Usefulness of Dye-Chromoendoscopic Mucosal pattern classification of flat type dysplasia in Diagnosing the Extent of Lesion of Ulcerative Colitis-Associated Neoplasia

Aims According to the SCENIC consensus statement, endoscopic resection (ER) of neoplastic lesions in patients with ulcerative colitis (UC) may be considered if the boundaries are clear. Since the publication of this statement, numerous reports have been made regarding endoscopic resection of neoplastic lesions in UC patients. However, it is still challenging to diagnose the extent of ulcerative colitis-associated neoplasia (UCAN) as flat dysplasia often spreading around the lesion. Our facility has previously reported on the characteristics of flat-type dysplasia observed with dye-chromoendoscopy (DCE). This study aims to verify the usefulness of DCE classification in diagnosing the extent of UCAN.

Methods From August 2022 to August 2024, 26 UC patients with 33 lesions suspected of being UCAN based on biopsy histology during surveillance colonoscopy were included in this study. DCE was performed to diagnose the extent of the lesions, followed by a retrospective analysis of 230 biopsy sites. The sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV) of DCE diagnosis were evaluated. Among the mucosal changes observed with DCE proposed by our institution, (1) small round pattern and (2) mesh pattern were considered indicative of UCAN, while (3) Ripple or Gyrus pattern was judged to be non-neoplastic areas, and biopsies were performed accordingly [1].

Results Of the 230 biopsy sites, dysplasia was detected in 54 out of 66 sites biopsied from small round pattern mucosa (sensitivity 0.750, specificity 0.891, PPV 0.863 [95% CI 0.757-0.936]) and in 28 out of 48 sites biopsied from mesh pattern mucosa (sensitivity 0.609, specificity 0.831, PPV 0.583 [95% CI 0.432-0.724]). Negative biopsies were performed on 116 sites with Ripple or Gyrus pattern mucosa, with an NPV of 0.845 [95% CI 0.766-0.905].

Conclusions The findings suggest that the DCE classification for flat type dysplasia is considered to be a useful for diagnosing the extent of UCAN.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Takabayashi K, Sugimoto S, Nanki K, Yoshimatsu Y, Kiyohara H, Mikami Y, Sujino T, Kato M, Hosoe N, Shimoda M, Yahagi N, Ogata H, Iwao Y, Kanai T. Characteristics of flat-type ulcerative colitis-associated neoplasia on chromoendoscopic imaging with indigo carmine dye spraying. Dig Endosc 2024; 36 (04): 446-454