Limits...
Endoscopic diagnosis of invasion depth for early colorectal carcinomas: a prospective comparative study of narrow-band imaging, acetic acid, and crystal violet.

Zhang JJ, Gu LY, Chen XY, Gao YJ, Ge ZZ, Li XB - Medicine (Baltimore) (2015)

Bottom Line: For image evaluation by novices, NBI achieved the highest accuracy of 80.6%, compared with that of 72.4% by acetic acid, and 75.8% by crystal violet.For diagnosis of SM-d carcinoma, NBI was slightly inferior to crystal violet staining, when performed by the expert endoscopist.However, NBI yielded higher accuracy than crystal violet staining, in terms of less experienced endoscopists.

View Article: PubMed Central - PubMed

Affiliation: From the State Key Laboratory for Oncogenes and Related Genes (JJ Z, XY C, YJ G, ZZ G, XB L), Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease; and Department of Rheumatology (LY G), South campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

ABSTRACT
Several studies have validated the effectiveness of narrow-band imaging (NBI) in estimating invasion depth of early colorectal cancers. However, comparative diagnostic accuracy between NBI and chromoendoscopy remains unclear. Other than crystal violet, use of acetic acid as a new staining method to diagnose deep submucosal invasive (SM-d) carcinomas has not been extensively evaluated. We aimed to assess the diagnostic accuracy and interobserver agreement of NBI, acetic acid enhancement, and crystal violet staining in predicting invasion depth of early colorectal cancers. A total of 112 early colorectal cancers were prospectively observed by NBI, acetic acid, and crystal violet staining in sequence by 1 expert colonoscopist. All endoscopic images of each technique were stored and reassessed. Finally, 294 images of 98 lesions were selected for evaluation by 3 less experienced endoscopists. The accuracy of NBI, acetic acid, and crystal violet for real-time diagnosis was 85.7%, 86.6%, and 92.9%, respectively. For image evaluation by novices, NBI achieved the highest accuracy of 80.6%, compared with that of 72.4% by acetic acid, and 75.8% by crystal violet. The kappa values of NBI, acetic acid, and crystal violet among the 3 trainees were 0.74 (95% CI 0.65-0.83), 0.68 (95% CI 0.59-0.77), and 0.70 (95% CI 0.61-0.79), respectively. For diagnosis of SM-d carcinoma, NBI was slightly inferior to crystal violet staining, when performed by the expert endoscopist. However, NBI yielded higher accuracy than crystal violet staining, in terms of less experienced endoscopists. Acetic acid enhancement with pit pattern analysis was capable of predicting SM-d carcinoma, comparable to the traditional crystal violet staining.

Show MeSH

Related in: MedlinePlus

Endoscopic images of a colorectal lesion histologically confirmed as sm2 cancer. (A) Conventional colonoscopy view. (B) Narrow-band imaging view indicated capillary pattern type IIIB, as nearly avascular or loose microvascular areas were observed. (C) Acetic acid enhancement showed an irregular glandular structure indicative of pit pattern type VI. (D) Crystal violet staining showed highly irregular pits and an amorphous structure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4554180&req=5

Figure 2: Endoscopic images of a colorectal lesion histologically confirmed as sm2 cancer. (A) Conventional colonoscopy view. (B) Narrow-band imaging view indicated capillary pattern type IIIB, as nearly avascular or loose microvascular areas were observed. (C) Acetic acid enhancement showed an irregular glandular structure indicative of pit pattern type VI. (D) Crystal violet staining showed highly irregular pits and an amorphous structure.

Mentions: Patients were prepared with 2 L of polyethylene glycol solution in the morning before the colonoscopy. All colonoscopies were performed by 1 expert with experience of more than 1000 cases in NBI and chromoendoscopy, using a magnifying colonoscope (CF-H260AZI; Olympus Medical systems, Tokyo, Japan) and an electric endoscopic system (EVIS 260 Spectrum; Olympus Medical systems). Lesions were detected by white light endoscopy and then evaluated by NBI, acetic acid, and crystal violet staining in sequence. Tumors having more than one of the following characteristics were suspected of early cancers and included in this study: depression, hardness, erosion, surface nodularity, convergence of mucosal folds, and mucosal friability.16,17 Following conventional view, lesions were observed by magnifying NBI for capillary pattern (CP) analysis. Subsequently, 1.5% acetic acid solution was injected from the forceps channel to stain the mucosa. After PP enhancement by acetic acid had disappeared, 0.05% crystal violet solution was sprayed. PP was evaluated according to Kudo's classification. For each lesion, endoscopic assessments of CPP and PP were recorded. Representative endoscopic images of each method of the same portion were taken and stored (Figures 1 and 2).


