Endoscopy 2011; 43(10): 869-875
DOI: 10.1055/s-0030-1256663
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Diagnosis of colorectal lesions with a novel endocytoscopic classification – a pilot study

S-E Kudo
1   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
K. Wakamura
1   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
N. Ikehara
1   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
Y. Mori
1   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
H. Inoue
1   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
S. Hamatani
2   Division of Pathology, Showa University Northern Yokohama Hospital, Yokohama, Japan
› Author Affiliations
Further Information

Publication History

submitted 18 October 2010

accepted after revision 15 May 2011

Publication Date:
11 August 2011 (online)

Background and study aims: Recent advances in endocytoscopy have enabled in vivo evaluation not on ly of structural atypia, but also of cellular atypia with observation of lumens and nuclei in the surface layer of the mucosa. The aim of this prospective pilot study was to evaluate the usefulness of our novel endocytoscopic classification in colorectal lesions.

Patients and methods: A total of 206 consecutive patients were enrolled in the study and underwent endocytoscopic examination. Endocytoscopic images were stored electronically and two endoscopists blinded to the findings at live examination assigned them diagnoses using the endocytoscopic (EC) classification. The endocytoscopic diagnosis was then compared to the final histopathological diagnosis.

Results: In all, 196 patients with 213 specimens were available for analysis. All normal mucosae were classified as EC1a and all hyperplastic polyps as EC1b. Dysplasias were mainly classified as EC2, while massively invasive submucosal cancers (SMm) or worse, which have the possibility of metastasis, were mainly EC3b. Assuming that an EC1b classification was diagnostic of hyperplastic polyps, we were able to differentiate nonneoplastic from neoplastic lesions with a sensitivity of 100 % and a specificity of 100 % (P < 0.05). Assuming that an EC3b classification was diagnostic of SMm or worse, we were able to differentiate “SMm or worse” from other neoplastic lesions (dysplasias and slightly invasive submucosal cancers) with a sensitivity of 90.1 % and a specificity of 99.2 % (P < 0.05).

Conclusions: The endocytoscopic classification was particularly useful for differentiating between neoplastic and nonneoplastic lesions and between “SMm or worse” and other neoplastic lesions, which in the case of colorectal neoplasms would help to determine treatment.

 
  • References

  • 1 Kudo S, Hirota S, Nakajima T et al Colorectal tumours and pit pattern. J Clin Pathol 1994; 47: 880-885
  • 2 Kudo S, Rubio CA, Teixeira CR et al Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 2001; 33: 367-373
  • 3 Inoue H, Kazawa T, Sato Y et al In vivo observation of living cancer cells in the esophagus, stomach, and colon using catheter-type contact endoscope, “Endo–Cytoscopy system”. Gastrointest Endosc Clin N Am 2004; 14: 589-594, x - xi
  • 4 Sasajima K, Kudo SE, Inoue H et al Real-time in vivo virtual histology of colorectal lesions when using the endocytoscopy system. Gastrointest Endosc 2006; 63: 1010-1017
  • 5 Hamou J, Salat-Baroux J, Coupez F, De Brux J. Microhysteroscopy: a new approach to the diagnosis of cervical intraepithelial neoplasia. Obstet Gynecol 1984; 63: 567-574
  • 6 Andrea M, Dias O, Santos A. Contact endoscopy of the vocal cord: normal and pathological patterns. Acta Otolaryngol 1995; 115: 314-316
  • 7 Kumagai Y, Monma K, Kawada K. Magnifying chromoendoscopy of the esophagus: in-vivo pathological diagnosis using an endocytoscopy system. Endoscopy 2004; 36: 590-594
  • 8 Inoue H, Kudo SE, Shiokawa A. Technology insight: Laser-scanning confocal microscopy and endocytoscopy for cellular observation of the gastrointestinal tract. Nat Clin Pract Gastroenterol Hepatol 2005; 2: 31-37
  • 9 Inoue H, Sasajima K, Kaga M et al Endoscopic in vivo evaluation of tissue atypia in the esophagus using a newly designed integrated endocytoscope: a pilot trial. Endoscopy 2006; 38: 891-895
  • 10 Rotondano G, Bianco MA, Salerno R et al Endocytoscopic classification of preneoplastic lesions in the colorectum. Int J Colorectal Dis 2010; 25: 1111-1116
  • 11 Kudo S-E, Wakamura K, Kashida H, Ikehara N. Real time diagnosis in the colorectum with integrated type endocytoscope. Gastrointest Endosc 2010; 71: AB209
  • 12 Kudo S, Tamura S, Nakajima T et al Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14
  • 13 Kudo S, Tamegai Y, Yamano H et al Endoscopic mucosal resection of the colon: the Japanese technique. Gastrointest Endosc Clin N Am 2001; 11: 519-535
  • 14 Tsuruta O, Toyonaga A, Ikeda H, Tanikawa K. Clinicopathological study of superficial-type invasive carcinoma of the colorectum: special reference to lymph node metastasis. Int J Oncol 1997; 10: 1003-1008
  • 15 Inoue H, Kudo SE, Shiokawa A. Novel endoscopic imaging techniques toward in vivo observation of living cancer cells in the gastrointestinal tract. Dig Dis 2004; 22: 334-337
  • 16 Kudo SE, Takemura O, Ohtsuka K. Flat and depressed types of early colorectal cancers: from East to West. Gastrointest Endosc Clin N Am 2008; 18: 581-593, xi
  • 17 Sakashita M, Inoue H, Kashida H et al Virtual histology of colorectal lesions using laser - scanning confocal microscopy. Endoscopy 2003; 35: 1033-1038
  • 18 Kiesslich R, Burg J, Vieth M et al Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 2004; 127: 706-713
  • 19 Olliver JR, Wild CP, Sahay P et al Chromoendoscopy with methylene blue and associated DNA damage in Barrett’s oesophagus. Lancet 2003; 362: 373-374
  • 20 Kodashima S, Fujishiro M, Takubo K et al Ex - vivo study of high-magnification chromoendoscopy in the gastrointestinal tract to determine the optimal staining conditions for endocytoscopy. Endoscopy 2006; 38: 1115-1121