Predicting depth of invasion for JNET Type 2B colorectal lesions: Is there a role for magnifying chromoendoscopy?

Introduction: We aimed to compare the efficacy of endoscopic ultrasound elastography (EUS-EG) with that of magnifying chromoendoscopy (MCE) and endoscopic ultrasonography (EUS) for the diagnosis of the depth of invasion in colorectal neoplasms. This is an important clinical issue as the depth of invasion is associated with the risk of metastasis. Methods: Consecutive patients with suspected superficial colorectal neoplasms, evaluated by MCE, EUS, and EUS-EG, for whom endoscopic submucosal dissection was considered, were enrolled in 2018 (derivation study) and in 2019–2020 (validation study). The primary clinical endpoint was the diagnostic yield differentiating intramucosal and shallow submucosal neoplasms from deep submucosal (dSM) and advanced colorectal cancers. In addition, inter- and intra-observer agreements of the elastic score of colorectal neoplasm (ES-CRN) were evaluated by 2 expert and 2 non-expert endoscopists. Results: Thirty-one (33 lesions) and 50 (55 lesions) patients were enrolled in the derivation and validation studies, respectively. Sensitivity, specificity, positive, and negative predictive values, and accuracy of assessment of the depth of submucosal or deeper invasion in the derivation and validation groups were as follows: EUS-EG, 100/88.2/86.7/100/93.3% and 77.8/86.1/73.7/88.6/83.3%; MCE, 66.7/94.4/90.9/77.3/81.8% and 84.2/91.4/84.2/91.4/88.9%; and EUS, 93.3/77.8/77.8/93.3/84.8% and 89.5/65.7/58.6/92.0/74.1%, respectively. For the 2 expert endoscopists, interobserver agreement for the ES-CRN (first and second assessments) in the derivation group was 0.84 and 0.78, respectively; these values were 0.73 and 0.49, respectively, for the 2 non-expert endoscopists. Discussion/Conclusion: All 3 modalities presented similar diagnostic yield. Inter- and intra-observer agreements of the ES-CRN were substantial, even for non-expert endoscopists. Therefore, EUS-EG may be a useful modality in determining the depth of invasion in colorectal neoplasms.

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Efficacy of the Invasive/Non-invasive Pattern by Magnifying Chromoendoscopy to Estimate the Depth of Invasion of Early Colorectal Neoplasms

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2008.02190.x ◽

2008 ◽

Vol 103 (11) ◽

pp. 2700-2706 ◽

Cited By ~ 197

Author(s):

Takahisa Matsuda ◽

Takahiro Fujii ◽

Yutaka Saito ◽

Takeshi Nakajima ◽

Toshio Uraoka ◽

...

Keyword(s):

Colorectal Neoplasms ◽

Depth Of Invasion ◽

Non Invasive ◽

Magnifying Chromoendoscopy

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NBI and NBI Combined with Magnifying Colonoscopy

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2012/173269 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11 ◽

Cited By ~ 20

Author(s):

Mineo Iwatate ◽

Taro Ikumoto ◽

Santa Hattori ◽

Wataru Sano ◽

Yasushi Sano ◽

...

Keyword(s):

Narrow Band Imaging ◽

Adenomatous Polyps ◽

Screening Colonoscopy ◽

Histological Evaluation ◽

Early Colorectal Cancer ◽

Depth Of Invasion ◽

Diagnostic Strategies ◽

Magnifying Colonoscopy ◽

Magnifying Chromoendoscopy ◽

Meta Analyses

Although magnifying chromoendoscopy had been a reliable diagnostic tool, narrow-band imaging (NBI) has been developed in Japan since 1999 and has now replaced the major role of chromoendoscopy because of its convenience and simplicity. In this paper, we principally describe the efficacy of magnifying chromoendoscopy and magnifying colonoscopy with NBI for detection, histological prediction, estimation of the depth of early colorectal cancer, and future prospects. Although some meta-analyses have concluded that NBI is not superior to white light imaging for detection of adenomatous polyps in screening colonoscopy, NBI with magnification colonoscopy is useful for histological prediction, or for estimating the depth of invasion. To standardize these diagnostic strategies, we will focus on the NBI International Colorectal Endoscopic (NICE) classification proposed for use by endoscopists with or without a magnifying endoscope. However, more prospective research is needed to prove that this classification can be applied with satisfactory availability, feasibility, and reliability. In the future, NBI might contribute to the evaluation of real-time histological prediction during colonoscopy, which has substantial benefits for both reducing the risk of polypectomy and saving the cost of histological evaluation by resecting and discarding diminutive adenomatous polyps (resect and discard strategy).

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Evaluation of hybrid PET/CT gastrography in gastric cancer

Onkologische Welt ◽

10.1055/s-0038-1631532 ◽

2013 ◽

Vol 04 (06) ◽

pp. 253-259

Author(s):

J. Jeong ◽

E. Kong ◽

K. Chun ◽

B. Jang ◽

T. Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Regional Lymph Node ◽

Preoperative Evaluation ◽

Cancer Staging ◽

Diagnostic Value ◽

Endoscopic Biopsy ◽

Depth Of Invasion ◽

Contrast Enhanced Ct ◽

Pet Ct ◽

Ct Gastrography

Summary Aim: With the recent advances in multidetector-row CT, a fusion of functional PET with three dimensional (3D) CT gastrography may provide enhanced diagnostic capability and help surgeons during preoperative planning. The diagnostic value of hybrid PET/CT gastrography was compared with that of conventional PET/CT alone in gastric cancer staging. Patients, methods: Patients with gastric cancer (n = 101) confirmed by endoscopic biopsy specimens underwent conventional PET/CT and regional PET with contrast enhanced CT, followed by gastrectomy with lymphadenectomy at our institution from November 2007 to November 2008. These images were fused into a hybrid PET/CT gastrography using the cardiac IQ fusion software. Conventional PET/CT and hybrid PET/ CT gastrography were evaluated for staging of gastric cancer. After gastrectomy, these were compared with pathologic reports respectively. Results: Gastric cancer was diagnosed as 50 early gastric cancer (EGC) and 51 advanced gastric cancer (AGC) on pathologic examination. In EGC, hybrid PET/CT gastrography and PET/CT identified 36 (72%) and 7 (14%) tumours, respectively. Hybrid PET/CT gastrography correctly delineated the subtype of 25 EGC. In AGC, all 51 (100%) tumours were identified on the hybrid PET/CT gastrography compared to 39 (76.5%) tumours on PET/CT. Hybrid PET/CT gastrography correctly classified the morphology of 42 AGC using the Bormann classification. Additionally, depth of invasion was correctly presented in 38 of 51 AGC. Hybrid PET/CT gastrography for regional lymph node (LN) metastasis in the EGC and AGC showed the sensitivity of 75% and 83.9%, and specificity 90.5% and 55%, respectively. Conclusion: Hybrid PET/CT gastrography is the more intuitive and comprehensive method for the preoperative evaluation of gastric cancer than conventional PET/CT.

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