Daniele Malaman

Computerized virtual chromoendoscopy versus indigo carmine chromoendoscopy combined with magnification for diagnosis of small colorectal lesions: a randomized and prospective study.

Background and study aims Magnifying colonoscopy with indigo carmine dye and the analysis of the capillary and the pit patterns by computed virtual chromoendoscopy (Fujinon Intelligent Color Enhancement, FICE) with magnification are effective for the differential diagnosis of neoplastic and non-neoplastic lesions. This study aimed to compare the accuracy of virtual and real chromoendoscopy in differentiating neoplastic and non-neoplastic colorectal lesions. Patients and methods A prospective randomized trial of magnification colonoscopy with targeted FICE (Group I – 72 patients/111 lesions) versus magnification colonoscopy with targeted indigo carmine dye (Group II – 72 patients/137 lesions) was performed in consecutive patients with lesions 1 cm or less. Histopathology of the specimens was regarded as the gold standard. Results In group I, 86 (77.5%) lesions showed an intense vascular pattern (positive capillary meshwork), of which 80 (93%) were histologically confirmed as adenomas. From 25 lesions with negative capillary meshwork, 23 (92%) were non-neoplastic. Sensitivity, specificity, accuracy, positive and negative predictive values of the capillary meshwork for the differential diagnosis of these lesions was 97.8, 79.3, 92.8, 93 and 92%, respectively. The same parameters for pit pattern analysis by FICE were 92.7, 82.3, 90.1, 93.8 and 80%, respectively. Indigo carmine magnified chromoscopy showed sensitivity, specificity, accuracy, positive and negative predictive values of 97, 88.9, 94.9, 96.1 and 91.4%, respectively in the discrimination between neoplastic and non-neoplastic lesions. Conclusion Magnified virtual chromoendoscopy is as accurate as indigo carmine magnified chromoendoscopy in distinguishing between neoplastic from non-neoplastic small colorectal lesions.

Comparative study between MBI (FICE®) and magnification chromoendoscopy with indigo carmine in the differential diagnosis of neoplastic and non-neoplastic lesions of the colorectum

CONTEXT Multiband imaging (MBI)/Fuji Intelligent Color Enhancement (FICE) is a spectral image processing technology that helps in vivo diagnosis of colorectal neoplasias. OBJECTIVE To compare the diagnostic accuracy of the magnification with either the electronic chromoendoscopy or indigo carmine dye in the differential diagnosis of neoplastic and non-neoplastic colorectal lesions. METHODS Seventy five patients with 157 colorectal lesions were prospectively evaluated. The capillary pattern, as well as the pit pattern according to the Kudo classification, of colorectal lesions were evaluated by means of the FICE system. Absence and presence of meshed capillary networks were labeled as non-neoplastic and neoplastic lesions, respectively. Afterwards, indigo carmine 0.8% was instilled and a new evaluation of the pit pattern was carried out. RESULTS One hundred and sixteen of the 157 lesions were classified as positive meshed capillary network, 115 of them were confirmed histologically as neoplasia. Other 32 lesions out of 41 with negative meshed capillary network were non-neoplastic. Sensitivity, specificity and accuracy were, respectively, 92.7%, 97% and 93.6%. Pit patterns I and II were confirmed as non-neoplastic lesions, and patterns III to V were confirmed as neoplasias. Sensitivity, specificity and accuracy for the electronic chromoendoscopy were, respectively, 94.4%, 97% and 94.9%. Meanwhile, the figures for the magnification with indigo carmine were, respectively, 97.6%, 93.9% and 96.8%. CONCLUSIONS Both methods, either the MBI/FICE system or the use of indigo carmine dye with magnification, achieved a high accuracy for the differential diagnosis between neoplastic and non-neoplastic colorectal lesions.

Digital Chromoendoscopy for Diagnosis of Diminutive Colorectal Lesions

Introduction. To compare the accuracy of digital and real-time chromoendoscopy for the differential diagnosis of diminutive (<5 mm) neoplastic and nonneoplastic colorectal lesions. Materials and Methods. This is a prospective randomized study comparing the Fujinon intelligent color enhancement (FICE) system (65 patients/95 lesions) and indigo carmine (69 patients/120 lesions) in the analysis of capillary meshwork and pit pattern, respectively. All lesions were less than 5 mm in diameter, and magnification was used in both groups. Histopathology was the gold standard examination. Results. Of 215 colorectal lesions, 153 (71.2%) were adenomas, and 62 were hyperplastic polyps (28.8%). Morphological analysis revealed 132 (61.4%) superficial lesions, with 7 (3.3%) depressed lesions, and 83 (38.6%) protruding lesions. Vascular meshwork analysis using FICE and magnification resulted in 91.7% sensitivity, 95.7% specificity, and 92.6% accuracy in differentiating neoplastic from nonneoplastic lesions. Pit pattern analysis with indigo carmine and magnification showed 96.5% sensitivity, 88.2% specificity, and 94.2% accuracy for the same purpose. Conclusion. Both magnifying virtual chromoendoscopy and indigo carmine chromoendoscopy showed high accuracy in the histopathological diagnosis of colorectal lesions less than 5 mm in diameter.