Endoscopic diagnosis of invasion depth for early colorectal carcinomas: a prospective comparative study of narrow-band imaging, acetic acid, and crystal violet.

Zhang JJ, Gu LY, Chen XY, Gao YJ, Ge ZZ, Li XB - Medicine (Baltimore) (2015)

Endoscopic images of a colorectal lesion histologically confirmed as sm2 cancer. (A) Conventional colonoscopy view. (B) Narrow-band imaging view indicated capillary pattern type IIIB, as nearly avascular or loose microvascular areas were observed. (C) Acetic acid enhancement showed an irregular glandular structure indicative of pit pattern type VI. (D) Crystal violet staining showed highly irregular pits and an amorphous structure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554180&req=5

Figure 2: Endoscopic images of a colorectal lesion histologically confirmed as sm2 cancer. (A) Conventional colonoscopy view. (B) Narrow-band imaging view indicated capillary pattern type IIIB, as nearly avascular or loose microvascular areas were observed. (C) Acetic acid enhancement showed an irregular glandular structure indicative of pit pattern type VI. (D) Crystal violet staining showed highly irregular pits and an amorphous structure.
Mentions: Patients were prepared with 2 L of polyethylene glycol solution in the morning before the colonoscopy. All colonoscopies were performed by 1 expert with experience of more than 1000 cases in NBI and chromoendoscopy, using a magnifying colonoscope (CF-H260AZI; Olympus Medical systems, Tokyo, Japan) and an electric endoscopic system (EVIS 260 Spectrum; Olympus Medical systems). Lesions were detected by white light endoscopy and then evaluated by NBI, acetic acid, and crystal violet staining in sequence. Tumors having more than one of the following characteristics were suspected of early cancers and included in this study: depression, hardness, erosion, surface nodularity, convergence of mucosal folds, and mucosal friability.16,17 Following conventional view, lesions were observed by magnifying NBI for capillary pattern (CP) analysis. Subsequently, 1.5% acetic acid solution was injected from the forceps channel to stain the mucosa. After PP enhancement by acetic acid had disappeared, 0.05% crystal violet solution was sprayed. PP was evaluated according to Kudo's classification. For each lesion, endoscopic assessments of CPP and PP were recorded. Representative endoscopic images of each method of the same portion were taken and stored (Figures 1 and 2).

Bottom Line: For image evaluation by novices, NBI achieved the highest accuracy of 80.6%, compared with that of 72.4% by acetic acid, and 75.8% by crystal violet.For diagnosis of SM-d carcinoma, NBI was slightly inferior to crystal violet staining, when performed by the expert endoscopist.However, NBI yielded higher accuracy than crystal violet staining, in terms of less experienced endoscopists.

View Article: PubMed Central - PubMed

Affiliation: From the State Key Laboratory for Oncogenes and Related Genes (JJ Z, XY C, YJ G, ZZ G, XB L), Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease; and Department of Rheumatology (LY G), South campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

ABSTRACT
Several studies have validated the effectiveness of narrow-band imaging (NBI) in estimating invasion depth of early colorectal cancers. However, comparative diagnostic accuracy between NBI and chromoendoscopy remains unclear. Other than crystal violet, use of acetic acid as a new staining method to diagnose deep submucosal invasive (SM-d) carcinomas has not been extensively evaluated. We aimed to assess the diagnostic accuracy and interobserver agreement of NBI, acetic acid enhancement, and crystal violet staining in predicting invasion depth of early colorectal cancers. A total of 112 early colorectal cancers were prospectively observed by NBI, acetic acid, and crystal violet staining in sequence by 1 expert colonoscopist. All endoscopic images of each technique were stored and reassessed. Finally, 294 images of 98 lesions were selected for evaluation by 3 less experienced endoscopists. The accuracy of NBI, acetic acid, and crystal violet for real-time diagnosis was 85.7%, 86.6%, and 92.9%, respectively. For image evaluation by novices, NBI achieved the highest accuracy of 80.6%, compared with that of 72.4% by acetic acid, and 75.8% by crystal violet. The kappa values of NBI, acetic acid, and crystal violet among the 3 trainees were 0.74 (95% CI 0.65-0.83), 0.68 (95% CI 0.59-0.77), and 0.70 (95% CI 0.61-0.79), respectively. For diagnosis of SM-d carcinoma, NBI was slightly inferior to crystal violet staining, when performed by the expert endoscopist. However, NBI yielded higher accuracy than crystal violet staining, in terms of less experienced endoscopists. Acetic acid enhancement with pit pattern analysis was capable of predicting SM-d carcinoma, comparable to the traditional crystal violet staining.

Show MeSH
Related in: MedlinePlus