Randomised controlled trial comparing modified Sano's and narrow band imaging international colorectal endoscopic classifications for colorectal lesions.

AIM: To assess the utility of modified Sano's (MS) vs the narrow band imaging international colorectal endoscopic (NICE) classification in differentiating colorectal polyps. METHODS: Patients undergoing colonoscopy between 2013 and 2015 were enrolled in this trial. Based on the MS or the NICE classifications, patients were randomised for real-time endoscopic diagnosis. This was followed by biopsies, endoscopic or surgical resection. The endoscopic diagnosis was then compared to the final (blinded) histopathology. The primary endpoint was the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of differentiating neoplastic and non-neoplastic polyps (MS II/IIo / IIIa / IIIb vs I or NICE 1 vs 2/3). The secondary endpoints were "endoscopic resectability" (MS II/IIo/IIIa vs I/IIIb or NICE 2 vs 1/3), NPV for diminutive distal adenomas and prediction of post-polypectomy surveillance intervals. RESULTS: A total of 348 patients were evaluated. The Sn, Sp, PPV and NPV in differentiating neoplastic polyps from non-neoplastic polyps were, 98.9%, 85.7%, 98.2% and 90.9% for MS; and 99.1%, 57.7%, 95.4% and 88.2% for NICE, respectively. The area under the receiver operating characteristic curve (AUC) for MS was 0.92 (95%CI: 0.86-0.98); and AUC for NICE was 0.78 (95%CI: 0.69, 0.88). The Sn, Sp, PPV and NPV in predicting "endoscopic resectability" were 98.9%, 86.1%, 97.8% and 92.5% for MS; and 98.6%, 66.7%, 94.7% and 88.9% for NICE, respectively. The AUC for MS was 0.92 (95%CI: 0.87-0.98); and the AUC for NICE was 0.83 (95%CI: 0.75-0.90). The AUC values were statistically different for both comparisons (P = 0.0165 and P = 0.0420, respectively). The accuracy for diagnosis of sessile serrated adenoma/polyp (SSA/P) with high confidence utilizing MS classification was 93.2%. The differentiation of SSA/P from other lesions achieved Sp, Sn, PPV and NPV of 87.2%, 91.5%, 89.6% and 98.6%, respectively. The NPV for predicting adenomas in diminutive rectosigmoid polyps (n = 150) was 96.6% and 95% with MS and NICE respectively. The calculated accuracy of post-polypectomy surveillance for MS group was 98.2% (167 out of 170) and for NICE group was 92.1% (139 out of 151). CONCLUSION: The MS classification outperformed the NICE classification in differentiating neoplastic polyps and predicting endoscopic resectability. Both classifications met ASGE PIVI thresholds.

Pedunculated-type T1 colorectal carcinoma with lung carcinoma metastasis at the deepest invasive portion.

We present a rare case of colorectal T1 carcinoma with metastasis of previous lung carcinoma found at the deepest invasive portion. A 61-year-old man presented with cervical lymphadenopathy 18 years after undergoing surgery for right lung carcinoma [poorly differentiated adenocarcinoma stage IIb (T3N0M0)]. Contrast-enhanced computed tomography showed enlarged lymph nodes (LNs) in the neck and mediastinal regions. Combined hybrid-F-fluorodeoxyglucose positron emission-computerized tomography showed increased radionuclide uptake in multiple cervical LNs and mediastinal LNs. LN biopsy revealed a poorly differentiated adenocarcinoma, suspected to be a metastatic tumor of the lung. Subsequent colonoscopy revealed a pedunculated-type lesion with a depressed area in the ascending colon. We performed polypectomy as total excisional biopsy; this tumor was composed mainly of moderately differentiated adenocarcinoma, partially mixed with mucinous adenocarcinoma. The pathological findings of the invasive front of the colorectal carcinoma showed poorly differentiated adenocarcinoma with a morphological pattern similar to that of the previous lung carcinoma. Furthermore, immunohistochemical results for the histological type of the deepest invasive portion of the tissue specimen were positive for thyroid transcription factor-1 but negative for Caudal-type homeobox 2. From these morphological and immunohistochemical findings, the final diagnosis was moderately differentiated lung carcinoma, pTX N3 M1b (LN, colon) Stage IV.

A Randomized Controlled Clinical Study Comparing the Diagnostic Accuracy of the Histologic Prediction for Colorectal Polyps Depending on the Use of Either Magnified or Nonmagnified Narrow Band Imaging.

