Kandiah et al reported the Portsmouth Acetic Acid Classification (PREDICT) to identify Barrett-associated neoplasia in the esophagus. The authors are from Portsmouth Hospital NHS Trust, Statconsultancy Limited (Amersham), Humanitas Research Hospital (Milan), VA Medical Center and Unversity of Kansas and St. John of God Hospital (Regensburg).
Patient selection: Barrett's esophagus
Exam: acetic acid chromoendoscopy
Parameters:
(1) acetowhitening of the musocal surface
(2) surface pattern of pits
Surface Acetowhitening
Barrett's
intact (no focal loss)
non-neoplastic
focal loss
neoplastic
Surface Pattern of Pits
Barrett's
uniform, evenly spaced, normal pit density
non-dysplastic
small pits, compactly packed, increased pit density
high-grade dysplasia
focal irregularity, disorganized pits
adenocarcinoma in situ
pit pattern absent
invasive adenocarcinoma
Performance:
• When performed by a trained endoscopist the sensitivity is 98% with a 97% negative predictive value.
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