Abstract
Background
Colorectal neoplasms with a type VI pit pattern include various lesions, such as adenomas, intramucosal cancers, and submucosal carcinomas.
Methods
We analyzed 96 colorectal neoplasms with a type VI pit pattern and identified six different variants: (1) unclear outline of the pit; (2) irregular margins of the pit; (3) narrowing of the pit; (4) ragged array of the pit; (5) high residual density of the pit; (6) abnormal branching of the pit. We examined the relationship between the appearance of each VI pit pattern and histology, including the depth of invasion.
Results
In univariate logistic regression analysis the unclear outline, irregular margins, and narrowing of the pit were significantly associated with a submucosal (SM) invasion ≥1000 μm (P < 0.01). In multivariate logistic regression analysis, unclear outline of the pit was shown to be the only significant predictor of highly invasive submucosal cancer (odds ratio = 24.20, P < 0.0001). Regarding tumor morphology, the following were significantly associated with an SM invasion ≥1000 μm: in protruded type, ragged array (P = 0.022), irregular margins of the pit (P = 0.011), and unclear outline of the pit (P < 0.01); in flat type, irregular margins of the pit (P < 0.01) and unclear outline of the pit (P < 0.01); and in the depressed type, narrowing of the pit (P = 0.015) and unclear outline of the pit (P < 0.01).
Conclusions
Subclassification of the type VI pit pattern is useful for determining the depth of invasion of colorectal neoplasms.
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References
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.
Hurlstone DP, Fujii T, Lobo AJ. Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy. Br J Surg. 2002;89:272–82.
Tanaka S, Kaltenbach T, Chayama K, Soetikno R. High magnification colonoscopy (with videos). Gastrointest Endosc. 2006;64:604–13.
Yamamoto S, Watanabe M, Hasegawa H, Baba H, Yoshinare K, Shiraishi J, Kitajima M. The risk of lymph node metastasis in T1 colorectal carcinoma. Hepatogastroenterology. 2004;51:998–1000.
Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, Kumamoto T, Ishiguro S, Kato Y, Shimoda T, Iwashita A, Ajioka Y, Watanabe H, Watanabe T, Muto T, Nagasako K. 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.
Oka S, Tanaka S, Kaneko I, Mouri R, Chayama K. Diagnosis of the invasion depth using magnifying videocolonoscopy in early colorectal carcinoma. Early Colorectal Cancer. 2005;9:161–8 (in Japanese with English abstract).
Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology. 2004;127:385–94.
Coverlizza S, Risio M, Ferrari A, Fenoglio-Preiser CM, Rossini FP. Colorectal adenomas containing invasive carcinoma. Pathologic assessment of lymph node metastatic potential. Cancer. 1989;64:1937–47.
Minamoto T, Mai M, Ogino T, Sawaguchi K, Ohta T, Fujimoto T, et al. Early invasive colorectal carcinomas metastatic to lymph node with attention to their nonpolypoid development. Am J Gastroenterol. 1993;88:1035–9.
Tsuruta O, Toyonaga A, Ikeda H, Tanikawa K, Morimatsu M. Clinicopathological study of superficial-type invasive carcinoma of the colorectum: special reference to lymph node metastasis. Int J Oncol. 1997;10:1003–8.
Sakuragi M, Togashi K, Konishi F, Koinuma K, Kawamura Y, Okada M, et al. Predictive factors for lymph node metastasis in T1 stage colorectal carcinomas. Dis Colon Rectum. 2003;46:1626–32.
Tamura S, Yokoyama Y, Ookawauchi K, Onishi T, Onishi S, Miyazaki J. Evaluation of the type V pit pattern in the lesions of colonic Tis and T1 cancer. Dig Endosc. 2003;15:185–9.
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.
Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. 1996;44:8–14.
Togashi K, Konishi F, Ishizuka T, Sato T, Senba S, Kanazawa K. Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel. Dis Colon Rectum. 1999;42:1602–8.
Kato S, Fujii T, Koba I, Sano Y, Fu KI, Parra-Blanco A, et al. Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: can significant lesions be distinguished? Endoscopy. 2001;33:306–10.
Tsuji Y. Usefulness of magnifying endoscopy for diagnosing tumorous lesions of the colorectum. Kurume Med J. 1998;45:87–94.
