Clinical usefulness of narrow band imaging magnifying colonoscopy for assessing ulcerative colitis-associated cancer/dysplasia

Abstract

Background and study aims: Colitis-associated cancer/dysplasia (CC/D) can affect the life expectancy of patients with ulcerative colitis (UC). Although the utility of magnifying chromocolonoscopy has been shown, the use of optical magnification with narrow band imaging (NBI) for distinguishing CC/D from non-neoplastic lesions in patients with UC has not been reported. We evaluated whether endoscopic findings are distinguishing and thus assessed the clinical usefulness of NBI magnification for differentiating UC-associated lesions. Patients and methods: The study involved 27 patients diagnosed and treated at Hiroshima University Hospital between September 2005 and March 2015: a neoplasia group (16 lesions) and a non-neoplasia group (17 lesions). The neoplasias comprised 9 dysplastic lesions, 5 intramucosal carcinomas, and 2 submucosal carcinomas, and 17 non-neoplastic lesions. Targeted biopsy samples of suspicious lesions detected by conventional colonoscopy were classified pathologically as neoplastic or non-neoplastic, and NBI magnifying colonoscopy findings (i. e., the surface [unclear/regular/irregular/amorphous] and vascular [same as the background mucosa/regular/irregular/avascular] patterns) of the 2 lesion types were compared. Results: Irregular/amorphous surface patterns were significantly more common in neoplastic lesions than in non-neoplastic lesions (81 % [13/16] vs. 18 % [3/17], respectively, P < 0.001). Irregular/avascular vessel pattern tended to be more common in neoplastic lesions (75 % [12/16] vs. 41 % [7/17], respectively). The surface pattern correctly predicted 82 % of neoplastic lesions, and the vessel pattern correctly predicted 67 % of non-neoplastic lesions. The 2 endoscopic findings together correctly predicted 91 % of neoplastic lesions. Conclusion: Surface pattern, determined by magnifying colonoscopy with NBI, is useful for differenting between UC-associated neoplastic and non-neoplastic lesions.

Clinical usefulness of magnifying colonoscopy for the diagnosis of ulcerative colitis‐associated neoplasia

“…found that dysplasia was characteristically darkened by obvious capillary vessels. Nishiyama et al . reported that irregular/amorphous surface patterns were useful for differentiation between UCAN and non‐neoplastic lesion.…”

“…East et al 17 found that dysplasia was characteristically darkened by obvious capillary vessels. Nishiyama et al 18 reported that irregular/amorphous surface patterns were useful for differentiation between UCAN and non-neoplastic lesion. Regarding MC, Kiesslich et al 19 showed that types III, IV and V pit pattern under MC, which were initially proposed for the diagnosis of neoplasm in non-UC subjects, 12,13 were suggestive of dysplasia even in UC patients.…”

Detection and characterization of colitis‐associated cancer/dysplasia: Based on reports from the JDDW 2017 and meta‐analyses of prospective studies concerning endoscopic procedure

“…reported that a tortuous surface structure on NBI magnification might serve as a clue for the identification of dysplasia in UC patients. Nishiyama et al . suggested irregular and amorphous surface patterns as key findings on NBI for distinguishing CC/D from non‐neoplastic lesions.…”

“…Nishiyama et al 9 suggested irregular and amorphous surface patterns as key findings on NBI for distinguishing CC/ D from non-neoplastic lesions. Recently, Sano et al established the JNET classification system for colorectal tumors, although whether or not JNET is useful for discriminating CC/D from non-neoplastic lesions and from sporadic tumors remains unclear.…”

Diagnostic Accuracy of Endoscopic Trimodal Imaging and Chromoendoscopy for Lesion Characterization in Ulcerative Colitis

“…Several endoscopic imaging techniques have been studied regarding their ability to differentiate dysplastic from non-dysplastic mucosa in patients with longstanding colitis. Besides CE, [8][9][10][11][12] these include advanced imaging techniques as i-Scan 10 , autofluorescence imaging (AFI), 13 narrow band imaging (NBI) 8,[13][14][15] and confocal laser endomicroscopy (CLE). 16,17 It is important to differentiate between dysplastic and non-dysplastic lesions endoscopically as only dysplastic lesions need to be removed to prevent CRC development.…”