BACKGROUND/AIMS: The aim of this study was to compare the diagnostic capabilities of narrow band imaging (NBI) colonoscopy with and without optical magnification in differentiating neoplastic from nonneoplastic colorectal polyps. METHODS: Between April 2012 and March 2013, 122 patients with colorectal polyps detected by using diagnostic conventional colonoscopy were prospectively enrolled. A total of 236 polyps were evaluated with NBI, in vivo in real time during therapeutic colonoscopy, by one experienced endoscopist. Whether magnification was used or not was determined by randomization. After an in vivo real-time endoscopic prediction of histology, all lesions were endoscopically excised. Surgical pathologic reports were used as the criterion standards. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of identifying neoplastic polyps were calculated. RESULTS: A total of 236 lesions with an average size of 5.6 mm in 122 patients were assessed (159 neoplastic, 77 nonneoplastic). The Sn, Sp, PPV, and NPV in differentiating neoplastic from nonneoplastic lesions with the magnified NBI were 97.5%, 83.3%, 94.0%, and 92.6%, respectively, whereas those of the nonmagnified NBI group were 97.5%, 85.1%, 91.7%, and 95.2%, respectively. CONCLUSIONS: Nonmagnified NBI colonoscopy distinguishes neoplastic from nonneoplastic colorectal polyps as accurately as does magnified NBI colonoscopy.

Clinical usefulness of endocytoscopy in the remission stage of ulcerative colitis: a pilot study.

BACKGROUND: Histopathology can be used to detect ulcerative colitis (UC) relapse, but diagnosis of the disease activity by histopathology requires multiple biopsies to be taken. Magnifying endocytoscopy provides a method for real-time ultra-magnifying imaging. It was recently reported that the endocytoscopy system score (ECSS) correlates well with the histopathology of UC. Here we evaluated the clinical usefulness of endocytoscopy for accurately monitoring UC during remission. METHODS: We performed endocytoscopy on 26 patients with UC in remission that had been diagnosed by conventional colonoscopy at our institution between January and April 2013. Endocytoscopy was performed at the area of the rectum where UC had been detected with conventional endoscopy. Biopsies were also taken from the same area and histopathology was evaluated by a single pathologist according to the Matts' grading system. The correlation between the relapse rate of UC and both the ECSS and the Matts' histopathological grade was evaluated. RESULTS: The ECSS of the intestinal mucosa in UC showed a correlation with the Matts' histopathological grade (Spearman's |r| = 0.647). The patients were classified into two groups: those with an ECSS of 0-2 (Grade A, 12 cases) and those with an ECSS of 3-6 (Grade B, 10 cases). To date, three Grade B cases have relapsed and no Grade A cases have relapsed. The average post-endocytoscopy surveillance period was 446 ± 92 days. CONCLUSIONS: The ECSS may be a predictive indicator for UC relapse since there was a correlation between the ECSS and the degree of inflammation as determined by histopathology.

A Randomized Controlled Clinical Study Comparing the Diagnostic Accuracy of the Histologic Prediction for Colorectal Polyps Depending on the Use of Either Magnified or Nonmagnified Narrow Band Imaging

BACKGROUND/AIMS: The aim of this study was to compare the diagnostic capabilities of narrow band imaging (NBI) colonoscopy with and without optical magnification in differentiating neoplastic from nonneoplastic colorectal polyps. METHODS: Between April 2012 and March 2013, 122 patients with colorectal polyps detected by using diagnostic conventional colonoscopy were prospectively enrolled. A total of 236 polyps were evaluated with NBI, in vivo in real time during therapeutic colonoscopy, by one experienced endoscopist. Whether magnification was used or not was determined by randomization. After an in vivo real-time endoscopic prediction of histology, all lesions were endoscopically excised. Surgical pathologic reports were used as the criterion standards. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of identifying neoplastic polyps were calculated. RESULTS: A total of 236 lesions with an average size of 5.6 mm in 122 patients were assessed (159 neoplastic, 77 nonneoplastic). The Sn, Sp, PPV, and NPV in differentiating neoplastic from nonneoplastic lesions with the magnified NBI were 97.5%, 83.3%, 94.0%, and 92.6%, respectively, whereas those of the nonmagnified NBI group were 97.5%, 85.1%, 91.7%, and 95.2%, respectively. CONCLUSIONS: Nonmagnified NBI colonoscopy distinguishes neoplastic from nonneoplastic colorectal polyps as accurately as does magnified NBI colonoscopy.

