The difficulty in an endoscopic diagnosis of colorectal tumors depends mainly on their gross configuration. As the superficial flat type and depressed type tumors are usually detected endoscopically by a faint redness on their surface, we evaluated the usefulness of an adopted type hemoglobin index color emphasis system in the lesion of a non‐granular (NG) type laterally spreading tumor (LST). The NG‐type LST was composed of only a flat surface without any nodules. The frequency of Tis was 20.2% and that of T1/T2 was 15.7% in the lesion of the NG‐type LST. Results showed that the adopted type hemoglobin index color emphasis system can emphasize the color level, as the redness and whiteness intensified in this system. The degree of redness and whiteness depended on the emphasis level, and the clarity of colors became clearer in level 5 than level 3 in a lesion of the NG‐type LST. This system may thus contribute to the endoscopic diagnosis of flat and depressed type colorectal lesions.
Background: The usefulness of magnifying videoendoscopic pit pattern diagnosis has been recognized in the differential diagnosis of colonic neoplasms. Also, the correspondence between lesions with a type V pit pattern and cancer has been emphasized. We evaluated the relationship between the type V pit pattern and carcinoma in situ or subdivided submucosal invading carcinomas.
Methods: During the period from May 1997 to December 2001, a total of 8696 colonoscopies were performed and 6672 colorectal lesions were detected. Colorectal lesions (47.7%; 3181/6672) were examined by videoendoscopic magnification. The type V pit pattern was divided into two groups: VI and VN. The submucosal extensions of cancers were classified as sm1, sm2 and sm3 according to the vertical level of invasion. All Tis (n = 57) and operated T1 carcinomas (n = 69) with the type V pit pattern were selected for this study.
Results: Cancer invasion with the type VI pit pattern was limited up to sm2, and the type VN pit pattern was closely related to sm3 extension in protruded type (P = 0.0005). The frequency of the appearance of the type VI pit pattern decreased and that of the type VN pit pattern increased as the invasion extended deeper into the submucosal layer in superficial‐type cancers (P < 0.0001).
Conclusions: Superficial type cancers well reflected the submucosal infiltrating cancer glands when their surface structure had a type VN pit pattern. In contrast, only 20% of sm2 cancers presented a type VN pit pattern among the protruded types.
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