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Clinical usefulness of pit patterns for detecting colonic lesions requiring surgical treatment

  • Original Article
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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The number of patients suffering from colorectal cancer is increasing. According to Japanese guidelines, lesions with a submucosal invasive depth >1,000 μm should be treated with radical proctocolectomy. We propose and evaluate a new clinical classification for pit patterns that uses endoscopy to assess lesion depth for determination of the appropriate therapeutic approach for early colorectal cancers and adenomas.

Methods

Endoscopic images of colorectal adenomas and early cancer cases with type VI pit pattern, resected surgically or endoscopically from April 2002 to April 2007 at Showa University Yokohama Northern Hospital, were utilized for analysis. Each image was retrospectively analyzed for (A) pit narrowness, (B) irregular pit margins, and (C) indistinct stromal staining. Sensitivity, specificity, and predictive value were evaluated as major outcomes, using pathological results as the standard.

Result

In total, 186 cases were assessed. With all features considered (A, B, and C), the sensitivity, specificity, and positive and negative predictive values were 47.8%, 86.3%, 66.0%, and 74.2%, respectively. When limited to two features (A and B), these values were 75.3%, 81.2%, 70.2%, and 84.8%, respectively.

Conclusion

Our results suggest that the established criteria can, to a certain degree, distinguish between high and low irregularity in colorectal lesions with VI pit pattern indicating submucosal cancer infiltration of more or less than 1,000 μm with the clinical consequence of surgery versus endoscopic mucosal resection/endoscopic mucosal dissection.

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Abbreviations

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

LAC:

Laparoscope assisted colectomy

OS:

Open surgery

JRSCCR:

The Japanese Society for Cancer of the Colon and Rectum

PPV:

Positive predictive value

NPV:

Negative predictive value

CI:

Confidence intervals

EUS:

Endoscopic ultrasound

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Acknowledgments

We would like to express our appreciation to Dr. Sasajima, Dr. Chinzei (Saitama Red Cross Hospital), and Dr. Ohmori (Rokko Island Hospital) for their instructive advices on this article.

Disclosure

The authors state that there are no financial disclosures relevant to this publication.

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Authors and Affiliations

  1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8505, Japan

    Yasutoshi Kobayashi, Shiro Hinotsu & Koji Kawakami

  2. Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

    Yasutoshi Kobayashi, Shin-ei Kudo, Hideyuki Miyachi, Toshihisa Hosoya, Nobunao Ikehara, Kazuo Ohtsuka & Hiroshi Kashida

  3. Department of Pathology, Showa University Northern Yokohama Hospital, Yokohama, Japan

    Shigeharu Hamatani

Authors
  1. Yasutoshi Kobayashi
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  2. Shin-ei Kudo
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  3. Hideyuki Miyachi
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  4. Toshihisa Hosoya
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  5. Nobunao Ikehara
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Correspondence to Koji Kawakami.

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Kobayashi, Y., Kudo, Se., Miyachi, H. et al. Clinical usefulness of pit patterns for detecting colonic lesions requiring surgical treatment. Int J Colorectal Dis 26, 1531–1540 (2011). https://doi.org/10.1007/s00384-011-1246-0

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  • DOI: https://doi.org/10.1007/s00384-011-1246-0

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