A novel ability of endocytoscopy to diagnose histological grade of differentiation in T1 colorectal carcinomas
submitted 21 March 2017
accepted after revision 26 June 2017
29 September 2017 (eFirst)
Background and study aims Endocytoscopic images closely resemble histopathology. We assessed whether endocytoscopy could be used to determine T1 colorectal cancer histological grade.
Patients and methods Endocytoscopic images of 161 lesions were divided into three types: tubular gland lumens, unclear gland lumens, and fused gland formations on endocytoscopy (FGFE). We retrospectively compared endocytoscopic findings with histological grade in the resected specimen superficial layer, and examined the incidence of risk factors for lymph node metastasis.
Results Of the 118 eligible lesions, the sensitivity, specificity, accuracy, negative predictive value, and positive likelihood ratio of tubular or unclear gland lumens to identify well-differentiated adenocarcinomas were 91.0 %, 93.1 %, 91.5 %, 77.1 %, and 13.20, respectively. To identify moderately differentiated adenocarcinomas for FGFE, these values were 93.1 %, 91.0 %, 91.5 %, 97.6 %, and 10.36, respectively. In the 35 lesions with FGFE, the rates of massive invasion, lymphovascular infiltration, and tumor budding were 97.1 %, 60.0 %, and 37.1 %, respectively.
Conclusions Endocytoscopy could be used to diagnose T1 colorectal cancer histological grade, and FGFE was a marker for recommending surgery.
- 1 Nishihara R, Wu K, Lochhead P. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105
- 2 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
- 3 Kudo SE, Wakamura K, Ikehara N. et al. Diagnosis of colorectal lesions with a novel endocytoscopic classification – a pilot study. Endoscopy 2011; 43: 869-875
- 4 Mori Y, Kudo S, Ikehara N. et al. Comprehensive diagnostic ability of endocytoscopy compared with biopsy for colorectal neoplasms: a prospective randomized noninferiority trial. Endoscopy 2013; 45: 98-105
- 5 Neumann H, Kudo SE, Kiesslich R. et al. Advanced colonoscopic imaging using endocytoscopy. Dig Endosc 2015; 27: 232-238
- 6 Ichimasa K, Kudo SE, Mori Y. et al. Double staining with crystal violet and methylene blue is appropriate for colonic endocytoscopy: an in vivo prospective pilot study. Dig Endosc 2014; 26: 403-408
- 7 Miyachi H, Kudo SE, Ichimasa K. et al. Management of T1 colorectal cancers after endoscopic treatment based on the risk stratification of lymph node metastasis. J Gastroenterol Hepatol 2015; 31: 1126-1132
- 8 Watanabe T, Itabashi M, Shimada Y. et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 2015; 20: 207-239
- 9 Kudo S, Rubio CA, Teixeira CR. et al. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 2001; 33: 367-373
- 10 Matsuda T, Fujii T, Saito Y. et al. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008; 103: 2700-2706
- 11 Bosman FT, World Health Organization. International Agency for Research on Cancer. WHO classification of tumours of the digestive system. 4th edn. Lyon: International Agency for Research on Cancer; 2010
- 12 Schmoll H, Van Cutsem E, Stein A. et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol 2012; 23: 2479-2516
- 13 Labianca R, Nordlinger B, Beretta G. et al. Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24: vi64-72
- 14 National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Colon Cancer (Version 2.2015). NCCN; 2015 Available from https://www.nccn.org/professionals/physician_gls/f_guidelines.asp