Acetic Acid Spray With Narrow-Band Imaging Is Useful to Clarify the Margin of Sessile Serrated Adenoma/Polyp

A sessile serrated adenoma/polyp (SSA/P) with cytological dysplasia in the right colon, which transformed to an invasive submucosal adenocarcinoma finally, was endoscopically observed in a 76-year-old woman. A whitish soft SSA/P (approximately 25 mm in diameter) was detected in the cecum. Biopsy samples were obtained from the small nodule, and the lesion was eventually diagnosed as an SSA/P with cytological dysplasia, considering endoscopic observations, among which the narrow-band imaging features suggested that the lesion was adenomatous, that is, a round-oval pattern, and hyperplastic, that is, comprising a circular pattern with dots and an invisible capillary vessel. After 11 months, an SSA/P had rapidly developed into a submucosal adenocarcinoma with lymphatic infiltrations, and the most aggressive deep invasion was observed in the central depression. This case suggests that right-side SSA/Ps with cytological dysplasia should be removed immediately, considering the potential for rapid progression to a larger size and eventually to deep and extensive cancer.

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Magnification endoscopy in combination with acetic acid enhancement and narrow-band imaging for the accurate diagnosis of colonic neoplasms

Endoscopy International Open ◽

10.1055/a-1068-2056 ◽

2020 ◽

Vol 08 (04) ◽

pp. E488-E497

Author(s):

Kotaro Shibagaki ◽

Norihisa Ishimura ◽

Takafumi Yuki ◽

Hideaki Taniguchi ◽

Masahito Aimi ◽

...

Keyword(s):

Acetic Acid ◽

Diagnostic Accuracy ◽

Endoscopic Resection ◽

Narrow Band ◽

Narrow Band Imaging ◽

Colonic Neoplasms ◽

High Accuracy ◽

Colorectal Polyps ◽

Histologic Diagnosis ◽

Magnification Endoscopy

Abstract Background and study aims Magnification endoscopy with narrow-band imaging (NBIME) and NBIME with acetic acid enhancement (A-NBIME) enable visualization of the vascular and microstructural patterns of colorectal polyp. We compared the diagnostic accuracy and reproducibility of white light endoscopy (WLE), NBIME, and A-NBIME for predictive histologic diagnosis. Patients and methods Consecutive colorectal polyps (N = 628; 38 hyperplasias, 488 adenomas, 72 M-SM1 cancers, and 30 SM2 cancers) were photographed with WLE, NBIME, and A-NBIME. Endoscopic images were independently reviewed by three experts, according to the traditional criteria for WLE, the Japan NBI Expert Team classification for NBIME, and pit pattern classification for A-NBIME to compare diagnostic accuracy and interobserver diagnostic agreement among modalities. Results The specificity (95 % confidence interval) of hyperplasia and SM2 cancer with WLE were 98.2 % (96.8 %–99.1%) and 99.4 % (98.5 %–99.9 %), respectively, showing high accuracy for endoscopic resection without magnifying observation. Diagnostic accuracy of WLE, NBIME, and A-NBIME was 80.8 % (77.4 %–83.8 %), 79.3 % (75.9 %–82.4 %), and 86.1 % (83.2 %–88.7 %), respectively, showing the highest accuracy for A-NBIME among modalities (P < .05). NBIME showed a lower PPV for M-SM1 cancer (P < .05), as with WLE (P = .08) compared to A-NBIME. Fleiss’s kappa values for WLE, NBIME, and A-NBIME diagnosis were 0.43 (0.39 – 0.46), 0.52 (0.49 – 0.56) and 0.65 (0.62 – 0.69), respectively, showing insufficient reproducibility of WLE and superiority of A-NBIME among modalities. Conclusion WLE showed high accuracy for endoscopic resection of colorectal polyps in expert diagnosis. NBIME demonstrated a higher diagnostic reproducibility than WLE. A-NBIME showed possible superiority among modalities in both diagnostic accuracy and reproducibility.

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