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Lu YB, Lu SC, Li FD, Le PH, Zhang KH, Sun ZZ, Huang YN, Weng YC, Chen WT, Fu YW, Qian JB, Hu B, Xu H, Chiu CT, Xu QW, Gong W. Artificial intelligence-aided diagnostic imaging: A state-of-the-art technique in precancerous screening. J Gastroenterol Hepatol 2024; 39:544-551. [PMID: 38059883 DOI: 10.1111/jgh.16429] [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: 07/18/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIM Chromoendoscopy with the use of indigo carmine (IC) dye is a crucial endoscopic technique to identify gastrointestinal neoplasms. However, its performance is limited by the endoscopist's skill, and no standards are available for lesion identification. Thus, we developed an artificial intelligence (AI) model to replace chromoendoscopy. METHODS This pilot study assessed the feasibility of our novel AI model in the conversion of white-light images (WLI) into virtual IC-dyed images based on a generative adversarial network. The predictions of our AI model were evaluated against the assessments of five endoscopic experts who were blinded to the purpose of this study with a staining quality rating from 1 (unacceptable) to 4 (excellent). RESULTS The AI model successfully transformed the WLI of polyps with different morphologies and different types of lesions in the gastrointestinal tract into virtual IC-dyed images. The quality ratings of the real IC-dyed and AI images did not significantly differ concerning surface structure (AI vs IC: 3.08 vs 3.00), lesion border (3.04 vs 2.98), and overall contrast (3.14 vs 3.02) from 10 sets of images (10 AI images and 10 real IC-dyed images). Although the score depended significantly on the evaluator, the staining methods (AI or real IC) and evaluators had no significant interaction (P > 0.05) with each other. CONCLUSION Our results demonstrated the feasibility of employing AI model's virtual IC staining, increasing the possibility of being employed in daily practice. This novel technology may facilitate gastrointestinal lesion identification in the future.
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Affiliation(s)
- Yang-Bor Lu
- Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
- Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
| | - Si-Cun Lu
- Departmemt of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Fu-Dong Li
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Puo-Hsien Le
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Kai-Hua Zhang
- School of Computer, Nanjing University of Information Science and Technology, Nanjing, China
| | - Zi-Zheng Sun
- School of Computer, Nanjing University of Information Science and Technology, Nanjing, China
| | - Yung-Ning Huang
- Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
- Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
| | - Yu-Chieh Weng
- Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
- Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yi-Wei Fu
- Department of Gastroenterology, Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jun-Bo Qian
- Department of Gastroenterology, The Second Hospital affiliated to Nantong University, Nantong, China
| | - Bin Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Xu
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Qin-Wei Xu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Gong
- Departmemt of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Shenzhen, China
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Kimura CMS, Kawaguti FS, Horvat N, Nahas CSR, Marques CFS, Pinto RA, de Rezende DT, Segatelli V, Safatle-Ribeiro AV, Junior UR, Maluf-Filho F, Nahas SC. Magnifying chromoendoscopy is a reliable method in the selection of rectal neoplasms for local excision. Tech Coloproctol 2023; 27:1047-1056. [PMID: 36906661 PMCID: PMC11181310 DOI: 10.1007/s10151-023-02773-7] [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: 10/05/2022] [Accepted: 02/12/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Adequate staging of early rectal neoplasms is essential for organ-preserving treatments, but magnetic resonance imaging (MRI) frequently overestimates the stage of those lesions. We aimed to compare the ability of magnifying chromoendoscopy and MRI to select patients with early rectal neoplasms for local excision. METHODS This retrospective study in a tertiary Western cancer center included consecutive patients evaluated by magnifying chromoendoscopy and MRI who underwent en bloc resection of nonpedunculated sessile polyps larger than 20 mm, laterally spreading tumors (LSTs) [Formula: see text] 20 mm, or depressed-type lesions of any size (Paris 0-IIc). Sensitivity, specificity, accuracy, and positive and negative predictive values of magnifying chromoendoscopy and MRI to determine which lesions were amenable to local excision (i.e., [Formula: see text] T1sm1) were calculated. RESULTS Specificity of magnifying chromoendoscopy was 97.3% (95% CI 92.2-99.4), and accuracy was 92.7% (95% CI 86.7-96.6) for predicting invasion deeper than T1sm1 (not amenable to local excision). MRI had lower specificity (60.5%, 95% CI 43.4-76.0) and lower accuracy (58.3%, 95% CI 43.2-72.4). Magnifying chromoendoscopy incorrectly predicted invasion depth in 10.7% of the cases in which the MRI was correct, while magnifying chromoendoscopy provided a correct diagnosis in 90% of the cases in which the MRI was incorrect (p = 0.001). Overstaging occurred in 33.3% of the cases in which magnifying chromoendoscopy was incorrect and 75% of the cases in which MRI was incorrect. CONCLUSION Magnifying chromoendoscopy is reliable for predicting invasion depth in early rectal neoplasms and selecting patients for local excision.
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Affiliation(s)
- C M S Kimura
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
- Department of Surgery, Stanford University School of Medicine, Stanford, USA
| | - F S Kawaguti
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Dr. Arnaldo Av, 251, 2nd Floor, São Paulo, Zip Code 01246-000, Brazil.
| | - N Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C S R Nahas
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - C F S Marques
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - R A Pinto
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - D T de Rezende
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Dr. Arnaldo Av, 251, 2nd Floor, São Paulo, Zip Code 01246-000, Brazil
| | - V Segatelli
- Division of Pathology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - A V Safatle-Ribeiro
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Dr. Arnaldo Av, 251, 2nd Floor, São Paulo, Zip Code 01246-000, Brazil
| | - U R Junior
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - F Maluf-Filho
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Dr. Arnaldo Av, 251, 2nd Floor, São Paulo, Zip Code 01246-000, Brazil
| | - S C Nahas
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Shibagaki K, Ishimura N, Yuki T, Taniguchi H, Aimi M, Kobayashi K, Kotani S, Yazaki T, Yamashita N, Tamagawa Y, Mishiro T, Ishihara S, Yasuda A, Kinshita Y. Magnification endoscopy in combination with acetic acid enhancement and narrow-band imaging for the accurate diagnosis of colonic neoplasms. Endosc Int Open 2020; 8:E488-E497. [PMID: 32258370 PMCID: PMC7089791 DOI: 10.1055/a-1068-2056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Magnification endoscopy with narrow-band imaging (NBIME) and NBIME with acetic acid enhancement (A-NBIME) enable visualization of the vascular and microstructural patterns of colorectal polyp. We compared the diagnostic accuracy and reproducibility of white light endoscopy (WLE), NBIME, and A-NBIME for predictive histologic diagnosis. Patients and methods Consecutive colorectal polyps (N = 628; 38 hyperplasias, 488 adenomas, 72 M-SM1 cancers, and 30 SM2 cancers) were photographed with WLE, NBIME, and A-NBIME. Endoscopic images were independently reviewed by three experts, according to the traditional criteria for WLE, the Japan NBI Expert Team classification for NBIME, and pit pattern classification for A-NBIME to compare diagnostic accuracy and interobserver diagnostic agreement among modalities. Results The specificity (95 % confidence interval) of hyperplasia and SM2 cancer with WLE were 98.2 % (96.8 %-99.1%) and 99.4 % (98.5 %-99.9 %), respectively, showing high accuracy for endoscopic resection without magnifying observation. Diagnostic accuracy of WLE, NBIME, and A-NBIME was 80.8 % (77.4 %-83.8 %), 79.3 % (75.9 %-82.4 %), and 86.1 % (83.2 %-88.7 %), respectively, showing the highest accuracy for A-NBIME among modalities ( P < .05). NBIME showed a lower PPV for M-SM1 cancer ( P < .05), as with WLE ( P = .08) compared to A-NBIME. Fleiss's kappa values for WLE, NBIME, and A-NBIME diagnosis were 0.43 (0.39 - 0.46), 0.52 (0.49 - 0.56) and 0.65 (0.62 - 0.69), respectively, showing insufficient reproducibility of WLE and superiority of A-NBIME among modalities. Conclusion WLE showed high accuracy for endoscopic resection of colorectal polyps in expert diagnosis. NBIME demonstrated a higher diagnostic reproducibility than WLE. A-NBIME showed possible superiority among modalities in both diagnostic accuracy and reproducibility.
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Affiliation(s)
- Kotaro Shibagaki
- Department of Endoscopy, Faculty of Medicine, Shimane University, Izumo, Japan,Corresponding author Kotaro Shibagaki, MD, PhD Department of Gastroenterology, Faculty of MedicineShimane University89-1 EnyaIzumoJapan 693-8501+81-85320-2187
| | - Norihisa Ishimura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Takafumi Yuki
- Division of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Hideaki Taniguchi
- Department of Gastroenterology, Tottori Municipal Hospital, Tottori, Japan
| | - Masahito Aimi
- Department of Gastroenterology, Tottori Municipal Hospital, Tottori, Japan
| | - Keita Kobayashi
- Department of Pathology, Tottori Municipal Hospital, Tottori, Japan
| | - Satoshi Kotani
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tomotaka Yazaki
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Noritsugu Yamashita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yuji Tamagawa
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tsuyoshi Mishiro
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Akira Yasuda
- Department of Medical informatics, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yoshikazu Kinshita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
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Sánchez-Montes C, García-Rodríguez A, Córdova H, Pellisé M, Fernández-Esparrach G. Advanced endoscopy technologies to improve the detection and characterisation of colorrectal polyps. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 43:46-56. [PMID: 31813615 DOI: 10.1016/j.gastrohep.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 11/19/2022]
Abstract
Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques.
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Affiliation(s)
- Cristina Sánchez-Montes
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Grupo de Investigación de Endoscopia Digestiva, IIS La Fe, Valencia, España
| | - Ana García-Rodríguez
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - María Pellisé
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España.
