Depth diagnosis of early colorectal cancer: Magnifying chromoendoscopy or image enhanced endoscopy with magnification?

Abstract

Depth diagnosis is extremely crucial in making a treatment choice between endoscopic resection and surgery in the early stages of cancers. Among several imaging modalities, we use magnifying endoscopy to diagnose lesions by close observation of the findings at mucosal surface layer. In combination with topical staining, magnifying endoscopy enables us to assess the definite pit structure, which referred to as magnifying chromoendoscopy (MCE). The pit pattern classification by MCE was proposed and is now widely accepted as the standard diagnostic criteria for colorectal lesions. Meanwhile, image enhanced endoscopy (IEE) represented by narrow-band imaging was developed to improve the visibility of surface and vascular findings without dyeing. Recent collaborative work performed by endoscopic experts in Japan yielded the unified diagnostic criteria, the Japan NBI Expert Team (JNET) classification, based on the findings of IEE with magnification. In this review, focusing on MCE and IEE with magnification, we aimed to give an outline of the pit pattern classification and the JNET classification, and further discuss their accuracy rate of depth diagnosis of early colorectal lesions by performing a review of the related literature. Both modalities have a high accuracy rate of nearly 90% for depth diagnosis. IEE with magnification is an ideal modality because it helps observe lesions without dye spraying; however, lesions with JNET type 2B have an inadequate diagnostic ability, which should be complemented by MCE. We conclude that accurate diagnosis is possible by examining lesions using both modalities properly to overcome the limitations of each modality.

The Clinical Application of Remimazolam Benzenesulfonate Combined with Esketamine Intravenous Anesthesia in Endoscopic Retrograde Cholangiopancreatography

“…Besides, thermal noise exists in the image acquisition device, which causes a series of noises in endoscopic images, such as pulse noise and salt and pepper noise. In the processes of acquiring and transmitting endoscopic images, color deviation and image quality degeneration also come into being [ 10 , 11 ]. Hence, 3D endoscopic image processing should not only consider the color and quality of images but also need to focus on the consistency of the colors of left and right binocular images.…”

Novel endoscopic ultrasonography classification for assured vertical resection margin (≥500 μm) in colorectal endoscopic submucosal dissection

“…The Japan NBI Expert Team (JNET) classification is a universal narrow-band imaging (NBI) magnifying endoscopic classification for colorectal tumors. 10 In this classification, Type 2B includes various lesions from LGD to SM-d lesion, [10][11][12][13][14] and an additional examination is necessary to determine the adequate therapeutic method.…”

Magnifying chromoendoscopy or image enhanced endoscopy with magnification?

“…When colorectal lesions are evaluated according to the JNET classification, Type 2B is diagnosed in a small number of cases (6.4%), and the majority of lesions can be diagnosed with NBI‐ME to determine the treatment strategy 10 . Ikematsu et al ., in their review, concluded that the accuracy of observation on NBI‐ME is lower than that of magnification after crystal violet staining; nevertheless, the reviewed results are acceptable for daily clinical use 1 . This review article clarified the role of each modality by presenting past reports on the positioning of IEE and chromoendoscopy in magnifying endoscopic examination in an easy‐to‐understand manner.…”

“…10 Ikematsu et al, in their review, concluded that the accuracy of observation on NBI-ME is lower than that of magnification after crystal violet staining; nevertheless, the reviewed results are acceptable for daily clinical use. 1 This review article clarified the role of each modality by presenting past reports on the positioning of IEE and chromoendoscopy in magnifying endoscopic examination in an easy-to-understand manner. Because IEE with magnification can be easily performed and does not require staining with special reagents, it is expected to be a widely used diagnostic method in daily clinical practice in the future.…”

“…Ikematsu et al published a review article, titled "Depth diagnosis of early colorectal cancer: Magnifying chromoendoscopy or image enhanced endoscopy with magnification?". 1 The authors reviewed previous papers on magnifying image-enhanced endoscopy (IEE) and chromoendoscopy with magnification to clarify the division of roles and stated that magnifying chromoendoscopy is the gold standard for depth diagnosis in early colorectal cancer (CRC). However, IEE has also been found to be highly useful in daily clinical practice because IEE with magnification can be used to easily obtain magnified endoscopic findings.…”