Magnifying chromoendoscopy and endoscopic ultrasonography measure invasion depth of early stage colorectal cancer with equal accuracy on the basis of a prospective trial.

BACKGROUND & AIMS: Magnifying chromoendoscopy (MC) and endoscopic ultrasonography (EUS) are used to estimate the depth of colorectal cancer (CRC) invasion, but it is not clear which procedure is more accurate. We performed a prospective study to compare MC and EUS. METHODS: A total of 70 patients with an early stage flat CRC lesion were enrolled at 6 institutions in Japan and randomly assigned to groups assessed by MC followed by EUS or EUS followed by MC. Results from MC and EUS measurements of 66 lesions were included in the final analysis. The invasion depth of each lesion was measured by each procedure and categorized as mucosal to slight submucosal (depth <1000 µm) or deep submucosal (depth ≥ 1000 µm); measurements were compared with the final diagnosis on the basis of the pathology analysis. All participating examiners achieved a mean κ value ≥ 0.6 for both MC and EUS before this trial. RESULTS: MC and EUS each measured the depth of lesion invasion with 71.2% accuracy (correctly for 47 of 66 lesions). MC identified lesions with deep submucosal invasion with 74.2% sensitivity and 68.6% specificity, whereas EUS identified them with 67.7% sensitivity and 74.3% specificity. The differences between MC and EUS measurements did not differ significantly. However, MC required significantly shorter observation time than EUS (361.7 ± 164.5 seconds vs 451.2 ± 209.4 seconds, P = .002). CONCLUSIONS: MC and EUS are equally accurate in estimating the invasion depth of early stage CRC lesions. However, neither procedure has sufficient diagnostic accuracy to be used as the standard. University Hospital Medical Network Clinical Trials Registry, Number: UMIN 000005085.

Endoscopic assessment of colorectal cancer with superficial or deep submucosal invasion using magnifying colonoscopy.

Among early colorectal carcinoma, endoscopic treatment is generally indicative for cases with intramucosal to submucosal (SM) superficial invasion, because cases with SM deep invasion should be treated surgically due to the risk of lymph node metastasis. It is important, therefore, to distinguish between superficial and deep SM invasion in early colorectal carcinoma prior to treatment. In this review we assessed the clinical usefulness and knack of pit pattern and narrow band imaging (NBI) diagnosis using magnifying observation. VN type pit pattern, type C3 in NBI Hiroshima classification and NBI type 3 in NBI international colorectal endoscopic (NICE) classification are useful predictors of SM deep invasion. In NBI magnifying observation evaluation of both the vascular pattern and surface pattern are important. We have to use pit pattern diagnosis and NBI magnifying diagnosis as the situation demands with the knowledge of both advantage and disadvantage in each diagnostic method.

Endoscopic Assessment of Colorectal Cancer with Superficial or Deep Submucosal Invasion Using Magnifying Colonoscopy

Among early colorectal carcinoma, endoscopic treatment is generally indicative for cases with intramucosal to submucosal (SM) superficial invasion, because cases with SM deep invasion should be treated surgically due to the risk of lymph node metastasis. It is important, therefore, to distinguish between superficial and deep SM invasion in early colorectal carcinoma prior to treatment. In this review we assessed the clinical usefulness and knack of pit pattern and narrow band imaging (NBI) diagnosis using magnifying observation. VN type pit pattern, type C3 in NBI Hiroshima classification and NBI type 3 in NBI international colorectal endoscopic (NICE) classification are useful predictors of SM deep invasion. In NBI magnifying observation evaluation of both the vascular pattern and surface pattern are important. We have to use pit pattern diagnosis and NBI magnifying diagnosis as the situation demands with the knowledge of both advantage and disadvantage in each diagnostic method.

Evaluation of magnifying colonoscopy in the diagnosis of serrated polyps.