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Optical Technologies for Endoscopic Real-Time Histologic Assessment of Colorectal Polyps: A Meta-Analysis. Am J Gastroenterol 2019; 114:1219-1230. [PMID: 30848728 DOI: 10.14309/ajg.0000000000000156] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Accurate, real-time, endoscopic risk stratification of colorectal polyps would improve decision-making and optimize clinical efficiency. Technologies to manipulate endoscopic optical outputs can be used to predict polyp histology in vivo; however, it remains unclear how accuracy has progressed and whether it is sufficient for routine clinical implementation. METHODS A meta-analysis was conducted by searching MEDLINE, Embase, and the Cochrane Library. Studies were included if they prospectively deployed an endoscopic optical technology for real-time in vivo prediction of adenomatous colorectal polyps. Polyposis and inflammatory bowel diseases were excluded. Bayesian bivariate meta-analysis was performed, presenting 95% confidence intervals (CI). RESULTS One hundred two studies using optical technologies on 33,123 colorectal polyps were included. Digital chromoendoscopy differentiated neoplasia (adenoma and adenocarcinoma) from benign polyps with sensitivity of 92.2% (90.6%-93.9% CI) and specificity of 84.0% (81.5%-86.3% CI), with no difference between constituent technologies (narrow-band imaging, Fuji intelligent Chromo Endoscopy, iSCAN) or with only diminutive polyps. Dye chromoendoscopy had sensitivity of 92.7% (90.1%-94.9% CI) and specificity of 86.6% (82.9%-89.9% CI), similarly unchanged for diminutive polyps. Spectral analysis of autofluorescence had sensitivity of 94.4% (84.0%-99.1% CI) and specificity of 50.9% (13.2%-88.8% CI). Endomicroscopy had sensitivity of 93.6% (85.3%-98.3% CI) and specificity of 92.5% (81.8%-98.1% CI). Computer-aided diagnosis had sensitivity of 88.9% (74.2%-96.7% CI) and specificity of 80.4% (52.6%-95.7% CI). Prediction confidence and endoscopist experience alone did not significantly improve any technology. The only subgroup to demonstrate a negative predictive value for adenoma above 90% was digital chromoendoscopy, making high confidence predictions of diminutive recto-sigmoid polyps. Chronologic meta-analyses show a falling negative predictive value over time. A significant publication bias exists. DISCUSSION This novel approach to meta-analysis demonstrates that existing optical technologies are increasingly unlikely to allow safe "resect and discard" strategies and that step-change innovation may be required. A "diagnose and leave" strategy may be supported for diminutive recto-sigmoid polyps diagnosed with high confidence; however, limitations exist in the evidence base for this cohort.
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Kandel P, Wallace MB. Should We Resect and Discard Low Risk Diminutive Colon Polyps. Clin Endosc 2019; 52:239-246. [PMID: 30661337 PMCID: PMC6547333 DOI: 10.5946/ce.2018.136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/04/2018] [Indexed: 02/06/2023] Open
Abstract
Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection with histological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis without histology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplastic polyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive value should be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be sufficiently accurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosis at least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regard to both safety and cost, it has yet to be used widely in practice. To fully implement such as strategy, there is a need for better-quality training, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose of colorectal polyps and its implications for colonoscopy practice.
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Affiliation(s)
- Pujan Kandel
- Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
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Utsumi T, Iwatate M, Sunakawa H, Teramoto A, Hirata D, Hattori S, Sano W, Hasuike N, Ichikawa K, Fujimori T, Sano Y. Additional chromoendoscopy for colorectal lesions initially diagnosed with low confidence by magnifying narrow-band imaging: Can it improve diagnostic accuracy? Dig Endosc 2018; 30 Suppl 1:45-50. [PMID: 29658652 DOI: 10.1111/den.13055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Magnifying chromoendoscopy has been one of the most reliable diagnostic methods for distinguishing neoplastic from non-neoplastic lesions. The aim of this prospective study was to clarify the clinical usefulness of magnifying chromoendoscopy for colorectal polyps initially diagnosed with low confidence (LC) by magnifying narrow-band imaging (NBI). METHODS Consecutive adult patients who underwent total colonoscopic examination with magnifying NBI between July and December 2016 at Sano Hospital were prospectively recruited. Endoscopists were asked to carry out additional magnifying chromoendoscopy for cases that had been initially diagnosed as Japan NBI Expert Team (JNET) Type 1 or 2A with LC by magnifying NBI. We investigated the diagnostic performance of magnifying NBI for polyps diagnosed as JNET Type 1 or 2A with LC (first phase) and that of subsequent magnifying chromoendoscopy (second phase) in differentiating neoplasia from non-neoplasia. RESULTS In 50 patients, we analyzed 53 polyps classified as JNET Type 1 or 2A with LC prediction. Accuracy and negative predictive value of magnifying NBI (first phase) were 58.5% (95% CI, 44.1-71.9%) and 66.0% (95% CI, 36.6-77.9%), and those of magnifying chromoendoscopy (second phase) were 66.0% (95% CI, 51.7-78.5%) and 61.1% (95% CI, 43.5-76.9%), respectively. CONCLUSION Regardless of the findings of additional chromoendoscopy, all polyps should be resected and submitted for histopathological examination when the confidence level in differentiating adenomatous from hyperplastic polyps by magnifying NBI is low.
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Affiliation(s)
- Takahiro Utsumi
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | - Mineo Iwatate
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | - Hironori Sunakawa
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | - Akira Teramoto
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | - Daizen Hirata
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | - Santa Hattori
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | - Wataru Sano
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | - Noriaki Hasuike
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | | | | | - Yasushi Sano
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
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Mizumoto T, Sanomura Y, Tanaka S, Kuroki K, Kurihara M, Yoshifuku Y, Oka S, Arihiro K, Shimamoto F, Chayama K. Clinical usefulness of magnifying endoscopy for non-ampullary duodenal tumors. Endosc Int Open 2017; 5:E297-E302. [PMID: 28382328 PMCID: PMC5378549 DOI: 10.1055/s-0043-103681] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Study aims This study aimed to investigate the clinical usefulness of magnifying endoscopy (ME) for non-ampullary duodenal tumors. Patients and methods We enrolled 103 consecutive patients with non-ampullary duodenal tumors that were observed by ME with narrow-band imaging (ME-NBI) and had pit pattern analysis before endoscopic resection at Hiroshima University Hospital before December 2014. ME-NBI images were classified as Type B or Type C according to the Hiroshima classification, and pit patterns were classified as regular or irregular. We studied the clinicopathological features and diagnoses with ME-NBI and pit pattern analyses according to the Vienna classification (category 3: 73 patients; category 4: 30 patients). Results Category 4 lesions were significantly larger than category 3 lesions. According to ME-NBI images, category 4 Type C lesions (83 %) were significantly more common than category 4 Type B lesions (17 %). According to pit pattern analyses, category 4 irregular lesions 4 (77 %) were significantly more common than category 4 regular lesions (23 %). The accuracies of using Type C ME-NBI images and irregular pit patterns to diagnose category 4 lesions were 87 % and 84 %, the sensitivities were 83 % and 77 %, and the specificities were 89 % and 88 %, respectively. There was no significant difference between ME-NBI and pit pattern analyses for diagnosing the histologic grade of non-ampullary duodenal tumors. Conclusion Our study showed that ME-NBI and pit pattern analysis had equivalent abilities to determine the histologic grade of non-ampullary duodenal tumors. ME-NBI may be more useful because it is a simple, less time-consuming procedure.
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Affiliation(s)
- Takeshi Mizumoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yoji Sanomura
- Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan,Corresponding author Yoji Sanomura, MD PhD Department of EndoscopyHiroshima University Hospital1-2-3 KasumiMinami-kuHiroshima 734-8551Japan+81-82-2532930
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kazutoshi Kuroki
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Mio Kurihara
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yoshikazu Yoshifuku
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Fumio Shimamoto
- Department of the Faculty of Humanities and Human Sciences, Hiroshima Shudo University, 1-1-1 Otsukahigashi, Asaminami-ku, Hiroshima 731-3195, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Yanai S, Nakamura S, Matsumoto T. Role of magnifying colonoscopy for diagnosis of colorectal neoplasms: From the perspective of Japanese colonoscopists. Dig Endosc 2016; 28:274-80. [PMID: 26538078 DOI: 10.1111/den.12568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/06/2015] [Accepted: 11/02/2015] [Indexed: 02/08/2023]
Abstract
Colorectal cancer is the third leading cause of cancer-related death. As the therapeutic strategy for colorectal cancer depends on the clinical stage of the tumor, precise and accurate staging is necessary prior to treatment decision-making. Colonoscopy is an essential tool for detection and prevention of colorectal cancer, as it also allows for removal of adenomatous lesions. Using conventional endoscopy, however, it is sometimes difficult to differentiate neoplastic lesions from non-neoplastic lesions. Several new endoscopic technologies have been developed to provide a more precise diagnosis. Magnifying chromoendoscopy and narrow-band imaging endoscopy with or without magnification are invaluable not only for distinction of colorectal neoplastic lesions from non-neoplastic lesions, but also for the accurate diagnosis of invasion depth in colorectal cancers. Based on an accumulation of a large number of clinical data, the use of magnifying colonoscopy has become inevitable for the prediction of histology and the diagnosis of invasion depth of colorectal neoplasms in Japan.
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Affiliation(s)
- Shunichi Yanai
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
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Tsuji S, Doyama H, Tsuji K, Tsuyama S, Tominaga K, Yoshida N, Takemura K, Yamada S, Niwa H, Katayanagi K, Kurumaya H, Okada T. Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy. World J Gastroenterol 2015; 21:11832-41. [PMID: 26557007 PMCID: PMC4631981 DOI: 10.3748/wjg.v21.i41.11832] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/18/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater's papilla, and it includes adenoma and adenocarcinoma. Recent developments in endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for real-time diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues.
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11
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Optical diagnosis of small colorectal polyps during colonoscopy: when to resect and discard? Best Pract Res Clin Gastroenterol 2015; 29:639-49. [PMID: 26381308 DOI: 10.1016/j.bpg.2015.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/05/2015] [Accepted: 06/18/2015] [Indexed: 01/31/2023]
Abstract
Colonoscopy with polypectomy has been shown to be effective in reducing incidence and mortality from colorectal cancer (CRC). The increase in use of colonoscopy in national bowel cancer screening programmes combined with improved technology has resulted in a large increase in detection of polyps. Most polyps detected at screening colonoscopy are small (<10 mm) or diminutive (<6 mm) and, in particular the latter, have a very small chance of containing advanced features or cancer. The main reason for resecting small adenomas and sending them to histopathology serves to inform on the future surveillance intervals. Being able to diagnose adenomas in vivo would allow for them to be resected and discarded, saving the costs associated with histopathology. Diagnosing distal hyperplastic polyps in vivo would allow for these to be left in situ reducing the risks associated with polypectomy. There are now a number of new technologies that could potentially make optical diagnosis a reality. Resect and discard policy is an attractive concept for patients, gastroenterologists and health service providers and would present an enticing change to current clinical practice.
