Endoscopy 2004; 36(12): 1089-1093
DOI: 10.1055/s-2004-826039
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Chromoendoscopy Using Indigo Carmine Dye Spraying with Magnifying Observation Is the Most Reliable Method for Differential Diagnosis between Non-Neoplastic and Neoplastic Colorectal Lesions: A Prospective Study

K.-I.  Fu1, 2 , Y.  Sano1 , S.  Kato1 , T.  Fujii1 , F.  Nagashima1 , T.  Yoshino1 , T.  Okuno1 , S.  Yoshida1 , T.  Fujimori2
  • 1Division of Gastrointestinal Oncology and Digestive Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
  • 2Department of Surgical and Molecular Pathology, Dokkyo University School of Medicine, Mibu, Shimotuga, Tochigi, Japan
Further Information

Publication History

Submitted 12 April 2003

Accepted after Revision 2 August 2004

Publication Date:
01 December 2004 (online)

Background and Aims: Differential diagnosis between non-neoplastic and neoplastic lesions is very important at colonoscopy, since removal or biopsy of non-neoplastic polyps wastes time and resources. We therefore conducted a prospective study to examine whether indigo carmine dye spraying with and without magnification is more reliable than the conventional method for differential diagnosis.
Patients and Methods: 122 patients with 206 lesions of 10 mm or smaller were recruited into this study. All lesions detected on colonoscopy were first diagnosed using the conventional view, then at chromoendoscopy using 0.2 % indigo carmine, and finally at chromoendoscopy with magnification. The diagnosis at each step were recorded consecutively. All lesions were finally categorized as neoplastic or non-neoplastic according to pit pattern; non-neoplastic lesions were biopsied for histological evaluation, and all the neoplastic ones were removed endoscopically. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as reference.
Results: Histologically, 46 lesions (22 %) were non-neoplastic and 160 (78 %) were neoplastic. The overall diagnostic accuracies by conventional view, chromoendoscopy, and chromoendoscopy with magnification were 84.0 % (173/206), 89.3 % (184/206) and 95.6 % (197/206), respectively.
Conclusion: Chromoendoscopy with magnification is the most reliable method for determining whether a colorectal lesion is non-neoplastic or neoplastic.

References

  • 1 Warner A S, Glick M E, Fogt F. Multiple large hyperplastic polyps of the colon coincident with adenocarcinoma.  Am J Gastroenterol. 1994;  89 123-125
  • 2 Vatan M H, Stalsbert H. The prevalence of polyps of the large intestine in Oslo: an autopsy study.  Cancer. 1982;  40 819-825
  • 3 O Brien M J, Winawer S J, Zauber A G. et al . The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas.  Gastroenterology. 1990;  98 564-566
  • 4 Wadas D D, Sanowski R A. Complications of the hot biopsy forceps technique.  Gastrointest Endosc. 1988;  34 32-37
  • 5 Waye J D. Management of complications of colonoscopic polypectomy.  Gastroenterologist. 1993;  1 158-164
  • 6 Jentschura D, Raute M, Winter J. et al . Complications in endoscopy of the lower gastrointestinal tract. Therapy and prognosis.  Surg Endosc. 1994;  8 672-676
  • 7 Yokota T, Sugihara K, Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions.  Dis Colon Rectum. 1994;  37 1108-1111
  • 8 Kato S, Fujii T, Koba I. et al . Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: Can significant lesions be distinguished?.  Endoscopy. 2001;  33 306-310
  • 9 Konishi K, Kaneko K, Kurahashi K. et al . A comparison of magnifying and nonmagnifying colonoscopy for diagnosis of colorectal polyps: a prospective study.  Gastrointest Endosc. 2003;  57 48-53
  • 10 Neale A V, Demers R Y, Budev H. et al . Clinical accuracy in diagnosing colorectal polyps.  Dis Colon Rectum. 1987;  30 247-250
  • 11 Norfleet R G, Ryan M E, Wymann J B. Adenomatous and hyperplastic polyps cannot be reliably distinguished by their appearance through the fiberoptic sigmoidscope.  Dig Dis Sci. 1988;  33 1175-1177
  • 12 Chapuis P H, Dent O F, Goulston K J. Clinical accuracy in diagnosis of small polyps using the flexible sigmoidscope.  Dis Colon Rectum. 1982;  25 669-672
  • 13 Rembacken B J, Fujii T, Cairns A. et al . Flat and depressed colonic neoplasm: a prospective study of 1000 colonoscopies in the UK.  Lancet. 2000;  355 1211-1214
  • 14 Eisen G M, Kim C Y, Fleischer D E. et al . High-resolution chromoendoscopy for classifying colonic polyps: a multicenter study.  Gastrointest Endosc. 2002;  55 687-694
  • 15 Kiesslich R, von Bergh M, Hahn M. et al . Chromoendoscopy with indigo carmine improves the detection of adenomatous and nonadenomatous lesions in the colon.  Endoscopy. 2001;  33 1001-1006
  • 16 Togashi K, Konishi F, Ishizuka T. et al . Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel.  Dis Colon Rectum. 1999;  42 1602-1608
  • 17 Kudo S, Hirota S, Nakajima T. et al . Colorectal tumors and pit pattern.  J Clin Pathol. 1994;  47 880-885
  • 18 Japanese Research Society for Cancer of the Colon and Rectum. General rules for clinical and pathological studies on cancer of the colon, rectum and anus.  Jpn J Surg. 1983;  13 557-573

Y. Sano, M. D.

Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East

6-5-1 Kashiwanoha · Kashiwa 277-8577 · Chiba · Japan

Fax: + 81-4-71314724 ·

Email: ysano@east.ncc.go.jp