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Zheng LF, Chen LP, Zhou LX, Zheng J, Jiang CS, Peng SR, Li DZ, Wang W. Evaluation of the extended Japan NBI expert team classification of subtype 2B in laterally spreading colorectal tumors based on blue laser imaging. J Dig Dis 2024; 25:361-367. [PMID: 38988129 DOI: 10.1111/1751-2980.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/16/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES The Japan NBI Expert Team (JNET) classification has good diagnostic potential for colorectal diseases. We aimed to explore the diagnostic value of the JNET classification type 2B (JNET2B) criteria for colorectal laterally spreading tumors (LSTs) based on magnifying endoscopy with blue laser imaging (ME-BLI) examination. METHODS Between January 2017 and June 2023, 218 patients who were diagnosed as having JNET2B-type LSTs using ME-BLI were included retrospectively. Endoscopic images were reinterpreted to categorize the LSTs as JNET2B-low (n = 178) and JNET2B-high (n = 53) LSTs. The JNET2B-low and JNET2B-high LSTs were compared based on their histopathological and morphological classifications. RESULTS Among the 178 JNET2B-low LSTs, 86 (48.3%) were histopathologically classified as low-grade intraepithelial neoplasia, 54 (30.3%) as high-grade intraepithelial neoplasia (HGIN), 37 (20.8%) as intramucosal carcinoma (IMC), and one (0.6%) as superficial invasive submucosal carcinoma (SMC1). Among the 53 JNET2B-high LSTs, five (9.4%) were classified as HGIN, 28 (52.9%) as IMC, 15 (28.3%) as SMC1, and 5 (9.4%) as deep invasive submucosal carcinoma. There were significant differences in this histopathological classification between the two groups (P < 0.001). However, there was no significant difference between JNET2B-low and JNET2B-high LSTs based on their morphological classification (granular vs nongranular) or size (<20 mm vs ≥20 mm). Besides, the κ value for JNET2B subtyping was 0.698 (95% confidence interval 0.592-0.804) between the two endoscopists who reassessed the endoscopic images. CONCLUSION The JNET2B subtyping of LSTs has a diagnostic potential in the preoperative setting, and may be valuable for treatment decision-making.
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Affiliation(s)
- Lin Fu Zheng
- Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, The 900th Hospital of Joint Logistic Support Force of PLA, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Long Ping Chen
- Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, The 900th Hospital of Joint Logistic Support Force of PLA, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Lin Xin Zhou
- Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, The 900th Hospital of Joint Logistic Support Force of PLA, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jin Zheng
- Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, The 900th Hospital of Joint Logistic Support Force of PLA, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chuan Shen Jiang
- Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, The 900th Hospital of Joint Logistic Support Force of PLA, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Shi Rui Peng
- Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, The 900th Hospital of Joint Logistic Support Force of PLA, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Da Zhou Li
- Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, The 900th Hospital of Joint Logistic Support Force of PLA, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Wen Wang
- Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, The 900th Hospital of Joint Logistic Support Force of PLA, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, Fujian Province, China
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Ikematsu H, Murano T, Shinmura K. Depth diagnosis of early colorectal cancer: Magnifying chromoendoscopy or image enhanced endoscopy with magnification? Dig Endosc 2022; 34:265-273. [PMID: 34289171 DOI: 10.1111/den.14087] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022]
Abstract
Depth diagnosis is extremely crucial in making a treatment choice between endoscopic resection and surgery in the early stages of cancers. Among several imaging modalities, we use magnifying endoscopy to diagnose lesions by close observation of the findings at mucosal surface layer. In combination with topical staining, magnifying endoscopy enables us to assess the definite pit structure, which referred to as magnifying chromoendoscopy (MCE). The pit pattern classification by MCE was proposed and is now widely accepted as the standard diagnostic criteria for colorectal lesions. Meanwhile, image enhanced endoscopy (IEE) represented by narrow-band imaging was developed to improve the visibility of surface and vascular findings without dyeing. Recent collaborative work performed by endoscopic experts in Japan yielded the unified diagnostic criteria, the Japan NBI Expert Team (JNET) classification, based on the findings of IEE with magnification. In this review, focusing on MCE and IEE with magnification, we aimed to give an outline of the pit pattern classification and the JNET classification, and further discuss their accuracy rate of depth diagnosis of early colorectal lesions by performing a review of the related literature. Both modalities have a high accuracy rate of nearly 90% for depth diagnosis. IEE with magnification is an ideal modality because it helps observe lesions without dye spraying; however, lesions with JNET type 2B have an inadequate diagnostic ability, which should be complemented by MCE. We conclude that accurate diagnosis is possible by examining lesions using both modalities properly to overcome the limitations of each modality.
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Affiliation(s)
- Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Chiba, Japan.,Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
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Abstract
INTRODUCTION Perioperative enhanced recovery after surgery (ERAS) concepts or fast-track are supposed to accelerate recovery after surgery, reduce postoperative complications and shorten the hospital stay when compared to traditional perioperative treatment. METHODS Electronic search of the PubMed database to identify systematic reviews with meta-analysis (SR) comparing ERAS and traditional treatment. RESULTS The presented SR investigated 70 randomized controlled studies (RCT) with 12,986 patients and 93 non-RCT (24,335 patients) concerning abdominal, thoracic and vascular as well as orthopedic surgery. The complication rates were decreased under ERAS following colorectal esophageal, liver and pulmonary resections as well as after implantation of hip endoprostheses. Pulmonary complications were reduced after ERAS esophageal, gastric and pulmonary resections. The first bowel movements occurred earlier after ERAS colorectal resections and delayed gastric emptying was less often observed after ERAS pancreatic resection. Following ERAS fast-track esophageal resection, anastomotic leakage was diagnosed less often as well as surgical complications after ERAS pulmonary resection. The ERAS in all studies concerning orthopedic surgery and trials investigating implantation of a hip endoprosthesis or knee endoprosthesis reduced the risk for postoperative blood transfusions. Regardless of the type of surgery, ERAS shortened hospital stay without increasing readmissions. CONCLUSION Numerous clinical trials have confirmed that ERAS reduces postoperative morbidity, shortens hospital stay and accelerates recovery without increasing readmission rates following most surgical operations.
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