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12
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Din S, Ball AJ, Riley SA, Kitsanta P, Johal S. Cold snare polypectomy: does snare type influence outcomes? Dig Endosc 2015; 27:603-8. [PMID: 25639685 DOI: 10.1111/den.12431] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/06/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Cold snare techniques are widely used for the removal of small and diminutive polyps. The influence of snare type on the effectiveness of cold snare polypectomy is unknown. METHODS Cold snare polypectomy of 3-7-mm polyps was undertaken using either a thin wire mini-snare (0.30 mm) or a thick wire mini-snare (0.47 mm). Primary outcome was endoscopic completeness of excision. Consensus regarding endoscopic assessment of completeness of excision was standardized and aided by chromoendoscopy. Secondary outcomes included: completeness of histological excision, polyp 'fly away', polyp retrieval rate, early or delayed bleeding and perforation. RESULTS One hundred and fifty-seven polyps were removed ranging from 3 to 7 mm, 62% were situated in the left side of the colon and 89.4% were sessile. Endoscopic completeness of excision was significantly higher with the thin wire snare compared to the thick wire snare (90.2% vs 73.3%, P < 0.05). There was a numerical trend towards a higher complete histological excision rate with the thin wire snare, but this did not reach statistical significance (73.3% vs 65.2%, P = 0.4). There was a fair level of agreement (kappa = 0.36) between endoscopic and histological completeness of excision. Polyp 'fly away' occurred less often with the thin wire snare (14.6% vs 35.3%, P = 0.002), but there was no significant difference in polyp retrieval rate (84.3% vs 83.8%, P = 0.94). There were no complications with either snare. CONCLUSION Snare type appears to be an important determinant of completeness of excision when removing small polyps by the cold snare technique.
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Affiliation(s)
- Said Din
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.,Department of Oncology, University of Sheffield, Medical School, Sheffield, UK
| | - Alex J Ball
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.,Department of Oncology, University of Sheffield, Medical School, Sheffield, UK
| | - Stuart A Riley
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Panagiota Kitsanta
- Department of Histopathology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Shawinder Johal
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
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13
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Abstract
Polypectomy at colonoscopy has been shown to reduce the subsequent risk of colorectal cancer. With the advent of national screening programs, the number of colonoscopies performed has increased worldwide. In addition, the recent drive for quality improvement combined with advances in colonoscopic technology has resulted in increased numbers of polyps detected, resected, and sent for histopathology leading to spiraling costs associated with the procedure. Being able to diagnose small polyps in vivo (optical diagnosis) would allow for adenomas to be resected and discarded without the need to retrieve them or send them for formal histopathology.
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14
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Abstract
Although removal of adenomatous polyps has been shown to decrease the risk of colon cancer, distal hyperplastic polyps are thought to not have malignant potential. Most polyps detected during colonoscopy are diminutive (≤ 5 mm) and rarely harbor advanced histology, such as high-grade dysplasia or cancer. Therefore, predicting histology in real-time during colonoscopy can potentially decrease the enormous expenditure that ensues from universal histopathologic evaluation of polyps, and several novel imaging technologies have been developed and tested over the past decade for this purpose. Of these different technologies, electronic chromoendoscopy seems to strike a fair balance between accuracy, feasibility, and cost.
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Affiliation(s)
- Shreyas Saligram
- University of Kansas School of Medicine, University of Kansas, Department of Gastroenterology, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Veterans Affairs Medical Center, Department of Gastroenterology, 4801 Linwood Blvd, Kansas City, MO 64128, USA
| | - Amit Rastogi
- University of Kansas School of Medicine, University of Kansas, Department of Gastroenterology, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Veterans Affairs Medical Center, Department of Gastroenterology, 4801 Linwood Blvd, Kansas City, MO 64128, USA.
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15
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Galloro G, Ruggiero S, Russo T, Saunders B. Recent advances to improve the endoscopic detection and differentiation of early colorectal neoplasia. Colorectal Dis 2015; 17 Suppl 1:25-30. [PMID: 25511858 DOI: 10.1111/codi.12818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G Galloro
- Department of Clinical Medicine and Surgery, Special Unit of Surgical Digestive Endoscopy, University of Naples Federico II - School of Medicine, Napoli, Italy
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16
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High-definition and high-magnification endoscopes. Gastrointest Endosc 2014; 80:919-27. [PMID: 25442091 DOI: 10.1016/j.gie.2014.06.019] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/04/2014] [Indexed: 02/07/2023]
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17
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Park Y, Ryu YM, Jung Y, Wang T, Baek Y, Yoon Y, Bae SM, Park J, Hwang S, Kim J, Do EJ, Kim SY, Chung E, Kim KH, Kim S, Myung SJ. Spraying quantum dot conjugates in the colon of live animals enabled rapid and multiplex cancer diagnosis using endoscopy. ACS NANO 2014; 8:8896-910. [PMID: 25188899 DOI: 10.1021/nn5009269] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The detection of colon cancer using endoscopy is widely used, but the interpretation of the diagnosis is based on the clinician's naked eye. This is subjective and can lead to false detection. Here we developed a rapid and accurate molecular fluorescence imaging technique using antibody-coated quantum dots (Ab-QDs) sprayed and washed simultaneously on colon tumor tissues inside live animals, subsequently excited and imaged by endoscopy. QDs were conjugated to matrix metalloproteinases (MMP) 9, MMP 14, or carcinoembryonic antigen (CEA) Abs with zwitterionic surface coating to reduce nonspecific bindings. The Ab-QD probes can diagnose tumors on sectioned mouse tissues, fresh mouse colons stained ex vivo and also in vivo as well as fresh human colon adenoma tissues in 30 min and can be imaged with a depth of 100 μm. The probes successfully detected not only cancers that are readily discernible by bare eyes but also hyperplasia and adenoma regions. Sum and cross signal operations provided postprocessed images that can show complementary information or regions of high priority. This multiplexed quantum dot, spray-and-wash, and endoscopy approach provides a significant advantage for detecting small or flat tumors that may be missed by conventional endoscopic examinations and bestows a strategy for the improvement of cancer diagnosis.
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Affiliation(s)
- Youngrong Park
- Department of Chemistry, Pohang University of Science and Technology (POSTECH) , San 31, Hyojadong, Nam-gu, Pohang 790-784, South Korea
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18
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Shinmura K, Konishi K, Yamochi T, Kubota Y, Yano Y, Katagiri A, Muramoto T, Kihara T, Tojo M, Konda K, Tagawa T, Yanagisawa F, Kogo M, Makino R, Takimoto M, Yoshida H. Molecular features of colorectal polyps presenting Kudo's type II mucosal crypt pattern: are they based on the same mechanism of tumorigenesis? Endosc Int Open 2014; 2:E171-7. [PMID: 26134964 PMCID: PMC4423326 DOI: 10.1055/s-0034-1377518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/10/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND STUDY AIMS The molecular features of serrated polyps (SPs) with hyperplastic crypt pattern, also called Kudo's type II observed by chromoendoscopy, were evaluated. METHODS The clinicopathological and molecular features of 114 SPs with a hyperplastic pit pattern detected under chromoendoscopy (five dysplastic SPs, 63 sessile serrated adenoma/polyps (SSA/Ps), 36 microvesicular hyperplastic polyps (MVHPs), and 10 goblet cell-rich hyperplastic polyps (GCHPs)) were examined. The frequency of KRAS and BRAF mutations and CpG island methylator phenotype (CIMP) were investigated. RESULTS Dysplastic SPs and SSA/Ps were frequently located in the proximal colon compared to others (SSA/Ps vs. MVHPs or GCHPs, P < 0.0001). No significant difference was found in the frequency of BRAF mutation among SPs apart from GCHP (60 % for dysplastic SPs, 44 % for SSA/Ps, 47 % for MVHPs, and 0 % for GCHPs). The frequency of CIMP was higher in dysplastic SPs or SSA/Ps than in MVHPs or GCHPs (60 % for dysplastic SPs, 56 % for SSA/Ps, 32 % for MVHPs, and 10 % for GCHPs) (SSA/Ps vs. GCHP, P = 0.0068). When serrated neoplasias (SNs) and MVHPs were classified into proximal and distal lesions, the frequency of CIMP was significantly higher in the proximal compared to the distal SNs (64 % vs. 11 %, P = 0.0032). Finally, multivariate analysis showed that proximal location and BRAF mutation were significantly associated with an increased risk of CIMP. CONCLUSIONS Distinct molecular features were observed between proximal and distal SPs with hyperplastic crypt pattern. Proximal MVHPs may develop more frequently through SSA/Ps to CIMP cancers than distal MVHPs.
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Affiliation(s)
- Kensuke Shinmura
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Kazuo Konishi
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan,Corresponding author Kazuo Konishi, MD
PhD Division of Gastroenterology, Department of
MedicineShowa University School of
Medicine1-5-8 Hatanodai,
Shinagawa-kuTokyo
142-8666Japan+81-3-37847553
| | - Toshiko Yamochi
- Department of Pathology, Showa University School of Medicine, Tokyo,
Japan
| | - Yutaro Kubota
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Yuichiro Yano
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Atsushi Katagiri
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Takashi Muramoto
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Toshihiro Kihara
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Masayuki Tojo
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Kenichi Konda
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Teppei Tagawa
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Fumito Yanagisawa
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
| | - Mari Kogo
- Department of Hospital Pharmaceutics, Showa University School of
Pharmacy, Tokyo, Japan
| | - Reiko Makino
- Clinical Collaborating Laboratory, Showa University School of Medicine,
Tokyo, Japan
| | - Masafumi Takimoto
- Department of Pathology, Showa University School of Medicine, Tokyo,
Japan
| | - Hitoshi Yoshida
- Division of Gastroenterology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
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19
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Usefulness of narrow-band imaging with dual-focus magnification for differential diagnosis of small colorectal polyps. Surg Endosc 2014; 29:844-50. [PMID: 25106719 DOI: 10.1007/s00464-014-3736-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/08/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many authors have already reported the usefulness of narrow-band imaging (NBI) for the differential diagnosis of non-neoplastic and neoplastic colorectal lesions. However, it is not clear whether magnification is required for differential diagnosis. The aim of this prospective study was to clarify the clinical usefulness of a newly developed NBI system with a dual focus function (dual-focus NBI) compared with conventional white-light imaging (WLI) and NBI without magnification for distinguishing between non-neoplastic and neoplastic lesions. PATIENTS AND METHODS Thirty-seven consecutive patients who underwent screening colonoscopy with the novel system between July and December 2013 were analyzed. Patients with polyps >10 mm and those with polyps previously evaluated by histologic examination or colonoscopy were excluded. Lesions were diagnosed in real time with WLI, NBI without magnification, and dual-focus NBI, and then excised endoscopically. Each diagnosis was compared to that in the final histopathology reports. The primary endpoint was the diagnostic accuracy and the confidence level assigned to each modality by the endoscopists. The secondary endpoint was the differentiation ability according to the size of the lesion (≤5 and 6-10 mm). RESULTS In all, 100 lesions including 76 adenomatous polyps and 24 hyperplastic polyps were analyzed in 37 patients. The overall diagnostic accuracy, sensitivity, and specificity for differentiating adenomatous from hyperplastic polyps were 87.0, 89.5, and 79.2 % for WLI, 93.0, 94.7, and 87.5 % for NBI without magnification, and 94.0, 96.1, and 87.5 % for dual-focus NBI, respectively. The level of confidence was significantly different between dual-focus NBI and WLI and NBI without magnification for diminutive (≤5 mm) lesions (p < 0.001 and p < 0.01). CONCLUSION Dual-focus NBI is especially useful for differential diagnosis of diminutive colorectal lesions.
