Background Barrett’s oesophagus is an established risk factor for developing oesophageal adenocarcinoma. However, Barrett’s neoplasia can be subtle and difficult to identify. Acetic acid chromoendoscopy (AAC) is a simple technique that has been demonstrated to highlight neoplastic areas but lesion recognition with AAC remains a challenge, thereby hampering its widespread use. Objective To develop and validate a simple classification system to identify Barrett’s neoplasia using AAC. Design The study was conducted in four phases: phase 1—development of component descriptive criteria; phase 2—development of a classification system; phase 3—validation of the classification system by endoscopists; and phase 4—validation of the classification system by non-endoscopists. Results Phases 1 and 2 led to the development of a simplified AAC classification system based on two criteria: focal loss of acetowhitening and surface patterns of Barrett’s mucosa. In phase 3, the application of PREDICT (Portsmouth acetic acid classification) by endoscopists improved the sensitivity and negative predictive value (NPV) from 79.3% and 80.2% to 98.1% and 97.4%, respectively (p<0.001). In phase 4, the application of PREDICT by non-endoscopists improved the sensitivity and NPV from 69.6% and 75.5% to 95.9% and 96.0%, respectively (p<0.001). Conclusion We developed and validated a classification system known as PREDICT for the diagnosis of Barrett’s neoplasia using AAC. The improvement seen in the sensitivity and NPV for detection of Barrett’s neoplasia in phase 3 demonstrates the clinical value of PREDICT and the similar improvement seen among non-endoscopists demonstrates the potential for generalisation of PREDICT once proven in real time.

中文翻译：

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国际开发和验证使用乙酸色素内镜鉴定巴雷特瘤形成的分类系统：朴茨茅斯乙酸分类 (PREDICT)

背景 Barrett 食管是发展为食管腺癌的既定风险因素。然而，巴雷特瘤形成可能很微妙且难以识别。乙酸色素内镜 (AAC) 是一种简单的技术，已被证明可以突出肿瘤区域，但 AAC 的病变识别仍然是一个挑战，从而阻碍了其广泛使用。目的 开发和验证一个简单的分类系统，以使用 AAC 识别 Barrett 瘤形成。设计 该研究分四个阶段进行： 第一阶段——制定组件描述标准；第 2 阶段——开发分类系统；第 3 阶段——内镜医师对分类系统的验证；第 4 阶段——非内镜医师对分类系统的验证。结果 第 1 阶段和第 2 阶段导致了基于两个标准的简化 AAC 分类系统的开发：醋酸白化的局灶性损失和 Barrett 黏膜的表面图案。在第 3 阶段，内镜医师应用 PREDICT（朴茨茅斯乙酸分类）将敏感性和阴性预测值 (NPV) 从 79.3% 和 80.2% 分别提高到 98.1% 和 97.4% (p<0.001)。在第 4 阶段，非内镜医师应用 PREDICT 将灵敏度和 NPV 分别从 69.6% 和 75.5% 提高到 95.9% 和 96.0% (p<0.001)。结论 我们开发并验证了一种称为 PREDICT 的分类系统，用于使用 AAC 诊断 Barrett 瘤形成。