High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: Implications for colon cancer screening

Axelrad, AM; Fleischer, DE; Geller, AJ; Nguyen, CC; Lewis, JH; Al-Kawas, FH; Avigan, MI; Montgomery, Elizabeth; Benjamin, SB

doi:10.1053/gast.1996.v110.pm8613016

Cited by 143 publications

(49 citation statements)

References 2 publications

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“…Currently, several advanced endoscopic imaging techniques have been attempted to improve the limitation of conventional endoscopy (13)(14)(15)(16)(17)(18)(19). In this pilot study, we analyzed the endoscopic characteristics of neoplastic lesions associated with UC using these advanced techniques, including CE, NbI and AFI.…”

Section: Discussionmentioning

confidence: 99%

“…Several advanced endoscopic imaging techniques, such as chromoendoscopy (CE) with dye-spraying (13)(14)(15), narrowband imaging (NBI) (16,17) and autofluorescence imaging (AFI) (18,19), which provide a more detailed visualization of the mucosa by enhancing morphology and vascularization, have been developed to improve upon the accuracy afforded by conventional WLI. In sporadic colorectal tumors, it has been clearly shown that these imaging techniques facilitate Pathology, 4 Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan early detection allowing for the removal of the lesions, thus avoiding the need for surgery (13).…”

Section: Introductionmentioning

confidence: 99%

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Advanced endoscopic features of ulcerative colitis-associated neoplasias: Quantification of autofluorescence imaging

Yoshioka

Mitsuyama

Takedatsu

et al. 2015

International Journal of Oncology

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Abstract. Ulcerative colitis (UC) patients are well known to carry a higher risk of developing colorectal dysplasia/cancer. However, it is hard to detect the lesion in the early phase during colonoscopy. This pilot study was conducted to analyze the endoscopic characteristics of neoplastic lesions associated with UC using advanced imaging techniques. This is a retrospective analysis of 15 colorectal neoplastic lesion obtained from 11 UC patients during remission who underwent whitelight-and advanced endoscopic imaging techniques, including chromoendoscopy, narrow-band imaging and autofluorescence imaging (AFI), and were treated with surgery. These lesions were analyzed for histology, location, size, shape, color and endoscopic features. The green/red ratio was also assessed to quantify the AFI intensity. All 11 patients had extensive colitis with the median disease duration of 14.0 years. A total of 15 lesions, consisting of 8 high-grade dysplasia and 7 cancer, was mostly located in the distal colon (86.7%, 13/15) with the mean size of 8.6 mm. The shape was protruding in 46.7% (7/15), flat elevated in 40.0% (6/15) and flat in 13.3% (2/15) and the color was red in 60.0% (9/15), same colored in 33.3% (5/15) and discolored in 6.7% (1/15). The lesion predominantly showed Kudo's neoplastic pit pattern in 86.7% (13/15; 5 type IIIL, 7 type IV and 1 type VI) on chromoendoscopy and Sano's neoplastic capillary pattern (type IIIa) in 63.6% (7/11) on narrow-band imaging, but were colored purple as neoplastic lesions in only 37.5% (3/8) on AFI. Of note, the AFI green/red ratio was significantly lower in the neoplastic lesions than UC-involved areas (p=0.00014) and UC-uninvolved areas (p=0.00651) irrespective of the lesion's size and histological type. In conclusion, endoscopic analysis based on advanced imaging, in particular AFI quantitation, may be helpful to detect early stage neoplastic lesions in long standing UC. Large-scale, prospective studies are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Advanced endoscopic features of ulcerative colitis-associated neoplasias: Quantification of autofluorescence imaging

Yoshioka

Mitsuyama

Takedatsu

et al. 2015

International Journal of Oncology

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“…Bringing these technologies together will greatly strengthen the diagnostic accuracy of the colonoscopy and diminish the risk of human error (1) .…”

Section: Discussionmentioning

confidence: 99%

Morphometric digital measurement of the luminal opening area of colonic crypts (pits) can differentiate the adenomas from other colonic lesions

Saul

Prolla

Silva

et al. 2009

Arq. Gastroenterol.