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20
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Konda K, Konishi K, Yamochi T, Ito YM, Nozawa H, Tojo M, Shinmura K, Kogo M, Katagiri A, Kubota Y, Muramoto T, Yano Y, Kobayashi Y, Kihara T, Tagawa T, Makino R, Takimoto M, Imawari M, Yoshida H. Distinct molecular features of different macroscopic subtypes of colorectal neoplasms. PLoS One 2014; 9:e103822. [PMID: 25093594 PMCID: PMC4122357 DOI: 10.1371/journal.pone.0103822] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/01/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Colorectal adenoma develops into cancer with the accumulation of genetic and epigenetic changes. We studied the underlying molecular and clinicopathological features to better understand the heterogeneity of colorectal neoplasms (CRNs). METHODS We evaluated both genetic (mutations of KRAS, BRAF, TP53, and PIK3CA, and microsatellite instability [MSI]) and epigenetic (methylation status of nine genes or sequences, including the CpG island methylator phenotype [CIMP] markers) alterations in 158 CRNs including 56 polypoid neoplasms (PNs), 25 granular type laterally spreading tumors (LST-Gs), 48 non-granular type LSTs (LST-NGs), 19 depressed neoplasms (DNs) and 10 small flat-elevated neoplasms (S-FNs) on the basis of macroscopic appearance. RESULTS S-FNs showed few molecular changes except SFRP1 methylation. Significant differences in the frequency of KRAS mutations were observed among subtypes (68% for LST-Gs, 36% for PNs, 16% for DNs and 6% for LST-NGs) (P<0.001). By contrast, the frequency of TP53 mutation was higher in DNs than PNs or LST-Gs (32% vs. 5% or 0%, respectively) (P<0.007). We also observed significant differences in the frequency of CIMP between LST-Gs and LST-NGs or PNs (32% vs. 6% or 5%, respectively) (P<0.005). Moreover, the methylation level of LINE-1 was significantly lower in DNs or LST-Gs than in PNs (58.3% or 60.5% vs. 63.2%, P<0.05). PIK3CA mutations were detected only in LSTs. Finally, multivariate analyses showed that macroscopic morphologies were significantly associated with an increased risk of molecular changes (PN or LST-G for KRAS mutation, odds ratio [OR] 9.11; LST-NG or DN for TP53 mutation, OR 5.30; LST-G for PIK3CA mutation, OR 26.53; LST-G or DN for LINE-1 hypomethylation, OR 3.41). CONCLUSION We demonstrated that CRNs could be classified into five macroscopic subtypes according to clinicopathological and molecular differences, suggesting that different mechanisms are involved in the pathogenesis of colorectal tumorigenesis.
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Affiliation(s)
- Kenichi Konda
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kazuo Konishi
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Toshiko Yamochi
- Department of Pathology, Showa University School of Medicine, Tokyo, Japan
| | - Yoichi M. Ito
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisako Nozawa
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Masayuki Tojo
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kensuke Shinmura
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Mari Kogo
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, Tokyo, Japan
| | - Atsushi Katagiri
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yutaro Kubota
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takashi Muramoto
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuichiro Yano
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshiya Kobayashi
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiro Kihara
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Teppei Tagawa
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Reiko Makino
- Clinical Collaborating laboratory, Showa University School of Medicine, Tokyo, Japan
| | - Masafumi Takimoto
- Department of Pathology, Showa University School of Medicine, Tokyo, Japan
| | - Michio Imawari
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hitoshi Yoshida
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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21
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Sakamoto T, Matsuda T, Nakajima T, Saito Y, Fujii T. Impact of clinical experience on type V pit pattern analysis using magnifying chromoendoscopy in early colorectal cancer: a cross-sectional interpretation test. BMC Gastroenterol 2014; 14:100. [PMID: 24885943 PMCID: PMC4046150 DOI: 10.1186/1471-230x-14-100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 05/19/2014] [Indexed: 12/16/2022] Open
Abstract
Background Although type V pit pattern analysis is effective in determining the invasion depth of early colorectal cancers, the clinical results may vary because findings are operator-dependent. This study aimed to assess the benefits of type V pit pattern analysis in estimating the invasion depth using magnifying chromoendoscopy compared to that with conventional colonoscopy. Methods A cross-sectional interpretation test involving 32 endoscopists with varying levels of experience performing colonoscopies was conducted. Fifty histopathologically diagnosed cases of intramucosal or submucosal cancer were selected retrospectively. The lesions were classified as superficial or deep by the endoscopists, based on magnifying chromoendoscopic and non-magnifying endoscopic images. The endoscopists were classified into 3 groups based on the number of colonoscopies performed: I (<500), II (501–5000), and III (>5000). Differences in the interpretation of invasion depth between group III and groups I and II were assessed using the Mann–Whitney U test. Results There was no significant difference in the median number of correct interpretations using non-magnifying endoscopic images among the groups. However, a significant difference (P = 0.007) was observed between the results of groups III and I when the analysis was performed using magnifying chromoendoscopic images. Conclusions When performed by less experienced endoscopists, pit pattern analysis of colonic lesions using magnifying chromoendoscopy is not a reliable modality for estimating invasion depth in early colorectal cancer.
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Affiliation(s)
- Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan.
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22
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Matsuda T, Kawano H, Hisabe T, Ikematsu H, Kobayashi N, Mizuno K, Oka S, Takeuchi Y, Tamai N, Uraoka T, Hewett D, Chiu HM. Current status and future perspectives of endoscopic diagnosis and treatment of diminutive colorectal polyps. Dig Endosc 2014; 26 Suppl 2:104-8. [PMID: 24750158 DOI: 10.1111/den.12281] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/10/2014] [Indexed: 02/07/2023]
Abstract
During colonoscopy, small and diminutive colorectal polyps are commonly encountered. It is estimated that at least one adenomatous polyp is detected in almost half of all patients undergoing screening colonoscopy. In contrast, the 'predict, resect, and discard' strategy for diminutive and small colorectal polyps is a current topic especially in Western countries. 'Is this an acceptable policy in Japan?' Herein, we report the results of a questionnaire survey with regard to the management of diminutive colorectal polyps, including the thoughts of Japanese endoscopists regarding the 'predict, resect, and discard' strategy. At the moment, we propose that this strategy should be used by skilled endoscopists only.
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Affiliation(s)
- Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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23
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Longcroft-Wheaton G, Bhandari P. A review of image-enhanced endoscopy in the evaluation of colonic polyps. Expert Rev Gastroenterol Hepatol 2014; 8:267-81. [PMID: 24491220 DOI: 10.1586/17474124.2014.881714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The practice of colonoscopy has changed considerably over the last decade. The growth of image-enhanced endoscopy have altered our concepts of how we perform colonoscopy. This article examines the evidence base behind these techniques and looks at where future research needs to be directed.
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24
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Abstract
Chromocolonoscopy is the process of endoscopically examining the colon mucosa after it has been stained with dye. The goal is to allow the endoscopist to identify subtle features in the mucosa, such as morphologically flat polyps or crypt patterns. Studies examining the efficacy of chromocolonoscopy to identify adenomas missed by conventional colonoscopy have shown that although chromocolonoscopy increases polyp yield, most additional lesions are small in size. Staining can also help in differentiating neoplastic from non-neoplastic polyps. Perhaps the most useful aspect of chromocolonoscopy is increasing the yield for dysplasia in patients undergoing colonoscopy for inflammatory bowel disease surveillance.
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Affiliation(s)
- Deepika Devuni
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
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25
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Dai J, Shen YF, Sano Y, Li XB, Xue HB, Zhao YJ, Gao YJ, Song Y, Ge ZZ. Evaluation of narrow-band imaging in the diagnosis of colorectal lesions: is a learning curve involved? Dig Endosc 2013; 25:180-8. [PMID: 23368810 DOI: 10.1111/j.1443-1661.2012.01367.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 07/12/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The usefulness of endoscopy narrow-band imaging (NBI) in differentiating colorectal lesions has been demonstrated. However, the learning curve associated with this technique is a concern for endoscopists. METHODS Prior to carrying out these colonoscopies, four endoscopists attended a training course designed to teach the principles of NBI and application of the Sano Capillary Pattern (CP) classification criteria. Following a pre-test, endoscopists used NBI with magnification and CP analysis for real-time colonoscopy exams to predict lesion histology. Three sets of 15 lesions were imaged. These three sets included both lesions requiring endoscopic treatment (e.g. target lesions) and lesions that were not, or could not be, treated by endoscopy (e.g. non-target lesions). The diagnostic accuracy of each endoscopist for each set of lesions was evaluated to assess the learning curve associated with the application of NBI. RESULTS Overall accuracy, sensitivity, and specificity for differentiating neoplastic and non-neoplastic lesions were 95.4%, 98.0%, and 92.0%, respectively. For target lesions versus non-target lesions, the diagnostic accuracy associated with the second set of lesions was better than that achieved with the first set of lesions (78.3% vs 96.7% (P = 0.02) and 70.0% vs 96.7% ( P < 0.01), respectively in each case). In contrast, the difference in diagnostic accuracy between the second and third sets of lesions was not significant. CONCLUSION NBI with magnification is a useful tool for the diagnosis of colorectal lesions. Moreover, following a short training program and with minimal clinic practice, less experienced endoscopists were able to become competent in the method.
