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Value of magnifying chromoendoscopy (ME-CE) and magnifying Optical Enhancement Technology (ME-OE) in classifying colorectal polyps: a prospective controlled study

ABSTRACT: Interventions: Gold Standard:Histopathological examination;Index test:jnet classification kudo classification Primary outcome(s): total number of colorectal adenomas Study Design: Sequential

DISEASE(S): Colorectal Adenoma

PROVIDER: 2692579 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Background and aimsVirtual magnifying chromoendoscopy with flexible spectral imaging color enhancement (FICE), image-enhanced endoscopy techniques, and dye-staining magnifying chromoendoscopy (with Indigo carmine and Crystal violet) have contributed to better visualization of the pit pattern and vascular structure of colorectal polyp. Therefore, magnifying chromoendoscopy is capable of predicting the histopathological results of colorectal polyp without biopsy and remains their diagnostic values over time, especially in scare-setting resources. This study compared the images of magnifying chromoendoscopy between FICE, Indigo carmine, and Crystal violet and then assessed their diagnostic values based on colorectal polyps' histopathology as a gold standard.MethodsA total of 332 polyps of 266 patients were endoscopically evaluated from June 2016 to September 2019. After identified by white light endoscopy, polyps continued to be evaluated by virtual magnifying chromoendoscopy (×50-150 times) with FICE. The capillary-vessel pattern was divided into 5 subtypes according to the number, morphology, and distribution of the fine blood vessels according to Teixeira classification. Next, they were stained with Indigo carmine 0.2% and then Crystal violet 0.05% and were classified according to Kudo's pit pattern classification. Finally, polyps were resected by endoscopy or surgery and biopsy and compared with histopathological results of either neoplastic or nonplastic polyp.ResultsThe number of neoplastic polyps was 278/332 with 231 adenoma polyps and 47 carcinoma polyps. Magnifying chromoendoscopy has high sensitivity and accuracy when compared with the histopathological results of colorectal polyps. The sensitivity, specificity, and accuracy of magnifying chromoendoscopy with Crystal violet are 97.2%, 72.2%, and 93.0%; with Indigo carmine are 96.0%, 72.2%, and 92.1%; and with FICE are 92.1%, 68.5%, and 88.3%.ConclusionsAmong the three methods, Crystal violet has the highest sensitivity and accuracy in predicting histopathological results of colorectal polyps. FICE has shown its diagnostic value with reliable sensitivity and accuracy and should still be a reasonable endoscopic choice for physicians in scare-setting resources regardless its moderate specificity. Physicians should base on their facility and capability to determine an appropriate endoscopy technique.

Project description:BackgroundOur recent prospective study found equivalent accuracy of magnifying chromoendoscopy (MC) and endoscopic ultrasonography (EUS) for diagnosing the invasion depth of colorectal cancer (CRC); however, whether these tools show diagnostic differences in categories such as tumor size and morphology remains unclear. Hence, we conducted detailed subset analysis of the prospective data.MethodsIn this multicenter, prospective, comparative trial, a total of 70 patients with early, flat CRC were enrolled from February 2011 to December 2012, and the results of 66 lesions were finally analyzed. Patients were randomly allocated to primary MC followed by EUS or to primary EUS followed by MC. Diagnoses of invasion depth by each tool were divided into intramucosal to slight submucosal invasion (invasion depth <1000 μm) and deep submucosal invasion (invasion depth ≥1000 μm), and then compared with the final pathological diagnosis by an independent pathologist blinded to clinical data. To standardize diagnoses among examiners, this trial was started after achievement of a mean κ value of ≥0.6 which was calculated from the average of κ values between each pair of participating endoscopists.ResultsBoth MC and EUS showed similar diagnostic outcomes, with no significant differences in prediction of invasion depth in subset analyses according to tumor size, location, and morphology. Lesions that were consistently diagnosed as Tis/T1-SMS or ≥T1-SMD with both tools revealed accuracy of 76-78%. Accuracy was low in borderline lesions with irregular pit pattern in MC and distorted findings of the third layer in EUS (MC, 58.5%; EUS, 50.0%).ConclusionsMC and EUS showed the same limited accuracy for predicting invasion depth in all categories of early CRC. Since the irregular pit pattern in MC, distorted findings to the third layer in EUS and inconsistent diagnosis between both tools were associated with low accuracy, further refinements or even novel methods are still needed for such lesions.Trial registrationUniversity hospital Medical Information Network Clinical Trials Registry UMIN 000005085.

Project description:BACKGROUND:Accurate detection of gastric infection by Helicobacter pylori (H. pylori) and premalignant lesions are important for effective provision of treatment, preventing the development of gastric neoplasia. Optical enhancement systems with optical magnification improved the identification of mucosal superficial and vascular patterns in patients with dyspepsia. AIM:To evaluate an optical enhancement system with high-definition magnification, for diagnosis of normal gastric mucosa, H. pylori-associated gastritis, and gastric atrophy. METHODS:A cross-sectional, nonrandomized study from November 2015 to April 2016 performed in a single-tertiary academic center from Ecuador. Seventy-two consecutive patients with functional dyspepsia according to the Rome III criteria, were tested for H. pylori using a stool antigen test and were assigned to an Hp + group or an Hp - control group. Esophagogastroduodenoscopy with high-definition optical magnification and digital chromoendoscopy was performed, and patients were classified into 4 groups, in accordance to the microvascular-architecture pattern of the mucosa. Interobserver and intraobserver agreement among operators were calculated. RESULTS:Of the 72 participants, 35 were Hp + and 37 were Hp -. Among 10 patients with normal mucosal histology in biopsy samples, 90% had a Type I pattern of microvascular architecture by endoscopy. Among participants with type IIa and type IIb patterns, significantly more were Hp+ than Hp- (32 vs 8), and most (31 out of 40) had histological diagnoses of chronic active gastritis. Two of the three participants with a histological diagnosis of atrophy had a type III microvascular pattern. The type I pattern predicted normal mucosa, type IIa-IIb predicted H. pylori infection, and type III predicted atrophy with sensitivities of 90.0%, 91.4%, and 66.7%, respectively. The intraobserver and interobserver agreements had kappa values of 0.91 and 0.89, respectively. CONCLUSION:High-definition optical magnification with digital chromoendoscopy is useful for diagnosis of normal gastric mucosa and H. pylori-associated gastritis with high accuracy, but further studies are needed to determine whether endoscopic diagnosis of gastric atrophy is feasible.

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Value of magnifying chromoendoscopy (ME-CE) and magnifying Optical Enhancement Technology (ME-OE) in classifying colorectal polyps: a prospective controlled study

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