Diagnostic features of sessile serrated adenoma/polyps on magnifying narrow band imaging: A prospective study of diagnostic accuracy

Yamashina, Takeshi; Takeuchi, Yoji; Uedo, Noriya; Aoi, Kenji; Matsuura, Noriko; Nagai, Kengo; Matsui, Futoshi; Ito, Takashi; Fujii, Masazumi; Yamamoto, Sachiko; Hanaoka, Noboru; Higashino, Koji; Ishihara, Ryu; Tomita, Yoshihiro; Iishi, Hiroyasu

doi:10.1111/jgh.12688

Cited by 67 publications

(84 citation statements)

References 14 publications

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“…The majority of sessile serrated adenomas might have been excluded from this study because they can share many features of hyperplastic polyps. 24,25 Delayed postpolypectomy bleeding could not be evaluated because additional EMR was performed to evaluate the presence of residual tissues after each polypectomy. The complete resection rates for adenomatous polyps %4 mm were not significantly different between the CSP group and the CFP group in our study.…”

Section: Discussionmentioning

confidence: 99%

Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial

Kim

Lee

Choi

et al. 2015

Gastrointestinal Endoscopy

155

131

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Section: Discussionmentioning

confidence: 99%

Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial

Kim

Lee

Choi

et al. 2015

Gastrointestinal Endoscopy

155

131

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“…37 Using 100-fold magnification, NBI has been able to visualize expanded crypt openings and thick branched vessels with improved performance, resulting in 84.3% sensitivity, 81.1% specificity, and 82.4% accuracy. 38 Autofluorescence imaging (AFI) uses differences in the fluorescence emission spectra from endogenous fluorophores. AFI has been used in combination with HD-WLE (high definition) and NBI in a tri-modal system to distinguish SSAs, but the diagnostic accuracy in a prospective study was poor.…”

Section: Discussionmentioning

confidence: 99%

Detection of Sessile Serrated Adenomas in the Proximal Colon Using Wide-Field Fluorescence Endoscopy

et al. 2017

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Background & Aims Many cancers in the proximal colon develop via from sessile serrated adenomas (SSAs), which have flat, subtle features that are difficult to detect with conventional white-light colonoscopy. Many SSA cells have the V600E mutation in BRAF. We investigated whether this feature could be used with imaging methods to detect SSAs in patients. Methods We used phage display to identify a peptide that binds specifically to SSAs, using subtractive hybridization with HT29 colorectal cancer cells containing the V600E mutation in BRAF and Hs738.St/Int cells as a control. Binding of fluorescently labeled peptide to colorectal cancer cells was evaluated with confocal fluorescence microscopy. Rats received intra-colonic 0.0086 mg/kg, 0.026 mg/kg, or 0.86 mg/kg peptide or vehicle and morbidity, mortality, and injury were monitored twice daily to assess toxicity. In the clinical safety study, fluorescently labeled peptide was topically administered, using a spray catheter, to the proximal colon of 25 subjects undergoing routine outpatient colonoscopies (3 subjects were given 2.25 µmol/L and 22 patients were given 76.4 µmol/L). We performed blood cell count, chemistry, liver function, and urine analyses approximately 24 hrs after peptide administration. In the clinical imaging study, 38 subjects undergoing routine outpatient colonoscopies, at high risk for colorectal cancer, or with a suspected unresected proximal colonic polyp, were first evaluated by white-light endoscopy, to identify suspicious regions. The fluorescently labeled peptide (76.4 µmol/L) was administered topically to proximal colon, unbound peptide was washed away, and white-light, reflectance, and fluorescence videos were recorded digitally. Fluorescence intensities of SSAs were compared with those of normal colonic mucosa. Endoscopists resected identified lesions, which were analyzed histologically by gastrointestinal pathologists (reference standard). We also analyzed the ability of the peptide to identify SSAs vs adenomas, hyperplastic polyps, and normal colonic mucosa in specimens obtained from the tissue bank at the University of Michigan. Results We identified the peptide sequence KCCFPAQ, and measured an apparent dissociation constant of kd = 72 nM and an apparent association time constant of k = 0.174 min−1 (5.76 min). During fluorescence imaging of patients during endoscopy, regions of SSA had 2.43-fold higher mean fluorescence intensity than that for normal colonic mucosa. Fluorescence labeling distinguished SSAs from normal colonic mucosa with 89% sensitivity and 92% specificity. The peptide had no observed toxic effects in animals or patients. In the analysis of ex vivo specimens, peptide bound to SSAs had significantly higher mean fluorescence intensity than to hyperplastic polyps. Conclusions We have identified a fluorescently labeled peptide that has no observed toxic effects in animals or humans and can be used for wide-field imaging of lesions in the proximal colon. It distinguishes SSAs from normal colonic mucosa with 89%...

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“…The surface structure has been presumed to be a consequence of the dilated crypt openings, which is one of the significant histologic findings of SSA/Ps. NBI colonoscopy was also able to detect round-open crypt openings, and in addition, it could detect abnormally dilated capillaries on the surface of SSA/Ps, which may be a source of VMV [10,11] . The VMV has been considered to conform to the microvascular changes extending into the deeper mucosal layer.…”

Section: Discussionmentioning

confidence: 99%

“…Under magnifying chromoendoscopy, the surface pattern was determined to be a pinecone-like pattern, a fern-like pattern, a star-like pattern or a round-open pit pattern in accordance with the classifications proposed by Kashida et al [8] and Kimura et al [9] . In addition, the findings of magnifying NBI colonoscopy were reviewed with respect to expanded crypt openings and varicose microvascular vessels (VMV), as proposed by Yamashina et al [10] and Uraoka et al [11] . The above-mentioned magnifying endoscopy was performed for ISLs.…”

Section: Data Collectionmentioning

confidence: 99%

Clinicopathologic Features of Inverted Serrated Lesions of the Large Bowel

Kawasaki

Kurahara²,

Oshiro³

et al. 2016

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Background/Aims: Serrated lesions (SLs) of the large bowel occasionally manifest as inverted growths with endophytic expansion within the muscularis mucosa. The aims of this investigation were to investigate the incidence of inverted SLs (ISLs) among SLs and to describe the clinicopathologic features. Methods: We reviewed the colonoscopy records from 2006 to 2014 at our institution and identified cases of endoscopically or surgically resected SLs, including hyperplastic polyps (HPs), sessile serrated adenomas/polyps (SSA/Ps) and traditional serrated adenomas (TSAs). The incidence of ISLs among the SLs and their colonoscopic findings were investigated retrospectively. Results: There were 35 HPs in 30 patients, 80 SSA/Ps in 65 patients and 70 TSAs in 65 patients. The incidence of ISLs was significantly higher among SSA/Ps (8.8%) and HPs (5.7%) than among TSAs (0%; p = 0.04). A predominant right-sided location, a flat-elevated configuration with a central depression and round-open pit pattern or expanded crypt openings were characteristic of ISLs of the SSA/P type. Conclusions: Right-sided flat lesions with a central depression and round or expanded crypts are indicative of ISLs of the SSA/P type.

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Diagnostic features of sessile serrated adenoma/polyps on magnifying narrow band imaging: A prospective study of diagnostic accuracy

Abstract: Identification of ECOs, supplemented with TBVs, has high sensitivity for the diagnosis of SSA/P. These findings may facilitate the use of endoscopic optical diagnosis in clinical practice.

Cited by 67 publications

References 14 publications

Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial

Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial

Detection of Sessile Serrated Adenomas in the Proximal Colon Using Wide-Field Fluorescence Endoscopy

Clinicopathologic Features of Inverted Serrated Lesions of the Large Bowel

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