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Efficacy of magnifying endoscopy with flexible spectral imaging color enhancement in the diagnosis of colorectal tumors

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Abstract

Background

Magnifying endoscopy with flexible spectral imaging color enhancement (FICE) is an image-enhanced endoscopy that captures the surface and vascular patterns of colorectal tumors. We evaluated and compared FICE magnification to narrow-band imaging (NBI) magnification.

Methods

Flexible spectral imaging color enhancement or NBI magnification was performed to the visualize surface and vascular patterns of colorectal tumors, classified into 4 types: Type A, Type B, Type C1/C2, and Type C3, as previously reported. A total of 235 colorectal tumors were examined. The correlations between classifications found by FICE or NBI magnification and histopathological diagnoses were examined. Image evaluation was validated by assessing inter-observer and intra-observer agreements on examinations.

Results

Twenty-eight hyperplastic polyps (HPs), 115 tubular adenomas (TAs), 72 mucosal and slightly invaded submucosal cancers (M-sSM), and 20 massively invaded submucosal cancers (mSM) were diagnosed. By FICE magnification, HP and TA were observed in 93.3 and 6.7% of Type A (15 lesions), respectively. TA, M-sSM, and HP were observed in 82.6, 15.4, and 2.0% of Type B (52 lesions), respectively. M-sSM, TA, and mSM were observed in 50.0, 46.0, and 4.0% of Type C1/2 (50 lesions), respectively. mSMs were observed in all 7 Type C3 lesions. In diagnosing mSM in Type C3, the sensitivity and specificity of FICE magnification were 77.7 and 100%, respectively, compared to those of NBI, at 63.6 and 99.0%, respectively. Imaging evaluation was validated accurately by intra- and intra-observer measurements showing consistent results.

Conclusions

The classification of colorectal tumors by FICE magnification correlated well with the histopathological diagnoses, similar to findings for NBI magnification. FICE magnification can be evaluated accurately with the same diagnostic classifications as those used for NBI magnification.

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References

  1. Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc. 2010;24:343–52.

    Article  PubMed  Google Scholar 

  2. Kudo S, Tamegai Y, Yamano H, Imai Y, Kogure E, Kashida H. Endoscopic mucosal resection of the colon: the Japanese technique. Gastrointest Endosc Clin N Am. 2001;11:519–35. Review.

    CAS  PubMed  Google Scholar 

  3. Yoshida N, Naito Y, Yagi N, Yoshikawa T. Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications. World J Gastroenterol. 2010;16:1688–95.

    Article  PubMed  Google Scholar 

  4. Yoshida N, Naito Y, Sakai K, Sumida Y, Kanemasa K, Inoue K, et al. Outcome of endoscopic submucosal dissection for colorectal tumors in elderly people. Int J Colorectal Dis. 2010;25:455–60.

    Article  PubMed  Google Scholar 

  5. Yoshida N, Wakabayashi N, Kanemasa K, Sumida Y, Hasegawa D, Inoue K, et al. Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy. 2009;41:758–61.

    Article  CAS  PubMed  Google Scholar 

  6. Toyonaga T, Man-I M, Morita Y, Sanuki T, Yoshida M, Kutsumi H, et al. The new resources of treatment for early stage colorectal tumors: EMR with small incision and simplified endoscopic submucosal dissection. Dig Endosc. 2009;21:S31–7.

    Article  PubMed  Google Scholar 

  7. Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39:534–43.

    Article  PubMed  Google Scholar 

  8. Kudo S, Hirota S, Nakajima T, Hosobe S, Kusaka H, Kobayashi T, et al. Colorectal tumours and pit pattern. J Clin Pathol. 1994;47:880–5.

    Article  CAS  PubMed  Google Scholar 

  9. Tobaru T, Mitsuyama K, Tsuruta O, Kawano H, Sata M. Sub-classification of type VI pit patterns in colorectal tumors: relation to the depth of tumor invasion. Int J Oncol. 2008;33:503–8.

    CAS  PubMed  Google Scholar 

  10. Yoshida N, Wakabayashi N, Hasegawa T, OkudaT Okuda K, Yasuda Y, et al. Analysis of the correlation between the scoring of irregular pits detected with magnifying endoscope in colorectal tumors and the histological diagnosis. Gastroenterol Endosc. 2007;49:1806–14.

