Background and study aims: Individuals carrying germline mutations in one of the genes responsible for hereditary nonpolyposis colon cancer (HNPCC) have a lifetime risk of up to 80 % of developing colorectal cancer. As there is evidence for a higher incidence of flat adenomatous precursors and because an accelerated adenoma–carcinoma sequence has been postulated for these patients, early detection of these lesions is essential. It was the aim of the present study to assess the detection rate of polypoid lesions by comparing chromocolonoscopy with standard white light colonoscopy and narrow-band imaging (NBI) colonoscopy.
Patients and methods: 109 patients were included (98 with a functionally relevant mutation in a mismatch repair gene, 11 fulfilling the strict Amsterdam criteria). In 47 patients, standard colonoscopy was followed by chromocolonoscopy with indigo carmine. In 62 patients, NBI was performed first followed by chromocolonoscopy.
Results: A total of 128 hyperplastic and 52 adenomatous lesions were detected. In the first series, 0.5 lesions/patient were identified by standard colonoscopy and 1.5 lesions/patient by chromocolonoscopy (P < 0.001). In the second series, 0.7 lesions/patient were detected by NBI colonoscopy and 1.8 lesions/patient by chromocolonoscopy (P = 0.01). At least one adenoma was detected in 15 % of patients by both standard and NBI colonoscopy compared with 28 % of patients by chromocolonoscopy.
Conclusion: According to this study, chromocolonoscopy detects significantly more hyperplastic and, in particular, adenomatous lesions than standard white light colonoscopy or NBI.
References
1
de la Chapelle A.
The incidence of Lynch syndrome.
Fam Cancer.
2005;
4
233-237
2
Vogelstein B, Fearon E R, Hamilton S R. et al .
Genetic alterations during colorectal-tumor development.
N Engl J Med.
1988;
319
525-532
3
Burke W, Petersen G, Lynch P. et al .
Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. Cancer Genetics Studies Consortium.
JAMA.
1997;
277
915-919
4
Bradshaw N, Holloway S, Penman I. et al .
Colonoscopy surveillance of individuals at risk of familial colorectal cancer.
Gut.
2003;
52
1748-1751
5
Jarvinen H J, Aarnio M, Mustonen H. et al .
Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer.
Gastroenterology.
2000;
118
829-834
6
Mecklin J, Jarvinen H.
Treatment and follow-up strategies in hereditary nonpolyposis colorectal carcinoma.
Dis Colon Rectum.
1993;
36
927-929
7
Winawer S, Fletcher R, Rex D. et al .
Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence.
Gastroenterology.
2003;
124
544-560
8
Lindor N M, Petersen G M, Hadley D W. et al .
Recommendations for the care of individuals with an inherited predisposition to Lynch Syndrome: a systematic review.
JAMA.
2006;
296
1507-1517
9
Rex D, Cutler C, Lemmel G. et al .
Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.
Gastroenterology.
1997;
112
24-28
10
Hixson L, Fennerty M, Sampliner R. et al .
Prospective study of the frequency and size distribution of polyps missed by colonoscopy.
J Natl Cancer Inst.
1990;
82
1769-1772
11
Hixson L, Fennerty M, Sampliner R, Garewal H.
Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps.
Gastrointest Endosc.
1991;
37
125-127
12
Waye J, Lewis B, Frankel A, Geller S.
Small colon polyps.
Am J Gastroenterol.
1988;
83
120-122
13
van Rijn J C, Reitsma J B, Stoker J. et al .
Polyp miss rate determined by tandem colonoscopy: a systematic review.
Am J Gastroenterol.
2006;
101
343-350
14
DeFrancisco J, Grady W.
Diagnosis and management of hereditary non-polyposis colon cancer.
Gastrointest Endosc.
2003;
58
390-408
15
Trecca A, Fujii T, Kato S. et al .
Small advanced colorectal adenocarcinomas: report on three cases.
Endoscopy.
1998;
30
493-495
16
Rijcken F, Hollema H, Kleibeuker J.
Proximal adenomas in hereditary non-polyposis colorectal cancer are prone to rapid malignant transformation.
Gut.
2002;
50
382-386
17
Watanabe T, Muto T, Sawada T, Miyaki M.
Flat adenoma as a precursor of colorectal carcinoma in hereditary nonpolyposis colorectal carcinoma.
Cancer.
1996;
77
627-634
18
Jass J.
Hyperplastic polyps and colorectal cancer: is there a link?.
Clin Gastroenterol Hepatol.
2004;
2
1-8
19
Vasen H F, Nagengast F M, Khan P M.
