Clinical usefulness of narrow band imaging magnifying colonoscopy for assessing ulcerative colitis-associated cancer/dysplasia

Background and study aims: Colitis-associated cancer/dysplasia (CC/D) can affect the life expectancy of patients with ulcerative colitis (UC). Although the utility of magnifying chromocolonoscopy has been shown, the use of optical magnification with narrow band imaging (NBI) for distinguishing CC/D from non-neoplastic lesions in patients with UC has not been reported. We evaluated whether endoscopic findings are distinguishing and thus assessed the clinical usefulness of NBI magnification for differentiating UC-associated lesions.

Patients and methods: The study involved 27 patients diagnosed and treated at Hiroshima University Hospital between September 2005 and March 2015: a neoplasia group (16 lesions) and a non-neoplasia group (17 lesions). The neoplasias comprised 9 dysplastic lesions, 5 intramucosal carcinomas, and 2 submucosal carcinomas, and 17 non-neoplastic lesions. Targeted biopsy samples of suspicious lesions detected by conventional colonoscopy were classified pathologically as neoplastic or non-neoplastic, and NBI magnifying colonoscopy findings (i. e., the surface [unclear/regular/irregular/amorphous] and vascular [same as the background mucosa/regular/irregular/avascular] patterns) of the 2 lesion types were compared.

Results: Irregular/amorphous surface patterns were significantly more common in neoplastic lesions than in non-neoplastic lesions (81 % [13/16] vs. 18 % [3/17], respectively, P < 0.001). Irregular/avascular vessel pattern tended to be more common in neoplastic lesions (75 % [12/16] vs. 41 % [7/17], respectively). The surface pattern correctly predicted 82 % of neoplastic lesions, and the vessel pattern correctly predicted 67 % of non-neoplastic lesions. The 2 endoscopic findings together correctly predicted 91 % of neoplastic lesions.

Conclusion: Surface pattern, determined by magnifying colonoscopy with NBI, is useful for differenting between UC-associated neoplastic and non-neoplastic lesions.

• References

• 1 Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48: 526-535
• 2 Magro F, Langner C, Driessen A et al. European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis 2013; 7: 827-851
• 3 Oka S, Tanaka S, Chayama K et al. Detection of nonpolypoid colorectal neoplasia using magnifying endoscopy in colonic inflammatory bowel disease. Gastrointest Endosc Clin N Am 2014; 24: 405-417
• 4 Ueno Y, Tanaka S, Chayama K. Non-polypoid colorectal neoplasms in ulcerative colitis. Gastrointest Endosc Clin N Am 2010; 20: 525-542
• 5 Hirata M, Tanaka S, Oka S et al. Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc 2007; 65: 988-995
• 6 Tanaka S, Sano Y. Aim to unify the narrow band imaging (NBI) magnifying classification for colorectal tumors: current status in Japan from a summary of the consensus symposium in the 79th Annual Meeting of the Japan Gastroenterological Endoscopy Society. Dig Endosc 2011; 23: 131-139
• 7 Oba S, Tanaka S, Sano Y et al. Current status of narrow-band imaging magnifying colonoscopy for colorectal neoplasia in Japan. Digestion 2011; 83: 167-172
• 8 Hayashi N, Tanaka S, Hewett DG et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78: 625-632
• 9 Tanaka S, Hayashi N, Oka S et al. Endoscopic assessment of colorectal cancer with superficial or deep submucosal invasion using magnifying colonoscopy. Clin Endosc 2013; 46: 138-146
• 10 East JE, Suzuki N, von Herbay A et al. Narrow band imaging with magnification for dysplasia detection and pit pattern assessment in ulcerative colitis surveillance: a case with multiple dysplasia associated lesions or masses. Gut 2006; 55: 1432-1435
• 11 Dekker E, van den Broek FJ, Reitsma JB et al. Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy 2007; 39: 216-221
• 12 Matsumoto T, Kudo T, Jo Y et al. Magnifying colonoscopy with narrow band imaging system for the diagnosis of dysplasia in ulcerative colitis: a pilot study. Gastrointest Endosc 2007; 66: 957-965
• 13 Pellisé M, López-Cerón M, Rodríguez de Miguel C et al. Narrow-band imaging as an alternative to chromoendoscopy for the detection of dysplasia in long-standing inflammatory bowel disease: a prospective, randomized, crossover study. Gastrointest Endosc 2011; 74: 840-848
• 14 Riddell RH, Goldman H, Ransohoff DF et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol 1983; 14: 931-968
• 15 Tischendorf JJ, Schirin-Sokhan R, Streetz K et al. Value of magnifying endoscopy in classifying colorectal polyps based on vascular pattern. Endoscopy 2010; 42: 22-27
• 16 Henry ZH, Yeaton P, Shami VM et al. Meshed capillary vessels found on narrow-band imaging without optical magnification effectively identifies colorectal neoplasia: a North American validation of the Japanese experience. Gastrointest Endosc 2010; 72: 118-126
• 17 Rastogi A, Pondugula K, Bansal A. Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. Gastrointest Endosc 2009; 69: 716-722
• 18 van den Broek FJ, Fockens P, van Eeden S et al. Narrow-band imaging versus high-definition endoscopy for the diagnosis of neoplasia in ulcerative colitis. Endoscopy 2011; 43: 108-115
• 19 Efthymiou M, Allen PB, Taylor AC et al. Chromoendoscopy versus narrow band imaging for colonic surveillance in inflammatory bowel disease. Inflamm Bowel Dis 2013; 19: 2132-2138
• 20 Hata K, Watanabe T, Motoi T et al. Pitfalls of pit pattern diagnosis in ulcerative colitis-associated dysplasia. Gastroenterology 2004; 126: 374-376
• 21 Nishiyama S, Oka S, Tanaka S et al. Is it possible to discriminate between neoplastic and non-neoplastic lesions in ulcerative colitis by magnifying colonoscopy?. Inflamm Bowel Dis 2014; 20: 508-513
• 22 Hurlstone DP, Sanders DS, Lobo AJ et al. Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis: a prospective evaluation. Endoscopy 2005; 37: 1186-1192
• 23 Matsumoto T, Nakamura S, Jo Y et al. Chromoscopy might improve diagnostic accuracy in cancer surveillance for ulcerative colitis. Am J Gastroenterol 2003; 98: 1827-1833
• 24 Marion JF, Waye JD, Present DH et al. Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial. Am J Gastroenterol 2008; 103: 2342-2349
• 25 Sada M, Igarashi M, Yoshizawa S et al. Dye spraying and magnifying endoscopy for dysplasia and cancer surveillance in ulcerative colitis. Dis Colon Rectum 2004; 47: 1816-1823
• 26 Kunihiro M, Tanaka S, Sumii M et al. Magnifying colonoscopic features of ulcerative colitis reflect histologic inflammation. Inflamm Bowel Dis 2004; 10: 737-744
• 27 Matsumoto T, Nakamura S, Moriyama T et al. Autofluorescence imaging colonoscopy for the diagnosis of dysplasia in ulcerative colitis. Inflamm Bowel Dis 2007; 13: 640-641
• 28 Matsumoto T, Nakamura S, Moriyama T et al. Autofluorescence imaging colonoscopy for the detection of dysplastic lesions in ulcerative colitis: a pilot study. Colorectal Dis 2010; 12: 291-297