{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:59:24Z","timestamp":1790305164713,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Ulcerative colitis\u2010associated neoplasia (UCAN) often presents as flat\u2010type dysplasia that is difficult to characterize endoscopically. We developed a FOCUS (Flat\u2010type dysplasia Optical assessment by Chromoendoscopy in Ulcerative colitiS) classification and evaluated its diagnostic performance and reproducibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single\u2010center retrospective study included 33 UCAN lesions from 26 patients. Prospectively recorded FOCUS classifications at 230 biopsy sites were compared with histopathology. Chromoendoscopic patterns were categorized as Type I (\u201csuggestive of non\u2010dysplasia,\u201d), Type II (\u201csuggestive of dysplasia with low confidence\u201d), or Type III (\u201csuggestive of dysplasia with high confidence\u201d). Diagnostic performance was assessed using two prespecified thresholds: Types II\/III versus Type I and Type III versus Types I\/II. Eight endoscopists independently classified all images; interobserver and intraobserver agreement were assessed using Fleiss' and Cohen's\n                      <jats:italic>\u03ba<\/jats:italic>\n                      , respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The dysplasia\u2010bearing rate increased stepwise from Type I to Type III (Type I 15.5%, Type II 58.3%, Type III 81.8%). Using the primary threshold, sensitivity was 82.0%, and specificity 75.4% (positive likelihood ratio 3.33; negative likelihood ratio 0.24). Interobserver agreement for the three\u2010category classification was moderate to substantial (Fleiss'\n                      <jats:italic>\u03ba<\/jats:italic>\n                      0.629; 95% CI 0.545\u20130.712), and median intraobserver agreement was substantial (Cohen's\n                      <jats:italic>\u03ba<\/jats:italic>\n                      0.738).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The FOCUS classification provides clinically meaningful risk stratification for flat\u2010type dysplasia in a high\u2010risk UCAN cohort, with acceptable interobserver and intraobserver reproducibility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.70280","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:46:41Z","timestamp":1788925601000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Performance and Reproducibility of Chromoendoscopic Classification (\n                    <scp>FOCUS<\/scp>\n                    Classification: Flat\u2010Type Dysplasia Optical Assessment by Chromoendoscopy in Ulcerative\n                    <scp>ColitiS<\/scp>\n                    ) for Flat\u2010Type Dysplasia in Ulcerative Colitis\u2013Associated Neoplasia"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4891-8246","authenticated-orcid":false,"given":"Kaoru","family":"Takabayashi","sequence":"first","affiliation":[{"name":"Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoma","family":"Murata","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoki","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Division of Research and Development for Minimally Invasive Treatment, Cancer Center Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurato","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3968-0969","authenticated-orcid":false,"given":"Teppei","family":"Masunaga","sequence":"additional","affiliation":[{"name":"Division of Research and Development for Minimally Invasive Treatment, Cancer Center Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumiko","family":"Kirita","sequence":"additional","affiliation":[{"name":"Division of Research and Development for Minimally Invasive Treatment, Cancer Center Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Mizutani","sequence":"additional","affiliation":[{"name":"Center for Diagnostic and Therapeutic Endoscopy Keio University School of Medicine  Tokyo 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