examination, 43 new mucosa] high-grade neoplasias were detected. The sensitivities of API in the experienced and less-experienced endoscopist groups were 71% (95% confidence interval [CI]: 55-87%) and 50% (95% CI: 32-68%), respectively. The PPV of API in the experienced and the less-experienced endoscopist groups were 25% (95% CI: 16-34%) and 26% (95% Cl: 15-37%), respectively. The sensitivity of API in lesions 10 mm (31%, 5/16 lesions) was significantly lower than that in lesions > 10 mm (78%. 21/27 lesions) (P= 0.003).
Conclusions: The sensitivity of AEI for the detection of new squamous mucosal high-grade neoplasias, and its PPV, were both low. Based on these results, a randomized study to compare API with standard techniques is not justified.