Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic accuracy of magnifying chromoendoscopy in the assessment of tumor invasion depth in early colorectal cancer: a systematic review and meta-analysis

  • Review
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study was to evaluate the ability of magnifying chromoendoscopy (MCE) to correctly differentiate early colorectal cancer (CRC) lesions with massively invasive submucosal cancer (SMm) from lesions without submucosal massive invasion (polyp, adenoma, dysplasia, intramucosal cancer, slightly invasive submucosal cancer (SMs)).

Methods

We searched PubMed, Embase, the Cochrane Library from the time of the establishment of each database to 5 April 2023. Stata 15 software was used to perform the meta-analysis for sensitivity, specificity, positive likelihood ratio (LR), and negative LR, diagnostic odds ratio, and 95% CI. A summary receiver-operating characteristic (SROC) curve was constructed, the area under the curve (AUC) was calculated, and the diagnostic value was evaluated. Furthermore, to explore the potential sources of heterogeneity, we used meta-regression to estimate the influencing factors of these studies and their impact on the diagnostic accuracy. MCE was used to evaluate the diagnostic accuracy in differentiating CRC lesions with SMm from lesions without submucosal massive invasion (polyp, adenoma, dysplasia, intramucosal cancer, SMs). Subgroup analysis was conducted as well. Deeks’ funnel plots were also used to assess publication bias.

Results

A total of 11,387 colorectal lesions were included in 19 articles, including polyp, adenoma, dysplasia, and early cancer (intramucosal cancer, SMs, and SMm). The aggregate sensitivity, specificity, positive LR, negative LR, and diagnostic advantage scores of MCE in the diagnosis of differentiating CRC lesions with SMm from lesions without submucosal massive invasion (polyp, adenoma, dysplasia, intramucosal cancer, SMs) were 0.78 (95% CI 0.72–0.83), 0.95 (0.95% CI 0.91–0.97), 15.4 (0.95% CI 8.7–27.4), 0.23 (0.95% CI 0.18–0.30), and 66 (0.95% CI 32–136), respectively. The AUC of the SROC curve was 0.91 (0.95% CI 0.88–0.93). No significant publication bias was found with Deeks’ funnel plot. The results showed significant heterogeneity due to the different objects included.

Conclusion

MCE can differentiate CRC lesions with SMm from lesions without submucosal massive invasion (polyp, adenoma, dysplasia, intramucosal cancer, SMs) with high accuracy and it can guide assessment of invasion depth of SMm in T1 early CRCs to help us select the most appropriate treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Yan H, Talty R, Aladelokun O, Bosenberg M, Johnson CH (2023) Ferroptosis in colorectal cancer: a future target? Br J Cancer 128(8):1439–1451

    Article  CAS  PubMed  Google Scholar 

  2. Kawaguti FS, Franco MC, Martins BC et al (2019) Role of magnification chromoendoscopy in the management of colorectal neoplastic lesions suspicious for submucosal invasion. Dis Colon Rectum 62(4):422–428

    Article  PubMed  Google Scholar 

  3. Zhang QW, Teng LM, Zhang XT et al (2017) Narrow-band imaging in the diagnosis of deep submucosal colorectal cancers: a systematic review and meta-analysis. Endoscopy 49(6):564–580

    Article  PubMed  Google Scholar 

  4. Ikematsu H, Murano T, Shinmura K (2022) Depth diagnosis of early colorectal cancer: magnifying chromoendoscopy or image enhanced endoscopy with magnification? Dig Endosc 34(2):265–273 (published correction appears in Dig Endosc. 2022 Sep;34(6):1273)

    Article  PubMed  Google Scholar 

  5. Shinozaki S, Osawa H, Hayashi Y, Lefor AK, Yamamoto H (2019) Linked color imaging for the detection of early gastrointestinal neoplasms. Ther Adv Gastroenterol 12:1756284819885246

