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Kawasaki K, Torisu T, Nagahata T, Esaki M, Kurahara K, Eizuka M, Tanaka Y, Fujiwara M, Kawatoko S, Oshiro Y, Yamada S, Ikegami K, Fujioka S, Fuyuno Y, Matsuno Y, Umeno J, Moriyama T, Kitazono T, Sugai T, Matsumoto T. Role of barium enema examination for the diagnosis of submucosal invasion depth in T1 colorectal cancers. Cancer Imaging 2021; 21:66. [PMID: 34876222 PMCID: PMC8650542 DOI: 10.1186/s40644-021-00437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The indication for endoscopic resection for submucosally invasive colorectal cancer (T1-CRC) depends on the preoperative diagnosis of invasion depth. The aim of this investigation was to evaluate the association between barium enema examination (BE) profile views and depth of submucosal (SM) invasion in CRCs. METHODS We reviewed the radiographic and endoscopic findings of 145 T1-CRCs diagnosed from 2008 to 2019. We measured the widths of horizontal and vertical rigidity under a BE profile view corresponding to CRC and compared the values with SM invasion depth. Horizontal rigidity was defined as the horizontal length and vertical rigidity as the vertical width of the barium defect corresponding to each target lesion. The most appropriate cut-off values for predicting SM invasion ≥1.8 mm were calculated by receiver operating characteristic curve analysis. RESULTS Values of horizontal rigidity (r = 0.626, P < 0.05) and vertical rigidity (r = 0.482, P < 0.05) correlated significantly with SM invasion depth. The most appropriate cut-off values for the prediction of SM invasion depth ≥ 1.8 mm were 4.5 mm for horizontal rigidity, with an accuracy of 80.7%; and 0.7 mm for vertical rigidity, with an accuracy of 77.9%. The prevalence of lympho-vascular invasion was significantly different when those cut-off values were applied (43.2% vs. 17.5% for horizontal rigidity, P < 0.005). CONCLUSIONS In T1-CRC, values of horizontal and vertical rigidities under a BE profile view were correlated with SM invasion depth. While the accuracy of the rigidities for the prediction of SM invasion depth ≥ 1.8 mm was not high, horizontal rigidity may be predictive of lympho-vascular invasion, thus aiding in therapeutic decision-making.
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Affiliation(s)
- Keisuke Kawasaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan. .,Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, 028-3695, Japan.
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Takahisa Nagahata
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Koichi Kurahara
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, 790-8524, Japan
| | - Makoto Eizuka
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, 028-3695, Japan.,Department of Diagnostic Pathology, Iwate Medical University, Yahaba, 790-8524, Japan
| | - Yoshihito Tanaka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, 790-8524, Japan
| | - Minako Fujiwara
- Department of Pathology, National Hospital Organization Kyushu Medical Center, Fukuoka, 810-8563, Japan.,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-0054, Japan
| | - Shinichiro Kawatoko
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan.,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-0054, Japan
| | - Yumi Oshiro
- Department of Pathology, Matsuyama Red Cross Hospital, Matsuyama, 790-8524, Japan
| | - Shun Yamada
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, 028-3695, Japan
| | - Koji Ikegami
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, 790-8524, Japan
| | - Shin Fujioka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Yuta Fuyuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Yuichi Matsuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Tomohiko Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, 790-8524, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, 028-3695, Japan
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Kawasaki K, Nakamura S, Eizuka M, Tanaka Y, Kumei T, Yanai S, Toya Y, Urushikubo J, Torisu T, Moriyama T, Umeno J, Sugai T, Matsumoto T. Is barium enema examination negligible for the management of colorectal cancer? Comparison with conventional colonoscopy and magnifying colonoscopy. Jpn J Radiol 2021; 39:1159-1167. [PMID: 34164768 DOI: 10.1007/s11604-021-01157-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/12/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this investigation was to evaluate the clinical value of barium enema (BE) examination for the management of colorectal epithelial neoplasms. METHODS We reviewed the colonoscopy records at our institution from 2014 to 2019 and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms evaluated by BE, conventional colonoscopy, magnifying narrow-band imaging colonoscopy (M-NBI), and magnifying chromoendoscopy (MCE). The yield of each modality for the diagnosis of massively submucosal invasive (mSM) colorectal cancer was evaluated by a receiver-operating characteristic analysis including the area under the curve (AUC). RESULTS We analyzed the records of 105 patients (17 adenomas, 53 high-grade dysplasias (HGDs), and 35 cancers). Smooth surface, irregularity in depression, and eccentric deformity on the profile view with BE were observed more frequently in mSM cancers than adenomas/HGDs/slightly submucosal invasive cancers (p < 0.01). The AUC of BE was 0.8355, the value of which was not different from the other three modalities (conventional colonoscopy 0.7678; M-NBI 0.7835; MCE 0.8376). Although the specificity, PPV, and accuracy of BE were lower than those of M-NBI and MCE, the sensitivity and NPV of BE were the highest among the four types of examinations. CONCLUSION BE is still available and may serve as a supplementary modality for the diagnosis of mSM cancers.
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Affiliation(s)
- Keisuke Kawasaki
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Makoto Eizuka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Yoshihito Tanaka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Tomo Kumei
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Shunichi Yanai
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Jun Urushikubo
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiko Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
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