    Google Scholar 

  11. Machida H, Sano Y, Hamamoto Y, Muto M, Kozu T, Tajiri H, et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy. 2004;36:1094–8.

    Article  CAS  PubMed  Google Scholar 

  12. Horimatsu T, Sano Y, Kaneko K, Ikematsu H, Katagiri A, Yano T, et al. Relationship between MVD and meshed-capillaries using magnifying NBI colonoscopy in colorectal precursor lesions. Hepatogastroenterology. 2009;56:372–7.

    PubMed  Google Scholar 

  13. Sano Y, Ikematsu H, Fu KI, Emura F, Katagiri A, Horimatsu T, et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc. 2009;69:278–83.

    Article  PubMed  Google Scholar 

  14. Ikematsu H, Matsuda T, Emura F, Saito Y, Uraoka T, Fu KI, et al. Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol. 2010;27:10–33.

    Google Scholar 

  15. Kanao H, Tanaka S, Oka S, Hirata M, Yoshida S, Chayama K. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc. 2009;69:631–6.

    Article  PubMed  Google Scholar 

  16. Santos CE, Lima JC, Lopes CV, Malaman D, David Salomão A, Garcia AC, et al. 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.

    Article  PubMed  Google Scholar 

  17. Parra-Blanco A, Jiménez A, Rembacken B, González N, Nicolás-Pérez D, Gimeno-García AZ, et al. Validation of Fujinon intelligent chromoendoscopy with high definition endoscopes in colonoscopy. World J Gastroenterol. 2009;15:5266–73.

    Article  PubMed  Google Scholar 

  18. Togashi K, Osawa H, Koinuma K, Hayashi Y, Miyata T, Sunada K, et al. A comparison of conventional endoscopy, chromoendoscopy, and the optimal-band imaging system for the differentiation of neoplastic and non-neoplastic colonic polyps. Gastrointest Endosc. 2009;69:734–41.

    Article  PubMed  Google Scholar 

  19. Pohl J, Nguyen-Tat M, Pech O, May A, Rabenstein T, Ell C. Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study. Am J Gastroenterol. 2008;103:562–9.

    Article  PubMed  Google Scholar 

  20. Chung SJ, Kim D, Song JH, Park MJ, Kim YS, Kim JS, et al. Efficacy of computed virtual chromoendoscopy on colorectal cancer screening: a prospective, randomized, back-to-back trial of Fuji intelligent color enhancement versus conventional colonoscopy to compare adenoma miss rates. Gastrointest Endosc. 2010;72:136–42.

    Article  PubMed  Google Scholar 

  21. Pohl J, Lotterer E, Balzer C, Sackmann M, Schmidt KD, Gossner L, et al. Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: a randomised multicentre trial. Gut. 2009;58:73–8.

    Article  CAS  PubMed  Google Scholar 

  22. Hamilton SR, Aaltonen LA, editors. World Health Organization classification of tumors. Pathology and genetics of tumours of the digestive system. Lyon: IARC Press; 2000. p. 104–109.

  23. Participants in the Paris workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(Suppl):S3–S43.

  24. Higashi R, Uraoka T, Kato J, Kuwaki K, Ishikawa S, Saito Y, et al. 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.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Naohisa Yoshida, Yuji Naito, Munehiro Kugai, Ken Inoue, Kazuhiko Uchiyama, Tomohisa Takagi, Takeshi Ishikawa, Osamu Handa, Hideyuki Konishi, Naoki Wakabayashi, Satoshi Kokura, Nobuaki Yagi & Toshikazu Yoshikawa

  2. Department of Gastroenterology, JR Osaka Rail Hospital, Osaka, Japan

    Yasutaka Morimoto

  3. Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Akio Yanagisawa

Authors
  1. Naohisa Yoshida
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  2. Yuji Naito
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  3. Munehiro Kugai
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  13. Yasutaka Morimoto
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  15. Toshikazu Yoshikawa
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Correspondence to Naohisa Yoshida.

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Yoshida, N., Naito, Y., Kugai, M. et al. Efficacy of magnifying endoscopy with flexible spectral imaging color enhancement in the diagnosis of colorectal tumors. J Gastroenterol 46, 65–72 (2011). https://doi.org/10.1007/s00535-010-0339-9

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  • DOI: https://doi.org/10.1007/s00535-010-0339-9

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