Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms

Hiroaki Ikematsu,Takahiro Fujimori,Toshio Uraoka,Yasushi Sano,Takahisa Matsuda,Yutaka Saito,Kuang-I Fu,Atsushi Ochiai,Kazuhiro Kaneko,Fabian Emura

doi:10.1186/1471-230x-10-33

Abstract

BackgroundCapillary patterns (CP) observed by magnifying Narrow Band Imaging (NBI) are useful for differentiating non-adenomatous from adenomatous colorectal polyps. However, there are few studies concerning the effectiveness of magnifying NBI for determining the depth of invasion in early colorectal neoplasms. We aimed to determine whether CP type IIIA/IIIB identified by magnifying NBI is effective for estimating the depth of invasion in early colorectal neoplasms.MethodsA series of 127 consecutive patients with 130 colorectal lesions were evaluated from October 2005 to October 2007 at the National Cancer Center Hospital East, Chiba, Japan. Lesions were classified as CP type IIIA or type IIIB according to the NBI CP classification. Lesions were histopathologically evaluated. Inter and intraobserver variabilities were assessed by three colonoscopists experienced in NBI.ResultsThere were 15 adenomas, 66 intramucosal cancers (pM) and 49 submucosal cancers (pSM): 16 pSM superficial (pSM1) and 33 pSM deep cancers (pSM2-3). Among lesions diagnosed as CP IIIA 86 out of 91 (94.5%) were adenomas, pM-ca, or pSM1; among lesions diagnosed as CP IIIB 28 out of 39 (72%) were pSM2-3. Sensitivity, specificity and diagnostic accuracy of the CP type III for differentiating pM-ca or pSM1 (<1000 μm) from pSM2-3 (≥1000 μm) were 84.8%, 88.7 % and 87.7%, respectively. Interobserver variability: κ = 0.68, 0.67, 0.72. Intraobserver agreement: κ = 0.79, 0.76, 0.75ConclusionIdentification of CP type IIIA/IIIB by magnifying NBI is useful for estimating the depth of invasion of early colorectal neoplasms.

Highlights

Capillary patterns (CP) observed by magnifying Narrow Band Imaging (NBI) are useful for differentiating non-adenomatous from adenomatous colorectal polyps
Our observations demonstrated that the CP assessed by magnifying NBI is useful for differentiating small colorectal non-neoplastic from neoplastic polyps [13] and is highly accurate at distinguishing between low-grade dysplasia and high-grade dysplasia/ invasive cancer, and can be used to predict the histopathology of colorectal neoplasia [14]
Among lesions diagnosed as CP IIIA 86 out of 91 (94.5%) were adenomas, pM, or pSM1; while among lesions diagnosed as CP IIIB 28 out of 39 (72%) were pSM2-3

Summary

Introduction

Capillary patterns (CP) observed by magnifying Narrow Band Imaging (NBI) are useful for differentiating non-adenomatous from adenomatous colorectal polyps. There are few studies concerning the effectiveness of magnifying NBI for determining the depth of invasion in early colorectal neoplasms. We aimed to determine whether CP type IIIA/IIIB identified by magnifying NBI is effective for estimating the depth of invasion in early colorectal neoplasms. Following complete surgical resection it has been found that colorectal cancers confined to the intramucosal layer (pM) or invading less than 1000 μm into the submucosa (pSM1), with no lymphovascular invasion or signs of poor differentiated histology do not have lymph node (LN) metastasis. In vivo estimation of the depth of invasion in early colorectal lesions may be important for an adequate therapeutic strategy. We developed in the late nineties the NBI system as an in vivo approach for visualizing microvascular anatomy or microvessels morphologic changes in superficial neoplasia [7,8,9]

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