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Objective To evaluate safety and efficacy of endoscopy therapy for early colorectal carcinoma of different types. Methods Clinical data of 113 patients with early colorectal carcinoma who were treated with different endoscopic therapies including polypectomy,EMR and ESD(ESD with snare and standard ESD)were retrospectively analyzed. The size, en bloc resection rate, curative resection rate, procedure time,associated complications and recurrence rate were compared among groups. Results Eleven pedunculated lesions were treated with polypectomy or EMR, which were en bloc resected and curative resected with no complication or local recurrence. Nineteen semi-pedunculated lesions were treated with EMR or ESD with no complications. Lesions treated with EMR were smaller than those of ESD(P=0.026), and had a lower en bloc resection rate[77.8%(14/18)VS 1/1,P=1.000]. The difference of curative resection rate and recurrence rate between groups was not significant(P>0.05). Eighty-three sessile lesions were treated with all three procedures.Lesions treated with ESD were larger than EMR(P=0.000),with a higher curative resection rate than EMR[95.5%(42/44)VS 77.8%(28/36),P=0.041]and a longer procedure time than EMR(P=0.000). There were no significant difference in severe complications[9.1%(4/44)VS 0],en bloc resection rates and recurrence rates(P>0.05). Ten lesions treated with ESD-S had a medium size between EMR and standard ESD group, with a significant shorter procedure time than standard ESD group(36.9 ± 24.7 min VS 120.4 ± 152.3 min, P=0.004).They were en bloc resected and complete resected. Conclusion Endoscopic treatment is safe and effective for early stage colorectal carcinoma. In order to get en bloc curative resection,endoscopists should carefully choose a suitable technique based on the macroscopic morphology of lesions. ESD-S can be used as a transitional method from EMR to ESD.
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Objective:To investigate the correlation between the expression of angiogenic factors (MVD, IGF-1, and STAT3) in colorectal carcinoma and adenoma and the microvascular characteristics under narrow band imaging (NBI), in order to evaluate the fea-sibility of NBI in real-time observation of angiogenesis. Methods:Patients with pathologically confirmed colorectal polyps were re-cruited and examined by NBI. Vascular patterns were classified into typeⅠ(invisible or faintly visible), typeⅡ(clearly visible and regularly arranged in a round, oval honeycomb-like pattern), and typeⅢ(clearly visible and irregularly arranged in terms of size and caliber or irregularly winded). Immunohistochemical staining was performed to determine the expression of CD34, IGF-1, and STAT3. Histological results were compared with the vascular patterns under NBI. Results:The NBI endoscopy results of 64 sites (15 adenocar-cinomas, 29 adenomas, and 20 normal tissues) from 58 patients were introduced and examined in this study. Adenomas ranked the first (82.1%, 23/28) among the vascular patternⅡcases, whereas early adenocarcinomas dominated the vascular patternⅢcases (66.7%, 10/15). The expression levels of MVD-CD34 and IGF-1 in normal mucosa, adenomas, and adenocarcinomas were significantly differ-ent (P<0.0001 and P=0.0062, respectively). All the expression levels of MVD-CD34, IGF-1, and STAT3 in sites displaying vascular pat-ternsⅠ,Ⅱ, andⅢwere significantly different (P<0.0001, P=0.0010, and P=0.0055, respectively). Spearman correlation coefficients between the NBI vascular patterns and the MVD-CD34, IGF-1, and STAT3 expression levels were 0.67, 0.41, and 0.40, respectively. Conclusion:Vascular pattern analysis through an NBI system can be a promising tool to evaluate angiogenesis of colorectal lesions in real-time endoscopic observation.
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The majority of colorectal carcinomas (95~100%) are thought to arise from adenomas. Yet colorectal carcinomas may rarely arise de novo. The popular definition of de novo carcinoma is that the lesion should consist exclusively of a carcinoma histologically and contain no adenomatous elements. Without an adenoma-carcinoma sequence, de novo carcinomas have a much higher rate of submucosal invasion, despite their small size. Their speed of growth is thought to be rapid. Some studies have shown that de novo carcinomas might arise as a macroscopically flat or depressed lesion, rather than a protruded one. However, the typical macroscopic findings of de novo carcinomas have not been established. They might be variable macroscopically and include a protruded type. We report a case of de novo colorectal carcinoma that invaded the submucosal layer involving a minute sessile polyp only 3 mm in diameter, which was removed by endoscopic mucosal resection.