    Article  Google Scholar 

  6. Kudo S, Rubio CA, Teixeira CR, Kashida H, Kogure E (2001) Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 33(4):367–373

    Article  CAS  PubMed  Google Scholar 

  7. Kato S, Fujii T, Koba I et al (2001) Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: can significant lesions be distinguished? Endoscopy 33(4):306–310

    Article  CAS  PubMed  Google Scholar 

  8. Kudo SE, Kashida H, Nakajima T, Tamura S, Nakajo K (1997) Endoscopic diagnosis and treatment of early colorectal cancer. World J Surg 21(7):694–701

    Article  CAS  PubMed  Google Scholar 

  9. Fu KI, Sano Y, Kato S et al (2004) Chromoendoscopy using indigo carmine dye spraying with magnifying observation is the most reliable method for differential diagnosis between non-neoplastic and neoplastic colorectal lesions: a prospective study. Endoscopy 36(12):1089–1093

    Article  PubMed  Google Scholar 

  10. Myung YS, Ko BM, Park SK et al (2015) Sa1534 combination of narrow band image, chromoendoscopy and endoscopic ultrasonography to predict deep submucosal invasion in scheduled ESD patients. Gastrointest Endosc 81(5):AB252

    Article  Google Scholar 

  11. Matsuda T, Fujii T, Saito Y et al (2008) Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 103(11):2700–2706

    Article  PubMed  Google Scholar 

  12. Hisabe T, Tsuda S, Hoashi T et al (2018) Validity of conventional endoscopy using “non-extension sign” for optical diagnosis of colorectal deep submucosal invasive cancer. Endosc Int Open 6(2):E156–E164

    Article  PubMed  PubMed Central  Google Scholar 

  13. Shimura T, Ebi M, Yamada T et al (2014) Magnifying chromoendoscopy and endoscopic ultrasonography measure invasion depth of early-stage colorectal cancer with equal accuracy on the basis of a prospective trial [published correction appears in Clin Gastroenterol Hepatol. 2014 May;12(5):902]. Clin Gastroenterol Hepatol 12(4):662-8e282

    Article  PubMed  Google Scholar 

  14. Okamoto Y, Watanabe H, Tominaga K et al (2011) Evaluation of microvessels in colorectal tumors by narrow band imaging magnification: including comparison with magnifying chromoendoscopy. Dig Dis Sci 56(2):532–538

    Article  PubMed  Google Scholar 

  15. Jang HW, Park SJ, Cheon JH, Kim TI, Kim WH, Hong SP (2014) Does magnifying narrow-band imaging or magnifying chromoendoscopy help experienced endoscopists assess invasion depth of large sessile and flat polyps? Dig Dis Sci 59(7):1520–1528

    Article  PubMed  Google Scholar 

  16. Hosotani K, Imai K, Hotta K et al (2020) Can advanced endoscopic imaging help us avoid surgery for endoscopically resectable colorectal neoplasms? A proof-of-concept study. Dig Dis Sci 65(6):1829–1837

    Article  CAS  PubMed  Google Scholar 

  17. Sakamoto T, Saito Y, Nakajima T, Matsuda T (2011) Comparison of magnifying chromoendoscopy and narrow-band imaging in estimation of early colorectal cancer invasion depth: a pilot study. Dig Endosc 23(2):118–123

    Article  PubMed  Google Scholar 

  18. Wada Y, Kashida H, Kudo SE, Misawa M, Ikehara N, Hamatani S (2010) Diagnostic accuracy of pit pattern and vascular pattern analyses in colorectal lesions. Dig Endosc 22(3):192–199

    Article  PubMed  Google Scholar 

  19. Esaki M, Yamamura T, Nakamura M et al (2021) Endoscopic ultrasound elastography as a novel diagnostic method for the assessment of hardness and depth of invasion in colorectal neoplasms. Digestion 102(5):701–713

