Endoscopy 2019; 51(04): S128
DOI: 10.1055/s-0039-1681548
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 10:30 – 11:00: Anorectal disorders ePoster Podium 1
Georg Thieme Verlag KG Stuttgart · New York

NARROW-BAND IMAGING PREDICTS THE HISTOLOGY OF ANAL SQUAMOUS INTRAEPITHELIAL LESION AND SUPERFICIALLY INVASIVE SQUAMOUS CELL CARCINOMA WITH HIGH ACCURACY

G Gizzi
1   MF Toniolo Hospital, Bologna, Italy
,
V Villani
1   MF Toniolo Hospital, Bologna, Italy
,
L Frazzoni
2   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
G Tamanini
2   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
M La Marca
2   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
L Fuccio
2   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Anal cancer incidence is increasing. Squamous cell carcinoma is the most frequent histologic type and is preceded by precancerous lesions, i.e. squamous intraepithelial lesions (SILs), and by superficially invasive squamous cell carcinoma (SISCCA), a microinvasive disease with low metastatic risk. SIL and SISCCA are amenable to conservative or excisional treatment, however their endoscopic identification is challenging. We aimed at assessing narrow-band imaging (NBI) in predicting histology of SIL and SISCCA.

Methods:

Retrospective analysis of prospectively collected database. Patients with suspected SIL and SISCCA underwent a rectosigmoidoscopy with high-definition colonoscopes (HDTV Olympus 180 Exera) or dual-focus colonoscopes (HDTV Olympus 190 Exera) with NBI evaluation and histological assessment. Three NBI patterns were identified: i) pattern I, elongation of intrapapillary capillary loops toward epithelial surface; ii) pattern II, thickened and tortuous intrapapillary capillary loops; iii) pattern III, mosaic-like disposition of intrapapillary capillary loops.

SILs were classified according to the LAST classification in high-grade (HSIL) and low-grade (LSIL). Correlation between tumour grade and NBI was evaluated with Spearman's rho coefficient. We calculated diagnostic accuracy of NBI in detecting the presence of HSIL or SISCCA vs. LSIL.

Results:

We documented 45 lesions in 42 patients (mean age 54.5 years; 24 females). In details, 33 (73.3%) lesions were LSIL, 9 (20%) were HSIL, and 3 (6.7%) were SISCCA. NBI pattern positively correlated to the tumour grade (Spearman's rho = 0.952, p < 0.001). Furthermore, 33/33 (100%) LSILs had NBI pattern I, 8/9 (88.9%) HSILs had NBI pattern II, and 3/3 SISCCAs had NBI pattern III. Diagnostic accuracy of NBI pattern II or III in detecting HSIL or SISCCA vs. LSIL was high (sensitivity = 91.7%, 95% CI 61.5 – 99.8%; specificity = 100%, 95% CI 89.4 – 100%).

Conclusions:

NBI evaluation of suspected SIL can differentiate low grade SIL from high grade SIL and SISCCA with high accuracy. The mosaic-like NBI pattern is strongly associated with SISCCA.