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Affiliation(s)
- Jun Dai
- Department of Gastroenterology, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health at Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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Abstract
Early detection of malignancies within the gastrointestinal tract is essential to improve the prognosis and outcome of affected patients. However, conventional white light endoscopy has a miss rate of up to 25% for gastrointestinal pathology, specifically in the context of small and flat lesions within the colon. Chromoendoscopy and other advanced imaging techniques aim at facilitating the visualization and detection of neoplastic lesions and have been applied throughout the gastrointestinal tract. Chromoendoscopy, particularly in combination with magnifying endoscopy has significantly improved means to detect neoplastic lesions in the gastrointestinal mucosa, particularly in ulcerative colitis and Crohn's colitis. In addition, chromoendoscopy is beneficial in the upper gastrointestinal tract, especially when evaluating Barrett's oesophagus (BO) for the presence of dysplasia. Furthermore, it also improves characterization, differentiation and diagnosis of endoscopically detected suspicious lesions, and helps to delineate the extent of neoplastic lesions that may be amenable to endoscopic resection. This review discusses the dyes, indications and advanced endoscopic imaging methods used in various chromoendoscopic techniques, and presents a critical overview of the existing evidence supporting their use in current practice with a particular emphasis on the role in inflammatory bowel disease and BO.
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Affiliation(s)
- P J Trivedi
- Centre for Liver Research and NIHR Institute of Biomedical Research, 5th Floor IBR Building, University of Birmingham, Birmingham B15 2TT, UK
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Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection. Int J Colorectal Dis 2013; 28:63-72. [PMID: 22842665 DOI: 10.1007/s00384-012-1543-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to investigate the clinicopathological features of specific subtypes of laterally spreading tumor (LST) and assessed the outcome of endoscopic submucosal dissection (ESD) based upon subdifferentiation status. METHODS A total of 137 LSTs were present in 135 patients; 96 were granular and 41 exhibited a nongranular pattern. Granular LSTs, subdivided into homogeneous and nodular mixed, and nongranular LSTs, subdivided into flat-elevated and pseudodepressed, were retrospectively evaluated with respect to clinicopathological features and results of ESD (en bloc R0 curative resection, procedure time, complication, and recurrence rate) according to specific subtype. RESULTS The distribution of high-grade intraepithelial neoplasia and submucosal carcinomas was more prominent among granular nodular mixed tumors than among granular homogeneous tumors (P = 0.007), whereas there was no significant difference between nongranular pseudodepressed tumors and flat-elevated tumors. The frequency of en bloc R0 curative resection did not differ significantly among specific subtypes. For nodular mixed and pseudodepressed lesions, the median tumor size was significantly larger (P < 0.001 for each) and mean procedure time was also longer (P < 0.05 for each) than for the other two subtypes. All complications, which included three perforations, five episodes of postoperative bleeding, and one recurrence, occurred in granular nodular mixed and nongranular pseudodepressed tumors. CONCLUSION The risk of cancer varies with the subtypes of LSTs. ESD is an effective treatment for LSTs, however ESD is more technically demanding and carries more complications in pseudodepressed and granular mixed subtypes.
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Santos JOM, Miyajima N, Carvalho R, Leal RF, Ayrizomo MDLS, Coy CSR. Feasibility of endoscopic submucosal dissection for gastric and colorectal lesions: Initial experience from the Gastrocentro--UNICAMP. Clinics (Sao Paulo) 2013; 68:141-6. [PMID: 23525307 PMCID: PMC3584284 DOI: 10.6061/clinics/2013(02)oa04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 07/17/2012] [Accepted: 10/10/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Endoscopic submucosal dissection is a technique developed in Japan for en bloc resection with a lower rate of recurrence. It is considered technically difficult and performed only in specialized centers. This study sought to report the initial experience from the Gastrocentro--Campinas State University for the treatment of gastric and colorectal lesions by endoscopic submucosal dissection. MATERIALS AND METHODS The guidelines of the Japanese Association of Gastric Cancer were used as evaluative criteria. For colorectal lesions, the recommended standards proposed by Uraoka et al. and Saito et al. were employed. The practicability of the method, the development of complications and histological analysis of the specimens were evaluated. RESULTS Sixteen patients underwent endoscopic submucosal dissection from June 2010 to April 2011; nine patients were treated for gastric lesions, and seven were treated for colorectal lesions. The average diameter of the gastric lesions was 28.6 mm, and the duration of resection was 103 min without complications. All lesions presented lesion-free margins. Of the seven colorectal tumors, four were located in the rectum and three were located in the colon. The average size was 26 mm, and the average procedure time was 163 min. Two complications occurred during the rectal resection procedures: perforation, which was treated with an endoscopic clip, and controlled bleeding. One of the lesions presented a compromised lateral margin without relapse after 90 days. Depth margins were all free of lesions. CONCLUSION Endoscopic submucosal dissection at our institution achieved high success rates, with few complications in preliminary procedures. The procedure also made appropriate lesion staging possible.
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Yoshida N, Yagi N, Yanagisawa A, Naito Y. Image-enhanced endoscopy for diagnosis of colorectal tumors in view of endoscopic treatment. World J Gastrointest Endosc 2012; 4:545-55. [PMID: 23293724 PMCID: PMC3536851 DOI: 10.4253/wjge.v4.i12.545] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 10/29/2012] [Accepted: 11/25/2012] [Indexed: 02/05/2023] Open
Abstract
Recently, image-enhanced endoscopy (IEE) has been used to diagnose gastrointestinal tumors. This method is a change from conventional white-light (WL) endoscopy without dyeing solution, requiring only the push of a button. In IEE, there are many advantages in diagnosis of neoplastic tumors, evaluation of invasion depth for cancerous lesions, and detection of neoplastic lesions. In narrow band imaging (NBI) systems (Olympus Medical Co., Tokyo, Japan), optical filters that allow narrow-band light to pass at wavelengths of 415 and 540 nm are used. Mucosal surface blood vessels are seen most clearly at 415 nm, which is the wavelength that corresponds to the hemoglobin absorption band, while vessels in the deep layer of the mucosa can be detected at 540 nm. Thus, NBI also can detect pit-like structures named surface pattern. The flexible spectral imaging color enhancement (FICE) system (Fujifilm Medical Co., Tokyo, Japan) is also an IEE but different to NBI. FICE depends on the use of spectral-estimation technology to reconstruct images at different wavelengths based on WL images. FICE can enhance vascular and surface patterns. The autofluorescence imaging (AFI) video endoscope system (Olympus Medical Co., Tokyo, Japan) is a new illumination method that uses the difference in intensity of autofluorescence between the normal area and neoplastic lesions. AFI light comprises a blue light for emitting and a green light for hemoglobin absorption. The aim of this review is to highlight the efficacy of IEE for diagnosis of colorectal tumors for endoscopic treatment.
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Affiliation(s)
- Naohisa Yoshida
- Naohisa Yoshida, Nobuaki Yagi, Yuji Naito, Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto 602-8566, Japan
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Digital chromoendoscopy for diagnosis of diminutive colorectal lesions. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2012; 2012:279521. [PMID: 23082070 PMCID: PMC3469075 DOI: 10.1155/2012/279521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 08/21/2012] [Indexed: 12/17/2022]
Abstract
Introduction. To compare the accuracy of digital and real-time chromoendoscopy for the differential diagnosis of diminutive (<5 mm) neoplastic and nonneoplastic colorectal lesions. Materials and Methods. This is a prospective randomized study comparing the Fujinon intelligent color enhancement (FICE) system (65 patients/95 lesions) and indigo carmine (69 patients/120 lesions) in the analysis of capillary meshwork and pit pattern, respectively. All lesions were less than 5 mm in diameter, and magnification was used in both groups. Histopathology was the gold standard examination. Results. Of 215 colorectal lesions, 153 (71.2%) were adenomas, and 62 were hyperplastic polyps (28.8%). Morphological analysis revealed 132 (61.4%) superficial lesions, with 7 (3.3%) depressed lesions, and 83 (38.6%) protruding lesions. Vascular meshwork analysis using FICE and magnification resulted in 91.7% sensitivity, 95.7% specificity, and 92.6% accuracy in differentiating neoplastic from nonneoplastic lesions. Pit pattern analysis with indigo carmine and magnification showed 96.5% sensitivity, 88.2% specificity, and 94.2% accuracy for the same purpose. Conclusion. Both magnifying virtual chromoendoscopy and indigo carmine chromoendoscopy showed high accuracy in the histopathological diagnosis of colorectal lesions less than 5 mm in diameter.
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Han ML, Lee YC, Chen CC, Fang YJ, Lee JY, Lin TL, Lin LW, Tseng PH, Wu MS, Wang HP. Computer-generated surface and tone enhancements to distinguish neoplastic from non-neoplastic colon polyps less than 1 cm in diameter. Int J Colorectal Dis 2012; 27:337-44. [PMID: 22006490 DOI: 10.1007/s00384-011-1319-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIMS Computer-generated enhancements, which can highlight the surface and color of a colonic lesion, may be helpful to predict the histology; however, it remains unclear whether this technology can distinguish neoplastic from non-neoplastic colon polyps when the polyps are <1 cm without magnification. PATIENTS AND METHODS Images of colorectal polyps less than 1 cm in diameter were obtained from 54 patients who underwent non-magnified colonoscopy with surface enhancement (SE) and tone enhancement (TE). We calculated the sensitivity, specificity, and accuracy in the prediction of histology. Inter- and intra-observer consistency was evaluated by inviting four endoscopists to rate 45 static images. RESULTS Overall sensitivity, specificity, and accuracy following the sequence of SE, TE colon, and TE pit pattern modes were 87.7% (95% confidence interval 81.3-94.1%), 84.1% (76.9-91.3%), and 86.1% (79.4-92.8%), respectively. For each modality, the results were 75.0% (68.7-81.3%), 82.7% (77.2-88.2%), and 77.2% (71.1-83.3%) for SE; 71.1% (64.5-77.7%), 78.8 (72.8-84.8), and 73.3% (66.8-79.8%) for TE colon mode; and 75.0% (68.7-81.3%), 80.8% (75.0-86.8%), and 76.7% (70.5-82.9%) for TE pit pattern mode. Their inter- and intra-observer agreements were all fair (κ range 0.522-0.568) and good (0.605-0.694), respectively. When the same rater evaluated the same lesion under different modalities, eight of 45 (18%) polyps yielded discordant interpretations, and the possibility of incorrect diagnoses was the highest with the TE colon mode. CONCLUSION Computer-generated enhancements are satisfactory in predicting the histology of small colon polyps without the need for magnification. This advantage is mostly related to the pit pattern enhancement.
