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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.

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Flow chart of patient selection in this study.
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Figure 3: Flow chart of patient selection in this study.

Mentions: Of the included 2238 patients with 2156 colorectal lesions, 132 lesions were initially suspected as early colorectal cancers by conventional endoscopy. After histological evaluation, 12 lesions were confirmed as adenomas and 8 lesions were advanced cancers. Thus, a total of 112 early colorectal cancers in 109 patients were analyzed (Figure 3). The mean age of the patients was 59.5 ± 12.3 years. The mean size of the lesions was 23.2 mm (ranged 8–60 mm). Morphologically, there were 37 polypoid, 54 flat elevated, and 21 depressed lesions. Thirty-nine lesions were located in the right-sided colon, 45 lesions were located in the left-sided colon, and 28 were rectal lesions. Upon histological evaluation, there were 31 adenomas with high-grade dysplasia, 34 intramucosal cancers, 13 SM-s cancers, and 34 SM-d cancers.


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)

Flow chart of patient selection in this study.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Flow chart of patient selection in this study.
Mentions: Of the included 2238 patients with 2156 colorectal lesions, 132 lesions were initially suspected as early colorectal cancers by conventional endoscopy. After histological evaluation, 12 lesions were confirmed as adenomas and 8 lesions were advanced cancers. Thus, a total of 112 early colorectal cancers in 109 patients were analyzed (Figure 3). The mean age of the patients was 59.5 ± 12.3 years. The mean size of the lesions was 23.2 mm (ranged 8–60 mm). Morphologically, there were 37 polypoid, 54 flat elevated, and 21 depressed lesions. Thirty-nine lesions were located in the right-sided colon, 45 lesions were located in the left-sided colon, and 28 were rectal lesions. Upon histological evaluation, there were 31 adenomas with high-grade dysplasia, 34 intramucosal cancers, 13 SM-s cancers, and 34 SM-d cancers.

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