Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy

doi:10.1016/S0016-5107(95)70066-8

Gastrointestinal Endoscopy

Volume 42, Issue 2, August 1995, Pages 114-122

https://doi.org/10.1016/S0016-5107(95)70066-8 Get rights and content

Abstract

Because small flat colorectal neoplastic lesions (i.e., flat adenomas and flat adenocarcinomas) may be as translucent as the surrounding mucosa, they can remain undetected at conventional endoscopy. By combining high-resolution video endoscopy and chromoscopy, we detected 109 colorectal flat neoplastic lesions in 55 of 232 patients studied. Forty-three (78%) of the 55 patients with flat neoplastic lesions were over 60 years of age. No flat neoplastic lesions were seen in patients under 40 years of age. Flat neoplastic lesions were more frequent in men (35%) than in women (15%). Seventy-seven (71%) of the 109 flat neoplastic lesions measured 0.5 cm or less, 23 (21%) between 0.6 and 1.0 cm, and 9 (8%) more than 1.0 cm. Low-grade dysplasia and high-grade dysplasia were found in 94 (86%) and 13 (12%) of the flat neoplastic lesions, respectively. Adenocarcinoma was diagnosed in 3 (3%) flat lesions: 1 (1%) carcinoma originating in a flat adenoma and 2 (2%) adenocarcinomas without recognizable adenomatous elements. No adenocarcinomas were seen in lesions measuring 1.0 cm or less. Fourteen flat neoplastic lesions had a central depression at endoscopy. Flat neoplastic lesions with central depression more frequently showed high-grade dysplasia (43%) than did flat neoplastic lesions without central depression (7%). Central depression in flat neoplastic lesions should be considered a possible endoscopic marker for severe dysplasia. Our results suggest that flat neoplastic lesions occur more frequently than previously reported in Scandinavia. Flat adenomas may play an important role in the histogenesis of colorectal cancer (Gastrointest Endosc 1995;42:114-22.)

Section snippets

MATERIALS AND METHODS

From 2373 patients referred for colonoscopy to the section of gastrointestinal endoscopy at the Karolinska Hospital during 1992 and 1993, we selected at random 347 patients for a special study with high-resolution video endoscopy and chromoscopy. One hundred fifteen patients were excluded because of inflammatory bowel disease (n =109), hereditary nonpolyposis colorectal cancer (n = 4), or familial adenomatous polyposis (n = 2). A total of 232 patients were finally included in the study. The

RESULTS

The results are condensed in Fig. 1.

. Endoscopic and histologic findings in the 232 patients. F + E, flat and exophytic polyps; F.N.P., flat neoplastic polyps; F.N.N.P., flat non-neoplastic polyps; E.N.P., exophytic neoplastic polyps; E.N.N.P., exophytic non-neoplastic polyps; U.N.P., unspecified neoplastic polyps; U.N.N.P., unspecified non-neoplastic polyps; F.CA, flat adenocarcinomas; E.CA, exophytic adenocarcinomas; Total, total number of polyps in each group. *Include 2 flat adenocarcinomas.

DISCUSSION

In previous studies, we have demonstrated that the colorectal mucosa is almost translucent when observed with conventional endoscopic illumination and it is therefore difficult to visualize minute changes in its epithelial surface.27, 28, 30 In this study, we combined high-resolution video endoscopy and chromoscopy to enhance the surface details of the colorectal mucosa.³⁰ By this method, we detected 109 flat neoplastic polyps in 55 (24) of 232 patients.

With the continuing improvement in the

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^☆: From the Section of Gastrointestinal Radiology and Endoscopy, Department of Diagnostic Radiology and Pathology, Karolinska Hospital, Stockholm, Sweden.

^☆☆: Reprint requests: Premysl Slezak, MD PhD, Section of Gastrointestinal Radiologhy and Endoscopy, Deparment of Diagonistic Radiology, Karolinska Hospital, 171 76, Stockholm, Swenden.

^★: 37/1/60116

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Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy☆,☆☆,★

Abstract

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

Hum Pathol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Small “flat adenoma” of the bowel with special reference to its clinicopathological features

Dis Colon Rectum

Flat adenoma and flat mucosal carcinoma (IIb type)—a new precursor of colorectal carcinoma? Report of two cases

Dis Colon Rectum

Flat adenomas in a colon cancer-prone kindred

J Natl Cancer Inst

DNA ploidy pattern of flat adenomas of the large bowel

Dis Colon Rectum

Clinicopathologic features of the flat adenoma

Dis Colon Rectum

Malignant potential in flat elevations

Dis Colon Rectum

Depressed adenoma in the large intestine: endoscopic features

Dis Colon Rectum

Small primary adenocarcinomas of the colon and rectum

JAMA

Minute cancers arising de novo in the human large intestine

Cancer

Early colorectal carcinoma with special reference to its development de novo

Cancer

Flat early cancers of the large intestine

Cancer

Clinicopathological study on flat and depressed minute colorectal carcinomas

Digestive Endoscopy

Fast-growing cancer of the colon and rectum

Am Surg

Early depressed adenocarcinomas of the large intestine

Cancer

Clinicopathological features and endoscopic diagnosis of superficial early adenocarcinomas of the large intestine

Dig Dis Sci