Interval cancers in hereditary non-polyposis colorectal cancer (Lynch syndrome).
Lancet.
1995;
345
1183-1184
20
Brooker J, Saunders B, Shah S. et al .
Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial.
Gastrointest Endosc.
2002;
56
333-338
21
Hurlstone D, Cross S, Adam I. et al .
Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis.
Gut.
2004;
53
284-290
22
Hurlstone D, Cross S, Adam I. et al .
A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom.
Am J Gastroenterol.
2003;
98
2543-2549
23
Kiesslich R, von Bergh M, Hahn M. et al .
Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon.
Endoscopy.
2001;
33
1001-1006
24
Rembacken B, Fujii T, Cairns A. et al .
Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK.
Lancet.
2000;
355
1211-1214
25
Tsuda S, Veress B, Toth E, Fork F.
Flat and depressed colorectal tumours in a southern Swedish population: a prospective chromoendoscopic and histopathological study.
Gut.
2002;
51
550-555
26
Saitoh Y, Waxman I, West A. et al .
Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population.
Gastroenterology.
2001;
120
1657-1665
27
Hurlstone D, Karajeh M, Cross S. et al .
The role of high-magnification-chromoscopic colonoscopy in hereditary nonpolyposis colorectal cancer screening: a prospective “back-to-back” endoscopic study.
Am J Gastroenterol.
2005;
100
2167-2173
28
Lecomte T, Cellier C, Meatchi T. et al .
Chromoendoscopic colonoscopy for detecting preneoplastic lesions in hereditary nonpolyposis colorectal cancer syndrome.
Clin Gastroenterol Hepatol.
2005;
3
897-902
29
Gono K, Obi T, Yamaguchi M. et al .
Appearance of enhanced tissue features in narrow-band endoscopic imaging.
J Biomed Opt.
2004;
9
568-577
30
Su M, Hsu C, Ho Y. et al .
Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps.
Am J Gastroenterol.
2006;
101
2711-2716
31
Chiu H, Chang C, Chen C. et al .
A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia.
Gut.
2007;
56
373-379
32
Hirata M, Tanaka S, Oka S. et al .
Evaluation of microvessels in colorectal tumors by narrow band imaging magnification.
Gastrointest Endosc.
2007;
66
945-952
33
Machida H, Sano Y, Hamamoto Y. et al .
Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study.
Endoscopy.
2004;
36
1094-1098
34
Matsumoto T, Kudo T, Jo Y. et al .
Magnifying colonoscopy with narrow band imaging system for the diagnosis of dysplasia in ulcerative colitis: a pilot study.
Gastrointest Endosc.
2007;
66
957-965
35
East J E, Suzuki N, Stavrinidis M. et al .
Narrow band imaging for colonoscopic surveillance in hereditary non-polyposis colorectal cancer.
Gut.
2008;
57
65-70
36
Tischendorf J, Wasmuth H, Koch A. et al .
Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study.
Endoscopy.
2007;
39
1092-1096
37
Kudo S.
Endoscopic mucosal resection of flat and depressed types of early colorectal cancer.
Endoscopy.
1993;
25
455-461
38
Hurlstone D, Fujii T, Lobo A.
Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy.
Br J Surg.
2002;
89
272-282
39
Schlemper R, Riddell R, Kato Y. et al .
The Vienna classification of gastrointestinal epithelial neoplasia.
Gut.
2000;
47
251-255
40
Dekker E, van den Broek F, Reitsma J. et al .
Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis.
Endoscopy.
2007;
39
216-221
41
Adler A, Pohl H, Papanikolaou I. et al .
A prospective randomized study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does NBI induce a learning effect?.
Gut.
2008;
57
59-64
42
Rex D, Helbig C.
High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging.
Gastroenterology.
2007;
133
42-47
43
Kaltenbach T, Friedland S, Soetikno R.
A randomized tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates.
Gut.
2008;
57
1406-1412
44
Goecke T, Schulmann K, Engel C. et al .
Genotype-phenotype comparison of German MLH1 and MSH2 mutation carriers clinically affected with Lynch syndrome: a report by the German HNPCC Consortium.
J Clin Oncol.
2006;
24
4285-4292
45
Pellisé M, Fernández-Esparrach G, Cárdenas A. et al .
Impact of wide-angle, high-definition endoscopy in the diagnosis of colorectal neoplasia: a randomized controlled trial.
Gastroenterology.
2008;
135
1062-1068
T. SauerbruchMD
Department of Internal Medicine I University of Bonn
Sigmund-Freud Straße 25 D-53115 Bonn Germany
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Email: tilman.sauerbruch@ukb.uni-bonn.de