Pit Pattern in Colorectal Neoplasia: Endoscopic Magnifying View

Kudo, Shin‐ei; Rubio, C A; Teixeira, Cláudio Rolim; Kashida, Hiroshi; Kogure, Etsuko

doi:10.1055/s-2004-826104

Cited by 456 publications

(372 citation statements)

References 8 publications

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“…arbitrated in the event that agreement was not reached. From each report, the reviewers independently collected the following data when available: year of publication, prospective or retrospective study design, enrollment period, number of patients included, mean age, gender distribution, lesion location (colon/rectum), Kudo pit-pattern classification [8], EUS, type of device used, mean operating time, mean tumor size, complication rate, rate of surgery due to complications, histology (adenoma, carcinoma in situ, invasive cancer, carcinoid), rate of histologically verified en bloc resection, rate of histologically verified complete resection (R0), rate of surgery for oncologic reasons, follow-up evaluation, histologically demonstrated recurrence, and need of further treatment for disease recurrence.…”

Section: Study Selectionmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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Background For almost 30 years, transanal endoscopic microsurgery (TEM) has been the mainstay treatment for large rectal lesions. With the advent of endoscopic submucosal dissection (ESD), flexible endoscopy has aimed at en bloc R0 resection of superficial lesions of the digestive tract. This systematic review and meta-analysis compared the safety and effectiveness of ESD and fullthickness rectal wall excision by TEM in the treatment of large nonpedunculated rectal lesions preoperatively assessed as noninvasive. Methods A systematic review of the literature published between 1984 and 2010 was conducted (Registration no. CRD42012001882). Data were integrated with those from the original databases requested from the study authors when needed. Pooled estimates of the proportions of patients with en bloc R0 resection, complications, recurrence, and need for further treatment in the ESD and TEM series were compared using random-effects single-arm meta-analysis. Results This review included 11 ESD and 10 TEM series (2,077 patients). The en bloc resection rate was 87.8 % (95 % confidence interval [CI] 84.3-90.6) for the ESD patients versus 98.7 % (95 % CI 97.4-99.3 %) for the TEM patients (P < 0.001). The R0 resection rate was 74.6 % (95 % CI 70.4-78.4 %) for the ESD patients versus 88.5 % (95 % CI 85.9-90.6 %) for the TEM patients (P < 0.001). The postoperative complications rate was 8.0 % (95 %, CI 5.4-11.8 %) for the ESD patients versus 8.4 % (95 % CI 5.2-13.4 %) for the TEM patients (P = 0.874). The recurrence rate was 2.6 % (95 % CI 1.3-5.2 %) for the ESD patients versus 5.2 % (95 % CI 4.0-6.9 %) for the TEM patients (P < 0.001). Nevertheless, the rate for the overall need of further abdominal treatment, defined as any type of surgery performed through an abdominal access, including both complications and pathology indications, was 8.4 % (95 % CI 4.9-13.9 %) for the ESD patients versus 1.8 % (95 % CI 0.8-3.7 %) for the TEM patients (P < 0.001). ConclusionsThe ESD procedure appears to be a safe technique, but TEM achieves a higher R0 resection rate when performed in full-thickness fashion, significantly reducing the need for further abdominal treatment. Keywords Rectal adenoma Transanal endoscopic microsurgery Endoscopic submucosal dissection Systematic review Meta-analysis For nearly 30 years, transanal endoscopic microsurgery (TEM) has been the optimal mainstay treatment for large rectal lesions. Initially conceived for treating benign lesions, its indications were extended to early rectal cancer treatment when Hermanek and Gall [1] assessed criteria to determine lesions at "low risk" for recurrence. One increasingly recognized advantage of the technique versus standard transanal surgery is the high rate of en bloc resection with disease-free margins, which is strictly related to the risk of recurrence [2]. With the advent of endoscopic submucosal dissection (ESD) about 10 years ago, flexible endoscopy permitted a surgical-like technique for en bloc resection of superficial lesions of the digestive trac...