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Affiliation(s)
- Ming-Lun Han
- Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
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Sakamoto T, Matsuda T, Aoki T, Nakajima T, Saito Y. Time saving with narrow-band imaging for distinguishing between neoplastic and non-neoplastic small colorectal lesions. J Gastroenterol Hepatol 2012; 27:351-5. [PMID: 21777283 DOI: 10.1111/j.1440-1746.2011.06854.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS For colonoscopic examinations, the narrow-band imaging (NBI) system is more convenient and timesaving than magnifying chromoendoscopy (MCE). However, the time-saving aspects of NBI techniques have not been assessed. The present study compared interpretation times between NBI and MCE techniques in distinguishing between neoplastic and non-neoplastic small colorectal lesions. METHODS Between January and March 2010, 693 consecutive patients who underwent colonoscopy at the National Cancer Center Hospital, Tokyo, Japan, were enrolled. When the first lesion was detected by conventional white-light observation, the patient was randomly assigned to undergo a sequence of NBI and MCE observations (group A: NBI-MCE, group B: MCE-NBI). The time to diagnosis with each modality (NBI, from changing to NBI until diagnosis; MCE, from the start of indigo carmine solution spraying until diagnosis) was recorded by an independent observer. The sensitivity, specificity, and diagnostic accuracy of the first modality used in each group (NBI or MCE) were assessed by referring to the histopathological data. RESULTS Seventy-one patients with 137 lesions were randomized to group A, and 80 patients with 163 lesions to group B. The median interpretation times were 12 s (interquartile range [IQR]: 7-19 s) in group A, and 17 s (IQR: 12-24 s) in group B, the difference being significant (P < 0.001). No significant differences were observed between NBI and MCE in terms of sensitivity, specificity, and diagnostic accuracy. CONCLUSIONS NBI reduces the interpretation times for distinguishing between neoplastic and non-neoplastic small lesions during colonoscopies, without loss of diagnostic accuracy.
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Affiliation(s)
- Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
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Iwatate M, Ikumoto T, Hattori S, Sano W, Sano Y, Fujimori T. NBI and NBI Combined with Magnifying Colonoscopy. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2012; 2012:173269. [PMID: 23304065 PMCID: PMC3523539 DOI: 10.1155/2012/173269] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 09/23/2012] [Indexed: 02/07/2023]
Abstract
Although magnifying chromoendoscopy had been a reliable diagnostic tool, narrow-band imaging (NBI) has been developed in Japan since 1999 and has now replaced the major role of chromoendoscopy because of its convenience and simplicity. In this paper, we principally describe the efficacy of magnifying chromoendoscopy and magnifying colonoscopy with NBI for detection, histological prediction, estimation of the depth of early colorectal cancer, and future prospects. Although some meta-analyses have concluded that NBI is not superior to white light imaging for detection of adenomatous polyps in screening colonoscopy, NBI with magnification colonoscopy is useful for histological prediction, or for estimating the depth of invasion. To standardize these diagnostic strategies, we will focus on the NBI International Colorectal Endoscopic (NICE) classification proposed for use by endoscopists with or without a magnifying endoscope. However, more prospective research is needed to prove that this classification can be applied with satisfactory availability, feasibility, and reliability. In the future, NBI might contribute to the evaluation of real-time histological prediction during colonoscopy, which has substantial benefits for both reducing the risk of polypectomy and saving the cost of histological evaluation by resecting and discarding diminutive adenomatous polyps (resect and discard strategy).
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Affiliation(s)
- Mineo Iwatate
- 1Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Japan
- *Mineo Iwatate:
| | - Taro Ikumoto
- 1Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Japan
| | - Santa Hattori
- 1Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Japan
| | - Wataru Sano
- 1Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Japan
| | - Yasushi Sano
- 1Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Japan
| | - Takahiro Fujimori
- 2Department of Surgical and Molecular Pathology, Dokkyo University School of Medicine, Tochigi, Japan
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Kobayashi Y, Hayashino Y, Jackson JL, Takagaki N, Hinotsu S, Kawakami K. Diagnostic performance of chromoendoscopy and narrow band imaging for colonic neoplasms: a meta-analysis. Colorectal Dis 2012; 14:18-28. [PMID: 20955514 DOI: 10.1111/j.1463-1318.2010.02449.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM We conducted a meta-analysis to compare the diagnostic test performance of chromoendoscopy and narrow band imaging (NBI) for colonic neoplasms. METHOD MEDLINE, EMBASE and the Cochrane Library were searched (1966 to March 2009). Articles were included if: (i) chromoendoscopy or NBI was used, (ii) sensitivity and specificity were reported; (iii) absolute numbers of true-positive, false-positive, true-negative and false-negative results were provided or could be calculated; and (iv) pathology was used as the reference standard. Sensitivity and specificity were pooled using random effects model. Secondary analyses were conducted by limiting the studies in which magnifying endoscopy was used alone as a diagnostic modality, and polyp size and macroscopic appearance of lesions were not considered. RESULTS Of 1342 screened articles, 27 met the inclusion criteria. Pooled sensitivity for chromoendoscopy and NBI was 0.94 (95% CI, 0.92-0.95) and 0.94 (0.91-0.97), and specificity was 0.82 (0.77-0.88) and 0.86 (0.83-0.89), respectively. There were no differences in sensitivity (P = 0.99) or specificity (P = 0.54) between the two methods. In the secondary analysis, pooled sensitivity for choromoendoscopy and NBI was 0.93 (95% CI, 0.90-0.97) and 0.96 (0.93-0.99) and specificity was 0.80 (0.73-0.87) and 0.85 (0.78-0.92). respectively. Overall, the pooled false-negative rate was 0.057 (95% CI, 0.040-0.73) for chromoendoscopy and 0.057 (95% CI, 0.028-0.085) for NBI. CONCLUSION Chromoendoscopy and NBI had similar diagnostic test characteristics in the assessment of colonic neoplasms; however, the false-negative rate for both methods of 5.7% is an unacceptably high rate and currently therefore, neither method is ready for general use.
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Affiliation(s)
- Y Kobayashi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Kobayashi Y, Kudo SE, Miyachi H, Hosoya T, Ikehara N, Ohtsuka K, Kashida H, Hamatani S, Hinotsu S, Kawakami K. Clinical usefulness of pit patterns for detecting colonic lesions requiring surgical treatment. Int J Colorectal Dis 2011; 26:1531-40. [PMID: 21607587 DOI: 10.1007/s00384-011-1246-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND The number of patients suffering from colorectal cancer is increasing. According to Japanese guidelines, lesions with a submucosal invasive depth >1,000 μm should be treated with radical proctocolectomy. We propose and evaluate a new clinical classification for pit patterns that uses endoscopy to assess lesion depth for determination of the appropriate therapeutic approach for early colorectal cancers and adenomas. METHODS Endoscopic images of colorectal adenomas and early cancer cases with type V(I) pit pattern, resected surgically or endoscopically from April 2002 to April 2007 at Showa University Yokohama Northern Hospital, were utilized for analysis. Each image was retrospectively analyzed for (A) pit narrowness, (B) irregular pit margins, and (C) indistinct stromal staining. Sensitivity, specificity, and predictive value were evaluated as major outcomes, using pathological results as the standard. RESULT In total, 186 cases were assessed. With all features considered (A, B, and C), the sensitivity, specificity, and positive and negative predictive values were 47.8%, 86.3%, 66.0%, and 74.2%, respectively. When limited to two features (A and B), these values were 75.3%, 81.2%, 70.2%, and 84.8%, respectively. CONCLUSION Our results suggest that the established criteria can, to a certain degree, distinguish between high and low irregularity in colorectal lesions with V(I) pit pattern indicating submucosal cancer infiltration of more or less than 1,000 μm with the clinical consequence of surgery versus endoscopic mucosal resection/endoscopic mucosal dissection.
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Affiliation(s)
- Yasutoshi Kobayashi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8505, Japan
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Santos CEOD, Malaman D, Pereira-Lima JC. Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas. ARQUIVOS DE GASTROENTEROLOGIA 2011; 48:242-7. [DOI: 10.1590/s0004-28032011000400005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 07/14/2011] [Indexed: 02/07/2023]
Abstract
CONTEXT: Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. OBJECTIVES: To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. METHODS: A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique. Complications and recurrence were analyzed. Patients were followed up for 18 months. RESULTS: There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). CONCLUSIONS: Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.
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DNA methylation profiles of primary colorectal carcinoma and matched liver metastasis. PLoS One 2011; 6:e27889. [PMID: 22132162 PMCID: PMC3221680 DOI: 10.1371/journal.pone.0027889] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 10/26/2011] [Indexed: 12/31/2022] Open
Abstract
Background The contribution of DNA methylation to the metastatic process in colorectal cancers (CRCs) is unclear. Methods We evaluated the methylation status of 13 genes (MINT1, MINT2, MINT31, MLH1, p16, p14, TIMP3, CDH1, CDH13, THBS1, MGMT, HPP1 and ERα) by bisulfite-pyrosequencing in 79 CRCs comprising 36 CRCs without liver metastasis and 43 CRCs with liver metastasis, including 16 paired primary CRCs and liver metastasis. We also performed methylated CpG island amplification microarrays (MCAM) in three paired primary and metastatic cancers. Results Methylation of p14, TIMP3 and HPP1 in primary CRCs progressively decreased from absence to presence of liver metastasis (13.1% vs. 4.3%; 14.8% vs. 3.7%; 43.9% vs. 35.8%, respectively) (P<.05). When paired primary and metastatic tumors were compared, only MGMT methylation was significantly higher in metastatic cancers (27.4% vs. 13.4%, P = .013), and this difference was due to an increase in methylation density rather than frequency in the majority of cases. MCAM showed an average 7.4% increase in DNA methylated genes in the metastatic samples. The numbers of differentially hypermethylated genes in the liver metastases increased with increasing time between resection of the primary and resection of the liver metastasis. Bisulfite-pyrosequencing validation in 12 paired samples showed that most of these increases were not conserved, and could be explained by differences in methylation density rather than frequency. Conclusions Most DNA methylation differences between primary CRCs and matched liver metastasis are due to random variation and an increase in DNA methylation density rather than de-novo inactivation and silencing. Thus, DNA methylation changes occur for the most part before progression to liver metastasis.