AIM: To elucidate the colonoscopic features of serrated lesions of the colorectum using magnifying colonoscopy. METHODS: Broad division of serrated lesions of the colorectum into hyperplastic polyps (HPs), traditional serrated adenomas (TSAs), and sessile serrated adenomas/polyps (SSA/Ps) has been proposed on the basis of recent molecular biological studies. However, few reports have examined the colonoscopic features of these divisions, including magnified colonoscopic findings. This study examined 118 lesions excised in our hospital as suspected serrated lesions after magnified observation between January 2008 and September 2011. Patient characteristics (sex, age), conventional colonoscopic findings (location, size, morphology, color, mucin) and magnified colonoscopic findings (pit pattern diagnosis) were interpreted by five colonoscopists with experience in over 1000 colonoscopies, and were compared with histopathological diagnoses. The pit patterns were categorized according to Kudo's classification, but a more detailed investigation was also performed using the subclassification [type II-Open (type II-O), type II-Long (type II-L), or type IV-Serrated (type IV-S)] proposed by Kimura T and Yamano H. RESULTS: Lesions comprised 23 HPs (23/118: 19.5%), 39 TSAs (39/118: 33.1%: with cancer in one case), 50 SSA/Ps (50/118: 42.4%: complicated with cancer in three cases), and six others (6/118: 5.1%). We excluded six others, including three regular adenomas, one hamartoma, one inflammatory polyp, and one juvenile polyp for further analysis. Conventional colonoscopy showed that SSA/Ps were characterized as larger in diameter than TSAs and HPs (SSA/P vs HP, 13.62 ± 8.62 mm vs 7.74 ± 3.24 mm, P < 0.001; SSA/Ps vs TSA, 13.62 ± 8.62 mm vs 9.89 ± 5.73 mm, P < 0.01); common in the right side of the colon [HPs, 30.4% (7/23): TSAs, 20.5% (8/39): SSA/P, 84.0% (42/50), P < 0.001]; flat-elevated lesion [HPs, 30.4% (7/23): TSAs, 5.1% (2/39): SSA/Ps, 90.0% (45/50), P < 0.001]; normal-colored or pale imucosa [HPs, 34.8% (8/23): TSAs, 10.3% (4/39): SSA/Ps, 80% (40/50), P < 0.001]; and with large amounts of mucin [HPs, 21.7% (5/23): TSAs, 17.9% (7/39): SSA/Ps, 72.0% (36/50), P < 0.001]. In magnified colonoscopic findings, 17 lesions showed either type II pit pattern alone or partial type II pit pattern as the basic architecture, with 14 HPs (14/17, 70.0%) and 3 SSA/Ps. Magnified colonoscopy showed the type II-O pit pattern as characteristic of SSA/Ps [sensitivity 83.7% (41/49), specificity 85.7% (54/63)]. Cancer was also present in three lesions, in all of which a type VI pit pattern was also present within the same lesion. There were four HPs and four TSAs each. The type IV-S pit pattern was characteristic of TSAs [sensitivity 96.7% (30/31), specificity 89.9% (72/81)]. Cancer was present in one lesion, in which a type VI pit pattern was also present within the same lesion. In our study, serrated lesions of the colorectum also possessed the features described in previous reports of conventional colonoscopic findings. The pit pattern diagnosis using magnifying colonoscopy, particularly magnified colonoscopic findings using subclassifications of surface architecture, reflected the pathological characteristics of SSA/Ps and TSAs, and will be useful for colonoscopic diagnosis. CONCLUSION: We suggest that this system could be a good diagnostic tool for SSA/Ps using magnifying colonoscopy.

Correlation of narrow band imaging with magnifying colonoscopy and histology in colorectal tumors.

BACKGROUND/AIMS: Narrow band imaging (NBI) is a new technique that uses optical filters for imaging of mucosal morphology. The aim of this study was to correlate findings of NBI with magnifying colonoscopy and histology for prediction of neoplastic colorectal lesion. METHODS: Between September 2005 and December 2007, 107 colon polyps from 68 patients were detected by conventional colonoscopy and subsequently evaluated by NBI with magnifying colonoscopy and analyzed for a pit pattern and a capillary pattern. More analysis was done regarding thickness and irregularity of capillary features. RESULTS: Pit pattern with NBI magnification to discriminate between neoplastic and non-neoplastic lesions had a sensitivity of 88.9% and a specificity of 87.5%; capillary pattern yielded test performance characteristics of 91.9% and 87.5%. In respect of capillary thickness, invisible capillaries were found significantly more often in hyperplastic lesions. All thick capillaries were found in neoplastic polyps, and found significantly more often in carcinomas with submucosal massive invasion (sm-m) (p<0.01). In respect of capillary irregularity, invisible capillaries were found significantly more often in hyperplasic lesions, and severely irregular capillaries were found significantly more often in sm-m lesions (p<0.01). CONCLUSIONS: Observation of capillary thickness and irregularity by NBI magnification is useful for correlating histological grade with carcinoma, especially with depth of submucosal invasion.

