Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy

Hurlstone, David P.; Fujii, Takeshi; Lobo, Alan

doi:10.1046/j.0007-1323.2001.02040.x

Cited by 77 publications

(68 citation statements)

References 31 publications

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“…Yet, an overarching purpose of this study was to determine if ACF identification and enumeration could be done in a manner that could conceivably be applied to routine clinical practice. Indeed, the ease with which we did MCC, along with the previously shown higher rate of this technique for identifying flat cancers (30), suggests that, as has been argued by others (30), chromoscopy should perhaps be the favored approach for colorectal cancer screening. As to whether ACF enumeration should likewise be routinely done is not clear and will require prospective studies to determine if the number of small ACFs present in a patient has prognostic significance with regard to future adenoma development.…”

Section: Discussionmentioning

confidence: 99%

Aberrant Crypt Focus Size Predicts Distal Polyp Histopathology

Kim

Arozulllah

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Aberrant crypt foci (ACF) are the earliest histopathologic lesion associated with colorectal cancer. ACFs are commonly used as a surrogate marker for colorectal cancer chemoprevention studies in rodents and, more recently, in humans. However, ACF prevalence in unselected populations is not known, nor which ACF features are important for predicting polyp histopathology. To address these questions, we did magnification chromo-colonoscopy on all patients undergoing routine colorectal cancer screening over a 31-month period. ACFs were classified by location, size (small, <20 crypts/ ACF; medium, 20-100 crypts/ACF; large, >100 crypts/ ACF), and whether they were elevated above the tissue plane. Overall, 802 magnification chromo-colonoscopies with ACF enumeration were done. Mean patient age was 58.6 F 8.5 years, of whom 56% were female, 58% were African American, 21% were Caucasian, and 16% were Latino. Total ACF number, along with increasing ACF size and elevation, correlated with the presence of distal hyperplastic polyps and were higher in African Americans. In contrast, ever-smaller ACFs correlated with the presence of distal adenomas and were independent of age and race. The odds ratio for patients with z6 small ACFs and adenomas was 6.02 (95% confidence interval, 2.64-13.70) compared with patients with V5 small ACFs, whereas the odds ratio for patients with z1 large ACF and hyperplastic polyps was 5.88 (95% confidence interval, 3.00-11.67) compared with patients with none. Small flat ACFs correlate with the presence of distal adenomas, whereas large raised ACFs correlate with the presence of hyperplastic polyps. (Cancer Epidemiol Biomarkers Prev 2008;17(5):1155 -62)

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Section: Discussionmentioning

confidence: 99%

Aberrant Crypt Focus Size Predicts Distal Polyp Histopathology

Kim

Arozulllah

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Targeted chromoscopy using 5-10 ml of 0.5% indigo carmine (IC) was used to delineate detailed morphology. 12 Lesions were classified morphologically according to the Paris Workshop guidelines. 1 Flat lesions were defined as mucosal change with a flat or slightly rounded surface with a height of less than half the diameter with no distinct stalk or pedicle (PT type II).…”

Section: Methodsmentioning

confidence: 99%

“…11 12 For PT II lesions vertically infiltrating sm layers 2 or 3, LNM rates exceed 10-15%. 12 Thus for EMR specimens the ''cut off'' value adopted by the Paris Workshop Group for quantitative micrometric measure is now assumed to be 1000 mm.…”

mentioning

confidence: 99%

High magnification chromoscopic colonoscopy or high frequency 20 MHz mini probe endoscopic ultrasound staging for early colorectal neoplasia: a comparative prospective analysis

