COLON CANCER

Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis

D P Hurlstone¹, S S Cross², I Adam³, A J Shorthouse³, S Brown³, D S Sanders¹, A J Lobo¹

¹ Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK
² Academic Unit of Pathology, Section of Oncology and Pathology, Division of Genomic Medicine, University of Sheffield Medical School, Sheffield, UK
³ Academic Department of Surgery, Royal Hallamshire Hospital, Sheffield, UK

Correspondence to:
Correspondence to:
Dr D P Hurlstone
17 Alexandra Gardens, Lyndhurst Rd, Nether Edge, Sheffield S11 9DQ, UK; p.hurlstone{at}shef.ac.uk

Background: High magnification chromoscopic colonoscopy (HMCC) permits the in vivo examination of the colorectal pit pattern, which has a high correlation with stereomicroscopic appearances of resected specimens. This new technology may provide an "optical biopsy" which can be used to aid diagnostic precision and guide therapeutic strategies. Conflicting data exist concerning the accuracy of this technique when discriminating neoplastic from non-neoplastic lesions, particularly when flat and depressed.

Aim: To prospectively examine the efficacy of HMCC for the diagnosis of neoplasia in flat and depressed colorectal lesions using standardised morphological, pit pattern, and histopathological criteria. Clinical recommendations for the use of HMCC are made.

Methods: Total colonoscopy was performed on 1850 patients by a single endoscopist from January 2001 to July 2003 using the C240Z magnifying colonoscope. Identified lesions were classed according to the Japanese Research Society guidelines, and pit pattern according to Kudos modified criteria. Pit pattern appearances were then compared with histopathology.

Results: A total of 1008 flat lesions were identified. The sensitivity and specificity of HMCC in distinguishing non-neoplastic from neoplastic lesions were 98% and 92%, respectively. However, when using HMCC to differentiate neoplastic/non-invasive from neoplastic/invasive lesions, sensitivity was poor (50%) with a specificity of 98%. Diagnostic accuracy was not influenced by size or morphological classification of lesions.

Conclusion: HMCC has a high overall accuracy at discriminating neoplastic from non-neoplastic lesions but is not 100% accurate. HMCC is a useful diagnostic tool in vivo but presently is not a replacement for histology. Requirements for further education and training in these techniques need to be addressed.

Keywords: adenoma; colorectal cancer; chromoscopy; colonoscopy; pit pattern; neoplasia

Abbreviations: CRC, colorectal cancer; HMCC, high magnification chromoscopic colonoscopy; HGD, high grade dysplasia; LGD, low grade dysplasia; NSS, normal saline solution; IC, indigo carmine; CV, crystal violet; EMR, endoscopic mucosal resection; USMP, ultrasound mini probe

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Abstracts
Gut 2006 55: a1-a119. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Fu, K, Tsujinaka, Y, Hamahata, Y, Matsuo, K, Tsutsumi, O (2008). "A brownish depressed area": a novel narrow band imaging colonoscopic finding of a depressed adenoma. Gut 57: 1177-1177 [Full Text]  
• Hurlstone, D. P., Brown, S. (2007). Techniques for targeting screening in ulcerative colitis. Postgrad. Med. J. 83: 451-460 [Abstract] [Full Text]  
• Hurlstone, D. P, Sanders, D. S, Atkinson, R., Hunter, M. D, McAlindon, M E, Lobo, A J, Cross, S. S, Thomson, M. (2007). Endoscopic mucosal resection for flat neoplasia in chronic ulcerative colitis: can we change the endoscopic management paradigm?. Gut 56: 838-846 [Abstract] [Full Text]  
• Nakamura, H., Fu, K.-I, Hurlstone, D. P., Kaji, Y., Fujimori, T. (2007). Submucosal xanthachromia after endoscopic mucosal resection: laparotomy or conservative therapy?. Gut 56: 448-449 [Full Text]  
• Nishio, Y, Ando, T, Maeda, O, Ishiguro, K, Watanabe, O, Ohmiya, N, Niwa, Y, Kusugami, K, Goto, H (2006). Pit patterns in rectal mucosa assessed by magnifying colonoscope are predictive of relapse in patients with quiescent ulcerative colitis. Gut 55: 1768-1773 [Abstract] [Full Text]  
• Hurlstone, D P, Brown, S, Cross, S S, Shorthouse, A J, Sanders, D S (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: 1585-1589 [Abstract] [Full Text]  
• Rembacken, B, Hurlstone, D P (2004). Should we remove all lesions at colonoscopy? * Author's reply. Gut 53: 1877-1878 [Full Text]  
• Kiesslich, R, Neurath, M F (2004). Endoscopic mucosal resection: an evolving therapeutic strategy for non-polypoid colorectal neoplasia. Gut 53: 1222-1224 [Full Text]  
• Hurlstone, D P, Sanders, D S, Cross, S S, Adam, I, Shorthouse, A J, Brown, S, Drew, K, Lobo, A J (2004). Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut 53: 1334-1339 [Abstract] [Full Text]  
• (2004). High Magnification Prediction of Histology in Flat and Depressed Colorectal Lesions. JWatch Gastroenterology 2004: 3-3 [Full Text]  
• Hurlstone, D P, Cross, S S, Slater, R, Sanders, D S, Brown, S (2004). Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy. Gut 53: 376-380 [Abstract] [Full Text]  

eLetters:

Read all eLetters

Invasive pattern is an indication for surgical treatment

Yutaka Saito, et al.

Gut Online, 2 Mar 2004 [Full text]

Histopathology using the Vienna criteria: clinical decision making is still adequate.

David P Hurlstone

Gut Online, 15 Mar 2004 [Full text]