Correlation of Narrow Band Imaging with Magnifying Colonoscopy and Histology in Colorectal Tumors

BACKGROUND/AIMS: Narrow band imaging (NBI) is a new technique that uses optical filters for imaging of mucosal morphology. The aim of this study was to correlate findings of NBI with magnifying colonoscopy and histology for prediction of neoplastic colorectal lesion. METHODS: Between September 2005 and December 2007, 107 colon polyps from 68 patients were detected by conventional colonoscopy and subsequently evaluated by NBI with magnifying colonoscopy and analyzed for a pit pattern and a capillary pattern. More analysis was done regarding thickness and irregularity of capillary features. RESULTS: Pit pattern with NBI magnification to discriminate between neoplastic and non-neoplastic lesions had a sensitivity of 88.9% and a specificity of 87.5%; capillary pattern yielded test performance characteristics of 91.9% and 87.5%. In respect of capillary thickness, invisible capillaries were found significantly more often in hyperplastic lesions. All thick capillaries were found in neoplastic polyps, and found significantly more often in carcinomas with submucosal massive invasion (sm-m) (p<0.01). In respect of capillary irregularity, invisible capillaries were found significantly more often in hyperplasic lesions, and severely irregular capillaries were found significantly more often in sm-m lesions (p<0.01). CONCLUSIONS: Observation of capillary thickness and irregularity by NBI magnification is useful for correlating histological grade with carcinoma, especially with depth of submucosal invasion.

Correlation of Narrow Band Imaging with Magnifying Colonoscopy and Histology in Colorectal Tumors

BACKGROUND/AIMS: Narrow band imaging (NBI) is a new technique that uses optical filters for imaging of mucosal morphology. The aim of this study was to correlate findings of NBI with magnifying colonoscopy and histology for prediction of neoplastic colorectal lesion. METHODS: Between September 2005 and December 2007, 107 colon polyps from 68 patients were detected by conventional colonoscopy and subsequently evaluated by NBI with magnifying colonoscopy and analyzed for a pit pattern and a capillary pattern. More analysis was done regarding thickness and irregularity of capillary features. RESULTS: Pit pattern with NBI magnification to discriminate between neoplastic and non-neoplastic lesions had a sensitivity of 88.9% and a specificity of 87.5%; capillary pattern yielded test performance characteristics of 91.9% and 87.5%. In respect of capillary thickness, invisible capillaries were found significantly more often in hyperplastic lesions. All thick capillaries were found in neoplastic polyps, and found significantly more often in carcinomas with submucosal massive invasion (sm-m) (p<0.01). In respect of capillary irregularity, invisible capillaries were found significantly more often in hyperplasic lesions, and severely irregular capillaries were found significantly more often in sm-m lesions (p<0.01). CONCLUSIONS: Observation of capillary thickness and irregularity by NBI magnification is useful for correlating histological grade with carcinoma, especially with depth of submucosal invasion.

Correlation of pit pattern by magnifying colonoscopy with histologic features and COX-2 expression in colonic polyps / 대한내과학회지

BACKGROUND/AIMS: Magnifying colonoscopy (MC) was introduced for prediction of pathologic findings. However, cyclooxgenase-2 (COX-2) expression in colonic polyps according to pit pattern has not been reported before. The aims of this study were to evaluate the usefulness of MC for differentiating polyps and to analyze COX-2 mRNA expression in colon polyps according to pit patterns. METHODS: We studied 36 patients (M:F=26:10; median age 55 years) who received endoscopic polypectomy at Asan Medical Center. The pit patterns were classified into six types (type I, II, IIIL, IIIS, IV, and V). The expression of COX-2 mRNA was determined by reverse transcription-polymerase chain reaction. RESULTS: Among 41 polyps from 36 patients, 38 polyps were diagnosed as benign colon polyps, and 3 polyps were diagnosed as early colon cancer. In assessing the histologic findings according to pit patterns, non-adenomatous polyps were detected in 50% of type I and II patterns, and pre-malignant polyps were detected in 94.5% of type IIIL, IIIS, IV, and V patterns. COX-2 mRNA expression rate increased in parallel with histologic grade (p=0.022). However, this was not correlated with pit pattern. CONCLUSIONS: MC pit patterns provide detailed gross morphologic features. COX-2 mRNA expression rate, while related to histologic progression, is not related directly to pit pattern, but further study is needed.