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Yano Y, Konishi K, Yamochi T, Katagiri A, Nozawa H, Suzuki H, Toyota M, Kubota Y, Muramoto T, Kobayashi Y, Tojo M, Konda K, Makino R, Kaneko K, Yoshikawa N, Ota H, Imawari M. Clinicopathological and molecular features of colorectal serrated neoplasias with different mucosal crypt patterns. Am J Gastroenterol 2011; 106:1351-8. [PMID: 21427714 DOI: 10.1038/ajg.2011.76] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Endoscopic examination shows that serrated neoplasias (SNs), such as serrated adenomas and sessile serrated adenomas, exhibit different mucosal crypt patterns. However, it remains unclear whether advanced serrated polyps with different mucosal crypt patterns have different clinicopathological or molecular features. METHODS We classified the mucosal crypt patterns of 86 SNs into three types (hyperplastic, adenomatous, and mixed pattern) and evaluated their clinicopathological and molecular features. RESULTS We found significant differences in the proliferative activity status between SNs with mixed/adenomatous patterns and those with the hyperplastic patterns. SNs with the hyperplastic pattern were frequently located in the proximal colon and had a macroscopically superficial appearance, whereas SNs with the adenomatous pattern were often located in the distal colon and had a protruding appearance. Furthermore, a significant difference was observed in the frequency of the CpG island methylator phenotype (CIMP), involving the methylation of two or more CIMP-related genes (MINT1, MINT2, MINT31, p16, and MLH1), between SNs with the hyperplastic pattern and those with the mixed/adenomatous patterns (18/32 (56%) vs. 8/28 (29%) or 7/26 (27%); P=0.0309 or P=0.0249, respectively). Moreover, the prevalence of KRAS mutations was significantly higher in SNs with the adenomatous pattern than in those with the hyperplastic pattern (7/26 (27%) vs. 1/32 (3%); P=0.0173). In comparison with other patterns, the mixed pattern was detected more frequently in mixed serrated polyps (MSPs), which contain separate histological components. Some MSPs exhibited concordant molecular alterations among the different histological components. CONCLUSIONS The clinicopathological and molecular features of SNs correlated strongly with their mucosal crypt patterns, which were observed using chromoendoscopy.
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Affiliation(s)
- Yuichiro Yano
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
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Rocco EG, Iannuzzi F, Dell'Era A, Falleni M, Moneghini L, Di Nuovo F, Braidotti P, Bulfamante G, Romagnoli S. Schwann cell hamartoma: case report. BMC Gastroenterol 2011; 11:68. [PMID: 21663626 PMCID: PMC3123296 DOI: 10.1186/1471-230x-11-68] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 06/10/2011] [Indexed: 12/20/2022] Open
Abstract
Background Colorectal polyps of mesenchymal origin represent a small percentage of gastrointestinal (GI) lesions. Nevertheless, they are encountered with increasing frequency since the widespread adoption of colonoscopy screening. Case presentation We report a case of a small colonic polyp that presented as intramucosal diffuse spindle cell proliferation with a benign cytological appearance, strong and diffuse immunoreactivity for S-100 protein, and pure Schwann cell phenotype. Careful morphological, immunohistochemical and clinical evaluation emphasize the differences from other stromal colonic lesions and distinguish it from schwannoma, a circumscribed benign nerve sheath tumor that rarely arises in the GI tract. Conclusion As recently proposed, this lesion was finally described as mucosal Schwann cell hamartoma.
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Affiliation(s)
- Elena Guerini Rocco
- Department of Medicine, Surgery and Dentistry, Division of Pathology, A,O, San Paolo and Fondazione IRCCS Cà-Granda Ospedale Maggiore Policlinico, University of Milan Medical School, Milan, Italy
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Ikematsu H, Saito Y, Yamano H. Comparative evaluation of endoscopic factors from conventional colonoscopy and narrow-band imaging of colorectal lesions. Dig Endosc 2011; 23 Suppl 1:95-100. [PMID: 21535212 DOI: 10.1111/j.1443-1661.2011.01145.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Narrow-band imaging (NBI) diagnosis of colorectal lesions requires further consideration and standardized classification for attaining consensus among endoscopists. OBJECTIVE Compare vascular findings and diagnosis of colorectal lesions using various endoscopic images to assess effectiveness of NBI with magnification. METHOD Three endoscopic factors (vascular findings; diagnosis from NBI with magnification images; and total diagnosis from all available colonoscopic images including white light endoscopy, chromoendoscopy, NBI with magnification and magnifying chromoendoscopy) for 15 colorectal lesions were evaluated by 12 expert colonoscopists (Group A), 36 endoscopists not expert in colonoscopy (Group B) and 55 individuals not medical doctors, but familiar with gastrointestinal endoscopy or other medical products (Group C). We calculated accuracy percentages for all three endoscopic factors based on responses from each group. Highest percentage for vascular finding, NBI with magnification diagnosis and total diagnosis for each lesion assumed to be opinion of each group. We compared incidence of agreement among three groups and calculated invasion depth diagnostic accuracy rate for each group. RESULTS For vascular findings from NBI with magnification images, incidence of complete agreement among three groups was 46.7%, incidence of disagreement among three groups was 46.7% and incidence of complete disagreement among three groups was 6.7%. For diagnosis from NBI with magnification images and total diagnosis from all available endoscopic images, incidence of complete agreement, disagreement and complete disagreement were 40.0%, 60.0% and 0.0%, respectively, and 60.0%, 40.0% and 0.0%, respectively. Invasion depth diagnostic accuracy from NBI with magnification images and all available endoscopic images were 60.0% and 73.3%, respectively, in Group A; 46.7% and 66.7%, respectively, in Group B; and 46.6% and 60.0%, respectively, in Group C. CONCLUSION Results suggest some level of educational training is required for effective application of NBI with magnification for precise diagnosis of colorectal lesions.
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Affiliation(s)
- Hiroaki Ikematsu
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
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Saito S, Tajiri H, Ohya T, Nikami T, Aihara H, Ikegami M. The benefit of using narrow-band imaging systems for observation of capillary networks before determining of treatments for early colon cancer. Dig Endosc 2011; 23 Suppl 1:120-5. [PMID: 21535217 DOI: 10.1111/j.1443-1661.2011.01122.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This study examined whether magnifying endoscopy with narrow-band Imaging observation could be useful selecting the appropriate treatment for early colon cancer. PATIENTS AND METHODS We analyzed 551 cases of colon tumors excised endoscopically or surgically, comprising 68 with large hyperplastic polyps, 25 traditional serrated adenomas, 141 tubular adenomas, 177 intramucosal cancers and 140 submucosal invasive (SM) cancers. We classified capillary network pattern into four types according to the degree of dilatation, irregularity and distribution of microcapillary features. These results were then compared with the histological findings. RESULTS The comparison of capillary pattern and histological features showed microcapillary networks by magnifying endoscopy with narrow-band imaging observation in intramucosal lesion or SM cancer with remnant neoplastic glands at the superficial layer. CONCLUSIONS The remaining microcapillary network was designed to maintain the architecture of neoplastic glands, even in the presence of subumucosal invasion. Consequently, loss of this network could correlate with depth of tumor invasion and histological reaction. Therefore, even if the tumor, remained of network was diagnosed to invade into SM layer, it should be checked up further examination by using magnifying endoscopy with crystal violet staining.
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Affiliation(s)
- Shoichi Saito
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
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Sakamoto T, Saito Y, Nakajima T, Matsuda T. Comparison of magnifying chromoendoscopy and narrow-band imaging in estimation of early colorectal cancer invasion depth: a pilot study. Dig Endosc 2011; 23:118-23. [PMID: 21429015 DOI: 10.1111/j.1443-1661.2010.01049.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several previous studies have identified narrow-band imaging (NBI) with magnification as being useful in evaluating early colorectal cancer invasion depth, but comparative diagnostic accuracy of invasion depth between pit pattern analysis using magnifying chromoendoscopy and NBI remains unclear. The aim of this retrospective study was to compare NBI and pit pattern analysis using magnifying chromoendoscopy in estimating early colorectal cancer invasion depth and to assess interobserver agreement. PATIENTS AND METHODS We analyzed a total of 72 early colorectal cancers in 72 patients fulfilling the inclusion criteria. Each lesion image was subsequently reviewed by two experienced colonoscopists (A, B) and then classified clinically based on invasive/non-invasive pattern and Sano's capillary pattern classification with a five-point scale of confidence. RESULTS In terms of diagnostic accuracy with confidence for A and B, the areas under the receiver operating characteristics curve were 0.84 and 0.81 for pit pattern analysis and 0.82 and 0.79 for NBI, respectively. Interobserver agreement for the diagnosis of submucosal deep (>1000 µm) invasion was evaluated for both modalities and indicated substantial agreement with pit pattern analysis (κ = 0.63) and moderate agreement with NBI (κ = 0.44). CONCLUSION Estimating invasion depth of early colorectal cancer using NBI appeared to have been comparable to pit pattern analysis, but there was greater interobserver variability using NBI.
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Affiliation(s)
- Taku Sakamoto
- Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
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Optical Enhancements in Diagnosis and Surveillance of Colorectal Neoplasia. CURRENT COLORECTAL CANCER REPORTS 2011. [DOI: 10.1007/s11888-010-0083-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Imaging by Magnifying Endoscopy with NBI Implicates the Remnant Capillary Network As an Indication for Endoscopic Resection in Early Colon Cancer. Int J Surg Oncol 2011; 2011:242608. [PMID: 22312499 PMCID: PMC3263659 DOI: 10.1155/2011/242608] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 12/11/2010] [Indexed: 12/13/2022] Open
Abstract
Introduction. This study examined whether magnifying endoscopy with NBI observation (ME-NBI) could be useful selecting the appropriate treatment for submucosal invasive cancer (SM cancer). Patients and Methods. We analyzed 515 cases of colon tumors excised endoscopically or surgically. We classified capillary network pattern into four types according to the degree of dilatation, irregularity, and distribution of microcapillary features. Results. The comparison of capillary pattern and histological features revealed microcapillary networks by using confocal laser-scanning microscopy and ME-NBI in intramucosal lesion or SM cancer with remnant neoplastic glands at the superficial layer. In contrast, the network was absent in SM cancer with desmoplastic reactions, which invaded deeper into the submucosal layer. Conclusions. The remaining microcapillary network is designed to maintain the architecture of neoplastic glands. Consequently, loss of this network could correlate with depth of tumor invasion and desmoplastic reaction. Therefore, we can decide the appropriate treatment by using ME-NBI method.
