Tu1658 The Diagnosis of Colorectal Cancer With NBI Magnifying Endoscopy, Magnifying Chromoendoscopy and Endocytoscopy

Abstract

The Diagnosis of Colorectal Cancer With NBI Magnifying Endoscopy, Magnifying Chromoendoscopy and Endocytoscopy Shin-Ei Kudo, Yoshiki Wada, Tomoyuki Ishigaki, Masashi Misawa, Yuichi Mori, Kunihiko Wakamura, Hideyuki Miyachi, Nobunao Ikehara, Fuyuhiko Yamamura, Shigeharu Hamatani Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan; Department of Pathology, Showa University Northern Yokohama Hospital, Yokohama, Japan Aim: The aim of this prospective study is to compare the usefulness of magnifying narrow band imaging (NBI), magnifying chromoendoscopy and endocytoscopy for the diagnosis of colorectal lesions and providing precise treatment decision by means of a thorough NBI evaluation combined to pit pattern. Method: The subject sample was composed of 278 patients who underwent a complete colonoscopic examination and endoscopic or surgical treatment from January 2006 to June 2010. A total of 290 submucosal invasive cancerous lesions was evaluated. The NBI/chromoendoscopy digital images were recorded and the diagnosis was made independently from each other by two endoscopists who were blinded to the final pathological conclusion. The vascular pattern was classified into six classes accordingly to our service1. The pit pattern was classified according to Kudo’s classification. The findings of endocytoscopy were classified into five classes2. In submucosal cancers, 145 cases were treated surgically. What so ever Kudo’s classification was used for the degree of submucosal invasion and classified cancer accordingly. Prediction of the invasion depth is very important for deciding a way of intervention. Sm1a or 1b cancer without vessel permeation does not metastasize. In contrast, sm1c, sm2 or sm3 lesions show a substantial proportion (around 10%) of nodal metastasis. Massively invasive submucosal cancer (SMm) was indicated for surgical operation. Slightly invasive submucosal cancer (SMs) was indicated for endoscopic treatment. Results: By recognizing irregular or sparse vascular pattern with NBI, SMm could be diagnosed with sensitivity and specificity of 94.9% and 76.0% respectively. Through chromoendoscopy, the differentiation between SMm and SMs was achieved by evaluating the pit pattern with sensitivity of 89.7% and specificity of 88.0%. On the other hand, when assuming EC3b endocytoscopical class as SMm, SMm could be diagnosed with sensitivity and specificity of 89.9% and 90.0% respectively. Conclusion: In diagnosis of submucosal cancer, the specificity of pit pattern was superior to NBI colonoscopy. Thus, it is desirable to perform chromoendoscopy in addition to NBI for distinguishing between SMs and SMm lesions and determining treatment selection, whether endoscopical or surgically. Nevertheless, since a high accurate method, endocytoscopy might prove the best treatment selection in the future.1. Wada Y, Kudo S, Kashida H et al. The diagnosis of colorectal lesions with magnifying narrow-band imaging system. Gastrointest Endosc 2009; 70: 522-312. Kudo S, Takemura O, Ohtsuka K. Flat and Depressed Types of Early Colorectal Cancers: From East to West. Gastrointest Endoscopy Clin N Am 2008; 18: 581-593.