Prevalence of non-polypoid colorectal neoplasms in southern Brazil.

Several studies suggest that non‐polypoid lesions (NPL) show higher aggressiveness than polypoid lesions, particularly depressed lesions. The present study aimed to assess the prevalence of NPL and the presence of advanced histology in a Brazilian population.

Endoscopic Curative Treatment of a Submucosal Invasive Rectal Adenocarcinoma

We report a case of a 45-year-old man with the diagnosis of rectal adenocarcinoma, in which a proctocolectomy was proposed and the patient refrained from surgery. A new colonoscopy was performed, which revealed a 2.5 cm diameter sessile lesion with irregular microvascular mesh work, thick capillaries with heterogeneous distribution and avascular areas, suggesting carcinoma with massive invasion of the sub-mucosa (a C3 lesion in the Hiroshima classification). However, we tried endoscopic resection and the lesion has completely elevated after Sub-mucosal hipertonic saline injection. Then the lesion was removed “en block” with a polypectomy snare. Histopathological study evidenced a moderately differentiated adenocarcinoma in a villous adenoma with high grade dysplasia with sub-mucosal invasion of 655 μm; there was no angiolymphatic invasion and the lateral and lower margins were lesion-free.

Observer agreement for diagnosis of colorectal lesions with analysis of the vascular pattern by image-enhanced endoscopy

Background/Aims: Image-enhanced endoscopy (IEE) can differentiate neoplastic from non-neoplastic colorectal lesions through indirect analysis of pit patterns and microvascular architecture. We evaluated the accuracy of Flexible Spectral Imaging Color Enhancement (FICE) in differentiating neoplastic from non-neoplastic lesions and observer agreement in the analysis of capillary pattern of colorectal lesions. Methods: A prospective double-blind trial was conducted in two referral endoscopy centers. Vascular pattern was analyzed by IEE with magnification. Lesions were divided into two groups and examined separately by two experts. Examiners, blinded to each other’s interpretations, switched groups and the lesions were reviewed. After 60 days, lesions were reevaluated. Results: In total, 76 patients were referred to colonoscopy for colon cancer screening. Of 100 colorectal lesions, 88 were neoplastic (73 tubular adenomas, 10 tubulovillous adenomas, 1 villous adenoma, 2 serrated adenomas, 2 adenocarcinomas) and 12 were non-neoplastic (hyperplastic polyps). Mean diameter of the lesions was 6.7 mm. Examiners 1 and 2 had 95 % accuracy. The interobserver kappa coefficient was 0.80 and the intraobserver kappa coefficient was 0.88 for examiner 1 and 0.73 for examiner 2. Conclusion: IEE with magnification is effective for real-time predictive histological diagnosis of colorectal lesions, with inter- and intraobserver agreement ranging from good to excellent.

MALIGNANCY IN LARGE COLORECTAL LESIONS

CONTEXT The size of colorectal lesions, besides a risk factor for malignancy, is a predictor for deeper invasion objectives: To evaluate the malignancy of colorectal lesions ≥20 mm. METHODS Between 2007 and 2011, 76 neoplasms ≥20 mm in 70 patients were analyzed. RESULTS The mean age of the patients was 67.4 years, and 41 were women. Mean lesion size was 24.7 mm ± 6.2 mm (range: 20 to 50 mm). Half of the neoplasms were polypoid and the other half were non-polypoid. Forty-two (55.3%) lesions were located in the left colon, and 34 in the right colon. There was a high prevalence of III L (39.5%) and IV (53.9%) pit patterns. There were 72 adenomas and 4 adenocarcinomas. Malignancy was observed in 5.3% of the lesions. Thirty-three lesions presented advanced histology (adenomas with high-grade dysplasia or early adenocarcinoma), with no difference in morphology and site. Only one lesion (1.3%) invaded the submucosa. Lesions larger than 30 mm had advanced histology (P = 0.001). The primary treatment was endoscopic resection, and invasive carcinoma was referred to surgery. Recurrence rate was 10.6%. CONCLUSIONS Large colorectal neoplasms showed a low rate of malignancy. Endoscopic treatment is an effective therapy for these lesions.