Subject(s)
Adenoma , Colorectal Neoplasms , PolypsABSTRACT
BACKGROUND/AIMS: Discrimination between mucosal and submucosal colorectal cancer is important because of different therapeutic plan. Although many characteristic endoscopic findings suggesting submucosal cancer were demonstrated, there are few reports about diagnostic accuracy and interobserver agreement among experienced endoscopists. So we studied about diagnostic accuracy and interobserver agreement about the diagnosis of submucosal invasive colorectal carcinoma by endoscopic findings. METHODS: Fifty patients (58% male, mean age 64 years) diagnosed pathologically as early colorectal carcinoma after polypectomy and operation were randomly selected. Fifteen cases were submucosal invasive colorectal carcinoma. Three experienced endoscopists (A, B and C) blinded to the patient's data reviewed photographs. RESULTS: Diagnostic accuracy of submucosal cancer by A, B and C were 82%, 74% and 78%, respectively. A to B and A to C showed moderate agreement in the diagnosis of submucosal invasion (kappa=0.504 and kappa=0.649). However, agreement power between B and C was somewhat weak (kappa=0.298). Among endoscopic findings, three experts strongly agreed on the features of white spots, hemorrhage and exudate (kappa=0;73, kappa=0.649 and kappa=0.641, respectively). CONCLUSIONS: Interobserver agreement in the diagnosis of submucosal colorectal carcinoma was moderate among three experts. More meticulous effort to improve interobserver agreement and accuracy in the diag- nosis of submucosal invasive colorectal carcinoma is mandatory.
Subject(s)
Humans , Male , Colorectal Neoplasms , Dental Caries , Diagnosis , Discrimination, Psychological , Exudates and Transudates , HemorrhageABSTRACT
Objective The gross appearance and histopathology as well a s the treatment of early colorectal carcinoma were investigated. Methods The clinical documents and histopathology of 105 cases(106 lesions) with early color ectal carcinoma detected by colonoscopy and proved pathologically after operatio n in past 16 years were retrospectively reviewed and analysed. Results 91.5％ of the early colorectal carcinoma were located distal to the sigmoid.The macro scopic type of these lesions under colonoscopy was classified as Ip type in 34 l esions,Ips type in 13,Is type in 26,Ⅱ a type in 11,Ⅱ a＋Ⅱ c type in 22(in whi ch 21 lesions are Sm carcinoma).Lymph node involvement was observed in 3 cases o f the 25 with Sm carcinoma (accounting for 12％ ).13 lesions(in 12 cases)were re moved under the colonoscopy,local recurrence was found in one case of Sm carcino ma during the follow up period and treated with radical operation.93 lesions(in 93 cases)were treated by local resection or radical surgery. Conclusions Most of the carcinomas withⅡ a＋Ⅱ c type were sm carcinoma.Histopathologically mos t of Sm carcinomas were poorly or moderately differentiated adenocarcinomas.Lymp h node involvement only appeared in Sm carcinoma.Radical operation should be per formed in the following conditions (1)the macroscopic type isⅡ a＋Ⅱ c type,(2) the histopathologic type is poorly differentiated adenocarcinoma,(3)involvement of submucosa or lymph node metastasis
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Objective To investigate the features of pit patterns by magnifying endoscopy on neo-plastic colorectal polyps. Methods The materials consisted of 129 polyps in 108 patients. Dye-assisted magnifying endoscopies were used to ascertain the pit patterns of polyps. Results Of 129 polyps, 106 were diagnosed pathologically as neoplastic lesions(adenomas and carcinomas) , in which 10 demonstratedⅡpit pattern with only mild to moderate atypia and no severe atypia; 73 ⅢL pit pattern; 1Ⅲs pit pattern; 7 Ⅳ pit pattern and 15 Ⅴ pit patterns which includes malignant change in 10 cases, and severe atypia in 5 cases. Ten lesions all demonstrated Ⅴ pit pattern were found to be carcinoma (7 mucosal and 2 submucosal and 1 advanced carcinomas). Of 7 mucosal carcinomas,6 showed ⅤA pit pattern,1 , Ⅴ N pit pattern; 2 submuco-sal carcinomas all showed VN pit pattern; 1 advanced carcinoma showed ⅤN pit pattern. Ten lateral sprea-ding tumors were also investigated, their pit patterns under magnifying endoscopy were Ⅲ LⅥor V pit pat-tern among them one case with malignant change. Conclusion The images of pit pattern obtained by magnif-ying endoscopy were essentially concordance to those provided by stereomicroscopy. The differentiation of tu-morous lesion or non-tumorous lesion can be fairly performed under the observation of pit patterns; it gives an important practical significance in diagnosing tumorous lesions.
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objective The consequences of macroscopic classification for early colorectal cancer(CRC),carried out by clinicians from China and Japan,were compared.Methods The endoscopic color photos and related materials of 7 selected patients with early CRC were distributed to each of 5 endoscopists from China and Japan to present everyone's own idea on classification.Results Some lesions assumed as typeⅡ (flat pattern) by Japanese were considered as typeⅠ (elevated pattern)by Chinese.While the lesions having protrusion with central depression were depicted by physicians of both sides according to the ratio of areas with different outlook,namelyⅡ a＋Ⅱ c orⅡ c＋Ⅱ a.Some new terms have been adopted currently by Japanese only,such asⅡ a＋ depression,LST(laterally spreading tumor).Conclusion Regarding the macroscopic classification indices for early CRC discrepancies exist between Sino-Japanese doctors.More comments and cooperation seem necessary to set up an unified criterion.