    Article  PubMed  Google Scholar 

  20. Kim JS, Lee BI, Choi H et al (2014) Brief education on microvasculature and pit pattern for trainees significantly improves estimation of the invasion depth of colorectal tumors. Gastroenterol Res Pract 2014:245396

    Article  PubMed  PubMed Central  Google Scholar 

  21. Abe S, Saito Y, Oono Y et al (2018) Pilot study on probe-based confocal laser endomicroscopy for colorectal neoplasms: an initial experience in Japan. Int J Colorectal Dis 33(8):1071–1078

    Article  PubMed  Google Scholar 

  22. Kudo SE, Mori Y, Wakamura K et al (2014) Endocytoscopy can provide additional diagnostic ability to magnifying chromoendoscopy for colorectal neoplasms. J Gastroenterol Hepatol 29(1):83–90

    Article  PubMed  Google Scholar 

  23. Kawasaki K, Nakamura S, Eizuka M et al (2021) Is barium enema examination negligible for the management of colorectal cancer? Comparison with conventional colonoscopy and magnifying colonoscopy. Jpn J Radiol 39(12):1159–1167

    Article  PubMed  Google Scholar 

  24. Kimura CMS, Kawaguti FS, Horvat N et al (2023) Magnifying chromoendoscopy is a reliable method in the selection of rectal neoplasms for local excision. Tech Coloproctol. https://doi.org/10.1007/s10151-023-02773-7

    Article  PubMed  Google Scholar 

  25. Onji K, Yoshida S, Tanaka S et al (2011) Quantitative analysis of colorectal lesions observed on magnified endoscopy images. J Gastroenterol 46(12):1382–1390

    Article  PubMed  Google Scholar 

  26. Hurlstone DP, Brown S, Cross SS, Shorthouse AJ, Sanders DS (2005) High magnification chromoscopic colonoscopy or high frequency 20 MHz mini probe endoscopic ultrasound staging for early colorectal neoplasia: a comparative prospective analysis. Gut 54(11):1585–1589

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Fu KI, Kato S, Sano Y et al (2008) Staging of early colorectal cancers: magnifying colonoscopy versus endoscopic ultrasonography for estimation of depth of invasion. Dig Dis Sci 53(7):1886–1892

    Article  PubMed  Google Scholar 

  28. Backes Y, Moss A, Reitsma JB, Siersema PD, Moons LM (2017) Narrow band imaging, magnifying chromoendoscopy, and gross morphological features for the optical diagnosis of T1 colorectal cancer and deep submucosal invasion: a systematic review and meta-analysis. Am J Gastroenterol 112(1):54–64

    Article  CAS  PubMed  Google Scholar 

  29. Ikehara H, Saito Y, Matsuda T, Uraoka T, Murakami Y (2010) Diagnosis of depth of invasion for early colorectal cancer using magnifying colonoscopy. J Gastroenterol Hepatol 25(5):905–912

    Article  PubMed  Google Scholar 

  30. van der Vlugt M, van Doorn SC, Wang J et al (2016) Optical diagnosis of malignant colorectal polyps: is it feasible? Endosc Int Open 4(7):E778–E783

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beijing University of Chinese Medicine, Beijing, 100029, China

    Y. Huang, Z. Yang, Y. Yao, G. Liu & R. Chen

  2. Department of Spleen-Stomach, Liver-Gallbladder, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China

    Y. Huang, Z. Yang, Y. Yao, G. Liu & R. Chen

Authors
  1. Y. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Z. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Not applicable.

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 kb)

Supplementary file2 (DOCX 47 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, Y., Yang, Z., Yao, Y. et al. Diagnostic accuracy of magnifying chromoendoscopy in the assessment of tumor invasion depth in early colorectal cancer: a systematic review and meta-analysis. Tech Coloproctol 27, 1155–1167 (2023). https://doi.org/10.1007/s10151-023-02833-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-023-02833-y

Keywords

Search

Navigation