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-Context -Differential diagnosis of hyperplastic vs adenomatous lesions is of crucial importance on the daily practice of colonoscopy.Objectives -This study aimed at quantifying digital morphometric characteristics of colonoscopic images obtained with magnification and chromoscopy of three different types of colonic lesions: hyperplastic, adenomas and carcinomas, and the normal mucosa surrounding the lesions. Methods -A total of 2,177 consecutive colonoscopies were analyzed and 105 images were chosen for analysis, divided into 37 hyperplastic lesions, 42 adenomas and 26 carcinomas. Specific digital morphometry was used, to measure the diameter and area of the pits from hyperplastic lesions, adenomatous and carcinomatous lesions, always comparing them with the normal mucosa surrounding pits. Results -Different morphometric measures were performed via image analysis software to measure the mean pit opening diameters and their respective area. The mean pit opening diameters and corresponding area measurements were statistically significant for all groups of lesions examined. Conclusions -The morphometric characteristics of colonoscopy images allowing the observer to compare differences between hyperplastic and adenomatous polyps and colorectal carcinoma lesions. Digital morphometric studies are feasible like the present study shows. This can help the colonoscopist in clinical decisions. A software with morphometric measures can apply and will permit the digital morphometric analysis. The data generated from the application of software, can provide valuable points in differentiation of various lesions, guiding the conduct clinical, already during the endoscopic procedure. Morphometric analysis is more an instance of decision to the colonoscopist and it has important value not for being subjective, but for being objective, since it generates digits of its measures. In these aspects, and among different characteristics, the measure of the area showed to be the most important measure in the differential aspect. Different lesions have different patterns of morphometric measures and theses patterns can be obtained from the study of the characteristics in databases. The endoscopic removal of adenomatous polyps (polypectomy), or a more detailed study of the neoplastic lesions for helping the decision if endoscopic removal (mucosectomy) or surgical resection, and a conservative position in hyperplastic lesions, are proceedings that morphometrics, with another parameters, can help to decide.

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“…Previously, chromoendoscopy with dye-spraying, which provides a more detailed visualization of the mucosa by enhancing its morphology, was developed to improve upon the accuracy afforded by conventional endoscopy (7)(8)(9). The authors of the present study (10,11) and other studies (12)(13)(14)(15)(16) have previously demonstrated that this imaging technique facilitates the detection of early-stage neoplastic lesions in UC.…”

Section: Introductionmentioning

confidence: 88%

Stereomicroscopic features of colitis-associated tumors in mice: Evaluation of pit pattern

et al. 2017

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Abstract.Patients with longstanding ulcerative colitis have an increased risk of colorectal cancer. Mouse models for colitis-associated tumors are indispensable for the development of novel strategies for prevention and intervention, as well as an improved understanding of the mechanisms underlying tumor formation. The present study examined whether stereomicroscopic observations with dye-application were able to detect and discriminate tumors in a colitis-associated tumor model in mice. Colonic tumors were induced in C57BL/6 mice by 15 cycles of treatment with dextran sulfate sodium (DSS) in drinking water. The mice were then divided into 4 groups: normal mice fed a control diet, normal mice fed an iron-supplemented diet, 0.7% DSS mice fed an iron diet and 1.5% DSS mice fed an iron diet. The entire colons were characterized with respect to both morphology and histology. The pit pattern architecture was analyzed using stereomicroscopy with dye agents (0.2% indigo carmine or 0.06% crystal violet). The tumor histology was graded as negative, indefinite or positive for dysplasia. The positive category was divided into two subcategories: low-grade dysplasia (LGD) and high-grade dysplasia (HGD). The tumor incidences and multiplicity were significantly higher in mice fed an iron diet and 1.5% DSS compared with in mice fed an iron diet and 0.7% DSS. Compared with LGD, HGD was predominantly located in the distal colon, was larger in size and had a higher incidence of elevated lesions (Is and IIa) and a lower incidence of flat lesions (IIb). In regards to the pit pattern, HGD had a high incidence of V I pits and a low incidence of IV, III L and II pits. In conclusion, evaluation of the pit pattern using stereomicroscopy with dye-application is useful for detecting and discriminating neoplastic changes in DSS mice and may further our understanding of the mechanisms that induce tumor formation in patients with ulcerative colitis and the characterization of pharmaceutical responses. IntroductionUlcerative colitis (UC) is a chronic relapsing disorder associated with uncontrolled inflammation within the gastrointestinal tract (1). Patients with longstanding UC have an increased risk of colorectal cancer (2,3). The molecular pathway that induces cancer in UC appears to differ from the well-known 'adenoma-carcinoma sequence', as these types of cancer often develop in flat or mildly elevated lesions and are distributed multifocally within an area of intestinal inflammation, called the 'inflammation-dysplasia-carcinoma sequence' (4-6). Therefore, the timely colonoscopic detection and diagnosis of neoplasia during early phase is crucially important for treatment.Previously, chromoendoscopy with dye-spraying, which provides a more detailed visualization of the mucosa by enhancing its morphology, was developed to improve upon the accuracy afforded by conventional endoscopy (7-9). The authors of the present study (10,11) and other studies (12)(13)(14)(15)(16) have previously demonstrated that this imaging technique facilitates the de...

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High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: Implications for colon cancer screening

Cited by 143 publications

References 2 publications

Advanced endoscopic features of ulcerative colitis-associated neoplasias: Quantification of autofluorescence imaging

Advanced endoscopic features of ulcerative colitis-associated neoplasias: Quantification of autofluorescence imaging

Morphometric digital measurement of the luminal opening area of colonic crypts (pits) can differentiate the adenomas from other colonic lesions

Stereomicroscopic features of colitis-associated tumors in mice: Evaluation of pit pattern

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