Tanaka S, Haruma K, Hirota Y, et al. Pit pattern diagnosis using magnifying colonoscope for colorectal tumor with special reference to the comparison with ordinary colonoscopic observation. Early Colorectal Cancer. 1999;3:147–55 (in Japanese with English abstract).
Tanaka S, Haruma K, Nagata S, Oka S, Chayama K. Diagnosis of invasion depth in early colorectal carcinoma by pit pattern analysis with magnifying endoscopy. Dig Endosc. 2001;13S:S2–5.
Tanaka S, Haruma K, Ito M, Nagata S, Oh-e H, Hirota Y, et al. Detailed colonoscopy for detecting early superficial carcinoma: recent developments. J Gastroenterol. 2000;35:121–5.
Tamura S, Yokoyama Y, Tadokoro T, Higashidani Y, Onishi S. Pit pattern and pathological diagnosis in the patients with colorectal tumors. Dig Endosc. 2001;13(Suppl):6–7.
Kudo S, Rubio CA, Teixeira CR, Kashida H, Kogure E. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001;33:367–73.
Kawano H, Tsuruta O, Ikeda H, Toyonaga A, Tanikawa K. Diagnosis of the level of depth in superficial depressed-type colorectal tumors in terms of stereomicroscopic pit patterns. Int J Oncol. 1998;12:769–75.
Onishi T, Tamura S, Kuratani Y, Onishi S, Yasuda N. Evaluation of the depth score of type V pit patterns in crypt orifices of colorectal neoplastic lesions. J Gastroenterol. 2008;43:291–7.
Kanao H, Tanaka S, Oka S, Kaneko I, Yoshida S, Arihiro K, et al. Clinical significance of type VI pit pattern subclassification in determining the depth of invasion of colorectal neoplasms. World J Gastroenterol. 2008;14(2):211–7.
Hamilton SR, Aaltonen LA, editors. World Health Organization classification of tumours: pathology and genetics of tumours of the digestive system. Lyon. France: IARC; 2000. p. 104–19.
Tanaka S, Haruma K, Oh-e H, Nagata S, Hirota Y, Furudoi A, et al. Conditions of curability after endoscopic resection for colorectal carcinoma with submucosally massive invasion. Oncol Rep. 2000;7:783–8.
Hamatani S, Hisayuki T. Histopathological analysis for typeVI pit patterns. Early Colorectal Cancer. 1999;3:147–55 (in Japanese with English abstract).
Tobaru T, Tsuruta O, Kawano H, Sawa Y, Sata M. Clinical efficacy of VI pit pattern subclassification employing magnifying endoscopy in diagnosis of early colorectal cancer invasion depth. Early Colorectal Cancer. 2007;5:403–8 (in Japanese with English abstract).
Tobaru T, Tsuruta O, Kawano H, Yoshimori K, Sata M. The relationship between the subclassification of type VI pit patterns and superficial histological constructions in early colorectal cancer. Early Colorectal Cancer. 2006;3:207–14 (in Japanese with English abstract).
Tobaru T, Tsuruta O, Kawano H, Yoshimori K, Toyonaga A. Efficacy of subclassified type VI pit pattern using magnifying endoscopy in diagnosis of invasion depth of early colorectal cancer. Early Colorectal Cancer. 2005;2:151–9 (in Japanese with English abstract).
Tsuji Y, Tsuruta O, Kawano H, Tobaru T, Tomiyasu N, Nakahara K, et al. Effectiveness of magnifying endoscopy in diagnosing the invasion depth of pedunculated and semi-pedunculated colorectal cancer. Stomach Intestine. 2002;12:1571–81 (in Japanese with English abstract).
Ajioka Y, Tsuruta O, Hayashi T, Fujii T. Case conference. Early Colorectal Cancer. 2007;5:434–51.
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Matsumoto, K., Nagahara, A., Terai, T. et al. Evaluation of new subclassification of type VI pit pattern for determining the depth and type of invasion of colorectal neoplasm. J Gastroenterol 46, 31–38 (2011). https://doi.org/10.1007/s00535-010-0300-y
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DOI: https://doi.org/10.1007/s00535-010-0300-y