Hurlstone

Brown²,

Cross³

et al. 2005

Gut

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Background: Successful endoscopic management of early colorectal cancer using endoscopic mucosal resection requires the mandatory prediction of invasive depth and lymph node metastasis. Previous data using the Nagata crypt types Vn(B)/(C) as clinical indicators of T2/N+ disease have shown low specificity (50%) with a tendency to over stage lesions. New mini probe ultrasound ''through the scope'' imaging permits staging of lesions proximal to the rectum using direct endoscopic visualisation. Aim: To compare the staging accuracy of the Nagata crypt type V with mini probe high frequency 20 MHz endoscopic ultrasound. Methods: Sixty two patients with a Paris type II flat cancer were imaged using magnification colonoscopy followed by 20/12.5 MHz ultrasound in a ''back to back'' design. Crystal violet staining (0.05%) at 1006 magnification permitted Nagata crypt criteria to be defined. Submucosal deep invasion (sm3+) was defined at ultrasound by the presence or absence of a disrupted third sonographic layer. Predicted T0/1: N0 lesions were resected using endoscopic mucosal resection with the remaining referred for surgery. Ultrasound and magnification staging were then compared with the resected histopathological specimens. Results: One patient was excluded from the study due to poor bowel preparation. Fifty two lesions from 52 patients therefore met inclusion criteria (12 sm1/13 sm2/27 sm3+). Ultrasound (20 MHz) was significantly more accurate for invasive depth staging compared with Nagata stage (p,0.0001) (overall accuracy 93% and 59%, respectively). The sensitivity for lymph node metastasis detection using ultrasound and magnification was 80% and 31%, respectively (p,0.001). The negative predictive value of ultrasound for invasive depth was better than that observed using magnification (88%/47%, respectively). The prevalence of nodal disease overall was 19% (10/52), with 80% (8/10) node positive lesions occurring in the sm3+ lesion group. Conclusions: High frequency 20 MHz ultrasound is superior to magnification alone when differentiating T1/2 disease with a high positive predictive value for sm3 differentiation. Sm3+ invasion was associated with nodal metastasis.

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“…A prevenção secundária para o CCR é altamente eficaz (1,2) e possibilita a redução considerá-vel em sua mortalidade para os indivíduos submetidos a rastreamento por colonoscopia por permitir a identificação e ressecção dos pólipos colorretais, lesões precursoras do câncer (3) .…”

Section: Introductionunclassified

Colonoscopia com magnificação de imagem: análise da variação interobservadores para os padrões de criptas e comparação das imagens endoscópicas com os achados histopatológicos

Zanoni

Cutait

Averbach

et al. 2006

Rev bras. colo-proctol.

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RESUMO: A colonoscopia com magnificação de imagem (CMI) é considerada uma técnica que possibilita o diagnóstico diferencial entre lesões colorretais neoplásicas e não-neoplásicas. Este estudo avaliou a variação da concordância interobservadores para os padrões de criptas através de três endoscopistas experientes com a classificação de INTRODUÇÃOO CCR constitui-se em neoplasia frequente no mundo, tendo considerável participação na mortandade por câncer. A prevenção secundária para o CCR é altamente eficaz (1,2) e possibilita a redução considerá-vel em sua mortalidade para os indivíduos submetidos a rastreamento por colonoscopia por permitir a identificação e ressecção dos pólipos colorretais, lesões precursoras do câncer (3) .Contudo, deve-se considerar a possibilidade da não-detecção de lesões polipóides (4,5,6) , a existência de lesões planas diminutas que apresentam comportamento biológico mais agressivo em relação as polipóides do mesmo tamanho (7,8,9,10) ou, então, presença de carcinomas precoces plano-deprimidos que podem ser invasivos, mesmo quando muito pequenos (11,12).Com o advento dos videoendoscópicos de alta resolução, lesões planas e plano-deprimidas, consideradas um desafio ao diagnóstico por colonoscopia convencional, passaram a ser mais frequentemente detectadas (13,14,15,16) e melhor definidas com o emprego da cromoendoscopia (CE) e colonoscopia com magnificação de imagem (CMI). Estas inovações permitiram também o diagnóstico diferencial endoscópico entre lesões neoplásicas e não-neoplásicas (11,17,18,19,20,21,22) .O estabelecimento do diagnóstico histológico de uma lesão ainda durante a endoscopia poderia eco-

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Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy

Abstract: Early CRC, in the form of flat or depressed lesions, can be difficult to detect using conventional colonoscopic techniques and penetrate the colonic mucosa deeply. The implications of detecting these lesions in relation to current approaches to the prevention of CRC are profound.

Cited by 77 publications

References 31 publications

Aberrant Crypt Focus Size Predicts Distal Polyp Histopathology

Aberrant Crypt Focus Size Predicts Distal Polyp Histopathology

High magnification chromoscopic colonoscopy or high frequency 20 MHz mini probe endoscopic ultrasound staging for early colorectal neoplasia: a comparative prospective analysis

Colonoscopia com magnificação de imagem: análise da variação interobservadores para os padrões de criptas e comparação das imagens endoscópicas com os achados histopatológicos

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