Application of magnifying colonoscopy in diagnosis and treatment of colorectal neoplastic lesions / 中国康复理论与实践

@#ObjectiveTo evaluate the clinical value of magnifying endoscopy in diagnosis and treatment of colorectal benign neoplastic lesions.Methods78 colorectal lesions in 61 patients were examined with magnifying colonoscopy after indigo carmine dye, and a pit pattern diagnosis was made for every lesion according to Kudo's classification.All the lesions were totally resected, and the specimen were sent for pathologic examinations.ResultsThe diagnostic sensitivity of neoplastic lesions was 98.4% and specificity was 85.7% when types Ⅰ and Ⅱ represented the pit pattern of nonneoplastic lesions, whereas types Ⅲ, Ⅳ, and Ⅴ represented adenoma and early colorectal cancer. The overall accuracy in differentiating adenoma and early colorectal cancer from nonneoplastic lesions was 96.2%.94.5% of adenomarous lesions were treated by colonoscopy.ConclusionThe magnifying colonoscopy can provide an instantenous accurate diagnosis of tumorous lesions in colon and rectum. Synchronize, minimally invasive and curative treatment is possible to be completed by using it for a large number of lesions.

Diagnosis and management of laterally spreading tumor of colon by dyeing and magnifying endoscopy / 中华消化内镜杂志

Objective Laterally spreading tumor (LST) has a close relationship with colorectal cancer, its diagnosis and treatment are differed from those of ordinary protuded tumors. The aim of this study is to attract much attention to this particular tumor. Methods Four thousand two hundred and ten patients were examined with magnifying endoscope and mucosa staining from December, first 2000 to May 31 , 2002. Results In 34 patients with LST, there were 35 lesions, including granular type 15, nodular - mixed type 18, and pseudocaved 2; and there were 4 patients with intramucosa carcinoma and other 2 with serrated adenoma. The biggest lesion is 68 mm ? 85 mm, and the smallest 11 mm? 12 mm. Of the 35 lesions the diameters are 8 within 11 -20 mm, 13, 21 -30 mm and 14 above 31mm. The pit patterns of the 35 lesions are mainly IV pit patterns, about 62. 9% (22/35). The pathological diagnoses of 3 patients with VA pit patterns LST are intramucosa carcinoma, and 8 patients with Ⅲ L pit patterns are tubulovillous adenoma. All of the 35 lesions are resected by EMR or EPMR. Complication occurred in two patients during treatment of EMR such as hemorrhage and local peritonitis. Conclusion Mucosa staining and magnifying endoscopy is very useful in detecting LST. We must pay more attention to those signs, such as reddish and eneven mucosa or unclear or interrupted vascular network. Furthermore it is necessary to stain the mucosa with indigo carmine spray to get the evidences of flat tumor. Pit patterns of LST mostly are IV or ⅢL, and LST with Ⅳ pit patterns are mainly villous adenoma, ⅢL tubular adenoma, while LST with the Ⅴ pit pattern signifies the cancerated metaplasia.

The importance of magnifying endoscopy and stereomicroscopy in the diagnoss of colon tumors / 解放军医学杂志

Objective To investigate the relationship between early colonic cancer and the pit patterns of abnormal colonic mucosa. Methods We examined the pit patterns of 124 polypi in 139 patients by magnifying colonoscopy and stereomicroscopy, and compared the relations between the pit patterns and pathological diagnosis of polypi. Results 5 cases of LST(laterally spreading tumor)and 9 cases of advanced cancer were found out of 124 polypi in 139 patients. 1 among these 5 cases of LST showed Ⅲ L pit pattern, and 4 showed Ⅳ pit pattern with both magnifying colonoscopy and stereomicroscopy. Magnifying colonoscopy showed high coincidence rate with stereomicroscopy. Conclusion Pit patterns are found to be very important in disguishing tumorous lesions from non-tumorous lesions, and to discover early colonic cancer. Ⅴ pit pattern indicates that the polyp is carcinomatous.

