Combined endocytoscopy with pit pattern diagnosis in ulcerative colitis‐associated neoplasia: Pilot study

Abstract

Objectives: Ulcerative colitis-associated neoplasias (UCAN) are often flat with an indistinct boundary from surrounding tissues, which makes differentiating UCAN from non-neoplasias difficult. Pit pattern (PIT) has been reported as one of the most effective indicators to identify UCAN. However, regenerated mucosa is also often diagnosed as a neoplastic PIT. Endocytoscopy (EC) allows visualization of cell nuclei. The aim of this retrospective study was to demonstrate the diagnostic ability of combined EC irregularly-formed nuclei with PIT (EC-IN-PIT) diagnosis to identify UCAN.Methods: This study involved patients with ulcerative colitis whose lesions were observed by EC. Each lesion was diagnosed by two independent expert endoscopists, using two types of diagnostic strategies: PIT alone and EC-IN-PIT. We evaluated and compared the diagnostic abilities of PIT alone and EC-IN-PIT. We also examined the difference in the diagnostic abilities of an EC-IN-PIT diagnosis according to endoscopic inflammation severity. Results:We analyzed 103 lesions from 62 patients; 23 lesions were UCAN and 80 were non-neoplastic. EC-IN-PIT diagnosis had a significantly higher specificity and accuracy compared with PIT alone: 84% versus 58% (P < 0.001), and 88% versus 67% (P < 0.01), respectively. The specificity and accuracy were significantly higher for Mayo endoscopic score (MES) 0-1 than MES 2-3: 93% versus 68% (P < 0.001) and 95% versus 74% (P < 0.001), respectively.Conclusions: Our novel EC-IN-PIT strategy had a better diagnostic ability than PIT alone to predict UCAN from suspected and initially detected lesions using conventional colonoscopy. UMIN clinical trial (UMIN000040698).

Evolving roles of magnifying endoscopy and endoscopic resection for neoplasia in inflammatory bowel diseases

“…Their data found that both pit patterns and its combination with endocytoscopy had high sensitivities to diagnose UC-associated neoplasia (97.8% vs 100%). In addition, the authors also demonstrated that the specificity was higher in the combined assessment of pit patterns with endocytoscopy compared to pit patterns alone (84.4% vs 57.5%) (Table 1 )[ 26 ]. This study demonstrated that endocytoscopy can enhance the specificity of pit patterns for the diagnosis of neoplasia in IBD patients, suggesting an endocytoscopy-assisted pit pattern assessment may be a novel approach to overcome the limitation of pit patterns alone.…”

“…This study demonstrated that endocytoscopy can enhance the specificity of pit patterns for the diagnosis of neoplasia in IBD patients, suggesting an endocytoscopy-assisted pit pattern assessment may be a novel approach to overcome the limitation of pit patterns alone. However, they also found that the specificity can be affected by active inflammation (Mayo endoscopic subscore 2-3) and that false positive rates were high (16.2% in type II-V pits with positive irregularly-formed nuclei and 10.3% in type V)[ 26 ]. Therefore, achieving endoscopic remission is essential for an accurate evaluation of pit-patterns or cellular nuclei using magnifying scopes.…”

Clinical Efficacy of Endocytoscopy for Gastrointestinal Endoscopy

“…Some prototype endocytoscopes have been reported; however, commercially available endocytoscopes for the upper and lower gastrointestinal tract (GIF-H290EC and CF-H290ECI; Olympus Corp. Tokyo, Japan) were launched in 2018. 4,5 These two scopes have one objective lens with 520-fold magnification and a manual zoom mechanism similar to a conventional magnifying endoscope. One endoscope can switch from normal observation to magnified observation and ultra-magnifying observation.…”

“…2. Endocytoscopic classification for colorectal lesions, proposed by Kudo et al 5 Their classification is based on the structure of the crypts and the shape of the nuclei.…”

“…In this study, pit pattern diagnosis plus EC provided significantly higher accuracy than conventional diagnosis. 5 However, this was a retrospective single-center study; hence, we must wait for further studies regarding the diagnostic performance for UC-associated neoplasia.…”