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Mizuno KI, Kudo SE, Ohtsuka K, Hamatani S, Wada Y, Inoue H, Aoyagi Y. Narrow-banding images and structures of microvessels of colonic lesions. Dig Dis Sci 2011; 56:1811-7. [PMID: 21188522 PMCID: PMC3097341 DOI: 10.1007/s10620-010-1519-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 12/01/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND Magnifying colonoscopy with NBI has been shown to be useful for the differential diagnosis of tumors. However, the relationship between findings on NBI magnification and the microvessel architecture of colorectal lesions remains to be clarified. AIMS The aim of this study was to clarify the correlation between NBI findings and the microvascular architecture of colorectal lesions according to the depth of microvessels from the mucosal surface. METHODS A total of 22 colorectal lesions (11 tubular adenomas and 11 hyperplasia) obtained from 22 patients were studied. These lesions were analyzed microscopically on tissue specimens immunostained with CD34. Three-dimensional images were reconstructed from serial sections of tubular adenomas, hyperplasia, and normal mucosa. RESULTS Three-dimensional reconstructed images of tubular adenoma and normal mucosa to a depth of less than 150 μm from the mucosal surface showed similar structures to images obtained by NBI magnification. Microvessel diameter was significantly larger in tubular adenoma than in normal mucosa (P = 0.002) and hyperplasia (P = 0.034), and microvessel area was significantly larger in tubular adenoma than in normal mucosa (P < 0.001) and hyperplasia (P < 0.001) only in the superficial mucosal layer (to a depth of less than 150 μm). CONCLUSIONS TA was characterized by thicker microvessels and higher volume of microvessels than NM and HP. Compared with white light, NBI can more accurately depict the characteristics of microvessels because it uses light with short wavelengths, thereby contributing to high diagnostic capability.
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Affiliation(s)
- Ken-ichi Mizuno
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuduki-ku, Yokohama-city, 224-8503 Japan
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuduki-ku, Yokohama-city, 224-8503 Japan
| | - Kazuo Ohtsuka
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuduki-ku, Yokohama-city, 224-8503 Japan
| | - Shigeharu Hamatani
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuduki-ku, Yokohama-city, 224-8503 Japan
| | - Yoshiki Wada
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuduki-ku, Yokohama-city, 224-8503 Japan
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuduki-ku, Yokohama-city, 224-8503 Japan
| | - Yutaka Aoyagi
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8122 Japan
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Sauk J, Hoffman A, Anandasabapathy S, Kiesslich R. High-definition and filter-aided colonoscopy. Gastroenterol Clin North Am 2010; 39:859-81. [PMID: 21093760 DOI: 10.1016/j.gtc.2010.08.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
New high-resolution colonoscopes and filter technologies are allowing us to visualize more lesions and better characterize lesions within the gastrointestinal tract. In light of recent findings that flat and serrated lesions are more likely to contain invasive cancer and that even small lesions (5-10 mm) may contain advanced histology, detecting these lesions earlier with improved optical technologies may help decrease the rate of interval cancers after colonoscopy. With the limited accuracy of white-light colonoscopy (59%-84%) in distinguishing non-neoplastic lesions from neoplastic lesions, these new technologies can help us improve our abilities to risk stratify patients and determine more precise surveillance intervals.
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Affiliation(s)
- Jenny Sauk
- The Henry D. Janowitz Division of Gastroenterology, Mount Sinai School of Medicine, 1 Gustave Levy Place, Box 1069, New York, NY 10029, USA
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Computerized virtual chromoendoscopy versus indigo carmine chromoendoscopy combined with magnification for diagnosis of small colorectal lesions: a randomized and prospective study. Eur J Gastroenterol Hepatol 2010; 22:1364-71. [PMID: 20453654 DOI: 10.1097/meg.0b013e32833a5d63] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND STUDY AIMS Magnifying colonoscopy with indigo carmine dye and the analysis of the capillary and the pit patterns by computed virtual chromoendoscopy (Fujinon Intelligent Color Enhancement, FICE) with magnification are effective for the differential diagnosis of neoplastic and non-neoplastic lesions. This study aimed to compare the accuracy of virtual and real chromoendoscopy in differentiating neoplastic and non-neoplastic colorectal lesions. PATIENTS AND METHODS A prospective randomized trial of magnification colonoscopy with targeted FICE (Group I - 72 patients/111 lesions) versus magnification colonoscopy with targeted indigo carmine dye (Group II - 72 patients/137 lesions) was performed in consecutive patients with lesions 1 cm or less. Histopathology of the specimens was regarded as the gold standard. RESULTS In group I, 86 (77.5%) lesions showed an intense vascular pattern (positive capillary meshwork), of which 80 (93%) were histologically confirmed as adenomas. From 25 lesions with negative capillary meshwork, 23 (92%) were non-neoplastic. Sensitivity, specificity, accuracy, positive and negative predictive values of the capillary meshwork for the differential diagnosis of these lesions was 97.8, 79.3, 92.8, 93 and 92%, respectively. The same parameters for pit pattern analysis by FICE were 92.7, 82.3, 90.1, 93.8 and 80%, respectively. Indigo carmine magnified chromoscopy showed sensitivity, specificity, accuracy, positive and negative predictive values of 97, 88.9, 94.9, 96.1 and 91.4%, respectively in the discrimination between neoplastic and non-neoplastic lesions. CONCLUSION Magnified virtual chromoendoscopy is as accurate as indigo carmine magnified chromoendoscopy in distinguishing between neoplastic from non-neoplastic small colorectal lesions.
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Ignjatovic A, Burling D, Ilangovan R, Clark SK, Taylor SA, East JE, Saunders BP. Flat colon polyps: what should radiologists know? Clin Radiol 2010; 65:958-66. [PMID: 21070898 DOI: 10.1016/j.crad.2010.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/11/2010] [Accepted: 05/28/2010] [Indexed: 02/06/2023]
Abstract
With the recent publication of international computed tomography (CT) colonography standards, which aim to improve quality of examinations, this review informs radiologists about the significance of flat polyps (adenomas and hyperplastic polyps) in colorectal cancer pathways. We describe flat polyp classification systems and propose how flat polyps should be reported to ensure patient management strategies are based on polyp morphology as well as size. Indeed, consistency when describing flat polyps is of increasing importance given the strengthening links between CT colonography and endoscopy.
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Affiliation(s)
- A Ignjatovic
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, Middlesex, UK
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Higashi R, Uraoka T, Kato J, Kuwaki K, Ishikawa S, Saito Y, Matsuda T, Ikematsu H, Sano Y, Suzuki S, Murakami Y, Yamamoto K. Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program. Gastrointest Endosc 2010; 72:127-35. [PMID: 20493482 DOI: 10.1016/j.gie.2010.01.054] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 01/25/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous reports assessing diagnostic skill using narrow-band imaging (NBI) and pit pattern analysis for colorectal polyps involved only highly experienced endoscopists. OBJECTIVE To evaluate diagnostic skills of less-experienced endoscopists (LEE group) for differentiation of diminutive colorectal polyps by using NBI and pit pattern analysis with and without magnification after an expanded training program. DESIGN Prospective study. PATIENTS This study involved 32 patients with 44 colorectal polyps (27 adenomas and 17 hyperplastic polyps) of < or =5 mm that were identified and analyzed by using conventional colonoscopy as well as non-magnification and magnification NBI and chromoendoscopy followed by endoscopic removal for histopathological analysis. INTERVENTION Before a training course, 220 endoscopic images were distributed in randomized order to residents with no prior endoscopy experience (NEE group) and to the LEE group, who had performed colonoscopies for more than 5 years but had never used NBI. The 220 images were also distributed to highly experienced endoscopists (HEE group) who had routinely used NBI for more than 5 years. The images were distributed to the NEE and LEE groups again after a training class. Magnification NBI and chromoendoscopy images were assessed by using the Sano and Kudo classification systems, respectively. MAIN OUTCOME MEASUREMENTS Diagnostic accuracy and interobserver agreement for each endoscopic modality in each group. RESULTS Diagnostic accuracy was significantly higher, and kappa (kappa) values improved in the LEE group for NBI with high magnification after expanded training. Diagnostic accuracy and kappa values when using high-magnification NBI were highest among endoscopic techniques for the LEE group after such training and the HEE group (accuracy 90% vs 93%; kappa = 0.79 vs 0.85, respectively). LIMITATIONS Study involved only polyps of < or =5 mm. CONCLUSION Using high-magnification NBI increased the differential diagnostic skill of the LEE group after expanded training so that it was equivalent to that of the HEE group.
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Affiliation(s)
- Reiji Higashi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Evaluation of autofluorescence colonoscopy for diagnosis of superficial colorectal neoplastic lesions. Int J Colorectal Dis 2010; 25:811-6. [PMID: 20422198 DOI: 10.1007/s00384-010-0943-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Autofluorescence (AF) imaging, which can potentially differentiate tissue types based on differences in fluorescence emission, may be useful in the diagnosis and treatment of colorectal malignancies. This study was designed to assess the potential usefulness of AF colonoscopy for evaluating superficial colorectal neoplastic lesions. METHODS A total of 49 colorectal lesions in 43 patients were investigated. All superficial colorectal neoplastic lesions were identified with white light (WL) colonoscopy. Each detected lesion was investigated by WL colonoscopy, AF colonoscopy, and chromoendoscopy using 0.2% indigo carmine dye. Three endoscopists, blinded to each patient's history, evaluated the still images (as obtained with these three methods) in random order and evaluated their influence on the assessment of lesion visualization. All the lesions were biopsied or resected endoscopically, with the pathological results used as the gold standard. RESULTS For visualization of the surface appearance and differences in color of the lesions compared with the surrounding mucosa, AF colonoscopy was superior to WL colonoscopy (p < 0.01) and comparable to chromoendoscopy (Mann-Whitney U test). For visualization of the circumferential margin, AF colonoscopy was superior to WL colonoscopy (p < 0.05) but inferior to chromoendoscopy (p < 0.01). CONCLUSIONS AF colonoscopy may be a valuable tool for detection and diagnosis of superficial colorectal neoplastic lesions.
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