Use Of The Conecct Classification Optimally Identifies Large Superficial Lesions Lacking Submucosal Carcinomas: A Prospective Study On 663 Lesions

Aims Endoscopic characterization is a fundamental step to predict lesion histology in order to choose the best resection modality between piece-meal EMR and ESD for large superficial colorectal lesions. CONECCT classification (COlorectal Neoplasia Endoscopic Classification to Choose the Treatment) grouped overt and covert sign of carcinoma in an all-in-one classification including all previous published criteria. CONECCT IIC subtype correspond to lesions at risk of submucosal cancer requiring absolute endoscopic en-bloc resection including pit or vascular abnormalities (SANO IIIA, JNET IIB types) and macroscopic worrisome features (LST-NG type; a macronodule larger than 1cm; a depressed area [Paris 0-IIc area]).

Methods We performed a diagnostic accuracy assessment study using CONECCT classification for predicting submucosal carcinoma in colorectal lesions larger than 20mm, with prospective data from two European expert centers using the latest generation of scope without magnification and compared with the final histological analysis. Diagnostic accuracy was compared to previously published worrisome features for risk of submucosal invasion (LST-NG type, macronodule larger than 1 cm, SANO IIIA area, Paris 0-IIC area).

Results Between 2016 and 2019, 663 lesions removed by ESD were assessed. CONECCT classification had a sensitivity of 100 %, specificity of 26.2 %, PPV 11.6 % and NPV 100 % to predict at least submucosal adenocarcinoma. CONECCT IIC lesions included 11.5 % of submucosal carcinoma. CONECCT was significantly more sensitive than the other worrisome feature (SANO IIIA, NG type, Paris 0-IIc area or a macronodule larger than 1 cm) taken independently for prediction of at least submucosal cancer. No differences were observed between FUJIFILM or OLYMPUS scope using the BLI or NBI systems.

Conclusions CONECCT classification, which combines covert and overt signs of carcinoma, identifies with a very high degree of accuracy (Se 100 %, NPV 100 %) low risk adenomas that could be treated either by piece-meal EMR or ESD according to the center’s expertise.

Citation: Brulé C, Pioche M, Albouys J et al. OP213 USE OF THE CONECCT CLASSIFICATION OPTIMALLY IDENTIFIES LARGE SUPERFICIAL LESIONS LACKING SUBMUCOSAL CARCINOMAS: A PROSPECTIVE STUDY ON 663 LESIONS. Endoscopy 2021; 53: S88.

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Artikel online veröffentlicht:
19. März 2021