Clinical Application and Limit of Magnifying Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Magnifying colonoscopy was developed for detailed examination of the surface of colorectal neoplastic lesions. While magnifying colonoscopy is useful for differentiating neoplastic lesions from nonneoplastic ones, for evaluating early colorectal cancers, it still has limits in practice. This study was designed to clarify the usefulness and the limits of magnifying colonoscopy. METHODS: Three hundred and fifty-two lesions, which were observed using magnifying colonoscopy from July to August 1999 and whose histologies were proven, were analyzed according to their pit patterns. The pit patterns are I, normal round pits; II, large starry-shaped pits; IIIs, small round pits; IIIL, large round or rod-shaped pits; IV, branched or gyrus-like pits; and V, irregularly shaped or nonstructural pits. In cases where a pit pattern was hard to read, the pattern was classified as 'D'. RESULTS: The dominant pit pattern for protruded lesions was IIIL, accounting for 44.6%. In diminutive lesions (< or =5 mm), II and IIIL were equally common, 40% of the total for those lesions, respectively. In medium-sized lesions (from 6 to 10 mm), IIIL was the major pit pattern, 45.6% of the total for that type of lesion. In lesions larger than 10 mm, IIIL and IV were the most common pit patterns, each accounting for 26.7% of the total. The overall accuracy ratio of pit pattern diagnoses was 79.5%. The frequency of difficult pit patterns to read was 6.3%. Among them, 77.3% were due to difficulty in interpreting the pit patterns, and 22.7% were due to an inability to clarify the pit pattern because of poor staining. Ninety-one percent of the difficult cases to read involved diminutive lesions, and 86% of those difficult cases involved tubular adenomas. CONCLUSIONS: The 80% accuracy rate for pit pattern diagnosis suggests that magnifying colonoscopy is probably useful, but problems, such as poor staining due to mucus and difficulty with interpretation, still exist.

The Comparison of Histo-pathologic Findings and Pit Patterns of Colorectal Tumors / 대한소화기내시경학회지

BACKGROUND AND AIMS: To investigate the morphological and histopathological associations between an individual pit seen on stereomicroscopy or magnifying colonoscopy and an individual crypt seen in histological sections of colorectal tumors. METHODS: Fifty two colorectal lesions were examined by colonoscopy. The mucosal pits of the lesions were observed using a magnifying colonoscopy with a zoom 1 to 100 magnification after administering indigo carmine spray. The pits of the excised specimens were observed by using a stereomicroscopy after 0.2% cresyl violet stain. The pit patterns were classified into six types: normal round pit (I); asteroid pit (II); small round pit (IIIs); large tubular pit (IIIL); gyrus-like pit (IV); and non-structural pattern or amorphysm (V). Histologic diagnoses were determined by H&E staining under light microscopy. RESULTS: The histologic findings according to the pit patterns were 1 chronic nonspecific inflammation and 1 submucosal tumor in 2 cases with type I pit pattern; 4 hyperplastic polyps in 4 cases with type II; 1 hyperplastic polyp, 16 adenomas with low-grade dysplasia, 3 adenomas with high-grade dysplasia, and 1 carcinoma in situ in 21 cases with type IIIL; 4 adenomas with low-grade dysplasia, 3 adenomas with high-grade dysplasia, and 4 carcinoma in situ in 11 cases with type IV; 1 adenoma with low-grade dysplasia in 1 case with type II IIIL; 3 adenomas with low-grade dysplasia, 4 adenomas with high-grade dysplasia, and 2 carcinoma in situ in 9 cases with type IIIL IV; 1 adenoma with high-grade dysplasia, 2 carcinoma in situ, and 1 adenocarcinoma in 4 cases with type IV V. In assessing the histologic findings according to pit pattern by stereomicroscopy, the overall diagnostic predictive value was 82.6% (43/52), and the diagnostic accuracy in differential diagnosis between nonneoplastic and neoplastic lesions was 98% (51/52). The ratio of agreement of the pit pattern between the magnifying colonoscopy and the stereomicroscopy was 68% (17/25). CONCLUSIONS: The results suggest that there was a close correlation between the pit patterns and the histologic findings of colorectal tumors, and that the observation of pit patterns of colorectal lesions provides a differential diagnosis between neoplastic and nonneoplastic lesions.

The Usefulness of Pit Patterns of Colorectal Tumors and Magnifying Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: To investigate the usefulness of pit patterns of colorectal tumors and magnifying colonoscopy. METHODS: The surface mucosal pits of seventy five colorectal lesions were observed using a magnifying colonoscopy with a zoom 1 to 100 magnification after indigo carmine or methylene blue spray. The lesions were removed by hot biopsy, palypectomy, or endoscopic mucosal resection. Histologic diagnoses were determined by light microscopy.