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Section: Study Selectionmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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“…Her colon was diverticular and we detected an irregular brownish polypoid lesion within the sigmoid. The polypoid component presented an amorphous pit pattern (Kudo's Vn) without a clear demarcation line [1]. The vascular pattern was patchy with avascular areas and large thick vessels corresponding to Sano's type 3b [2] (▶ Fig.…”

mentioning

confidence: 99%

A benign colorectal lesion with amorphous pit (Kudo Vn) and avascular pattern (Sano’s 3b): differential diagnosis with deep invasive adenocarcinoma

et al. 2017

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“…The opening of a colonic crypt is referred to as a pit , and the speci c arrangement of the gland openings in various lesions is called the pit pattern . This pattern is considered to re ect the epithelial aberrations originating in the luminal sector of the epithelium, meaning that changes in the deeper layers are reflected on the surface 5 . In this respect, the diagnostic process that uses magnifying endoscopy is similar to that used by the examining pathologist, although discrepancies might exist between the pathological features of the surface and of deeper tissues 5 .…”

Section: Evaluation Of Publication Biasmentioning

confidence: 99%

“…This pattern is considered to re ect the epithelial aberrations originating in the luminal sector of the epithelium, meaning that changes in the deeper layers are reflected on the surface 5 . In this respect, the diagnostic process that uses magnifying endoscopy is similar to that used by the examining pathologist, although discrepancies might exist between the pathological features of the surface and of deeper tissues 5 . Several studies on the combined use of magnifying endoscopy and choromoendoscopy have led to acceptance of Kudo s classi cation of pit patterns as a standard, and this classi cation is currently the most widely used system for differentiating normal mucosa from neoplasms 3,5 .…”

Section: Evaluation Of Publication Biasmentioning

confidence: 99%

“…The traditional criteria for predicting the histopathology and the carcinomatous depth of colorectal lesions are those advocated by Kudo et al 3 in the mid-1990s. In these criteria, called Kudo s pit pattern classification, dye spraying chromoendoscopy and magnifying endoscopy are used to differentiate among non-neoplastic, neoplastic, and cancerous lesions 5 . Meanwhile, after the advent of a new endoscopic technology called Narrow Band Imaging NBI early in the 21st century, several researchers proposed that this modality could be used with certain predictive criteria of cancer depth 6,7 .…”

Section: Introductionmentioning

confidence: 99%

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A Comparison of Magnifying Chromoendoscopy Versus Narrow Band Imaging in the Diagnosis of Depth of Invasion for Early Colorectal Cancers

Kobayashi

Kudo

Miyachi

et al. 2011

Showa Univ J Med Sci

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: Although chromoendoscopy and narrow band imaging NBI are widely used in diagnosing the invasion depth of colorectal cancers, comparative studies of these modalities are lacking. This meta-analysis compared the performance of these two modalities in colorectal cancer diagnosis. MEDLINE, EMBASE, and Cochrane Library were searched for relevant original articles published up to December 20 th , 2010. Major criteria for article inclusion were : i magnifying chromoendoscopy or NBI was used as a diagnostic modality and pit pattern or vascular pattern was used as a diagnostic classi cation ; ii sensitivity and speci city were reported ; iii absolute numbers of true-positive, false-positive, true-negative, and false-negative cases, or their equivalent, were provided ; and iv pathology of biopsy, endoscopy, or surgical treatment was used as the reference standard. Sensitivity and speci city were pooled using a random effects model. Regression analysis was performed to compare the discriminatory power between chromoendoscopy and NBI by including a dummy variable. We made the assumption that a positive regression coef cient implied a better discriminatory power for NBI, and vice versa. Of 1846 screened articles, 16 ful lled all inclusion criteria. Pooled sensitivity for chromoendoscopy and NBI was 0.85 95 CI : 0.82-0.87 and 0.80 0.76-0.85 , respectively, and specificity was 0.98 0.97-0.99 and 0.98 0.97-0.99 , respectively. The regression coef cient for chromoendoscopy versus NBI was 0.02 95 CI : 1.18-1.71 . These results indicate that chromoendoscopy and NBI may have similar power for the diagnostic assessment of colonic neoplasms. However, other factors such as convenience, time, and cost still must be taken into account in making the nal diagnostic choice.

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Pit Pattern in Colorectal Neoplasia: Endoscopic Magnifying View

Cited by 456 publications

References 8 publications

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

A benign colorectal lesion with amorphous pit (Kudo Vn) and avascular pattern (Sano’s 3b): differential diagnosis with deep invasive adenocarcinoma

A Comparison of Magnifying Chromoendoscopy Versus Narrow Band Imaging in the Diagnosis of Depth of Invasion for Early Colorectal Cancers

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