Top

International Journal of Colorectal Disease

Published in:

01-11-2007 | Original Article

Magnifying colonoscopy: interobserver agreement in the assessment of colonic pit patterns and its correlation with histopathological findings

Authors: Esdras Camargo Andrade Zanoni, Raul Cutait, Marcelo Averbach, Lix Alfredo Reis de Oliveira, Cláudio Rolim Teixeira, Paulo Alberto Falco Pires Corrêa, José Luiz Paccos, Giulio F. Rossini, Luiz H. Câmara Lopes

Published in: International Journal of Colorectal Disease | Issue 11/2007

Abstract

Background and study aims

Magnifying colonoscopy (MC) is recognized as an aid to the differential diagnosis between neoplastic and nonneoplastic lesions. This study evaluated interobserver agreement of experienced endoscopists in the assessment of colonic pit patterns through the Kudo’s classification and correlated morphological aspects with histopathological findings.

Materials and methods

A total of 213 magnification chromoendoscopic pictures of colonic lesions were collected from 161 consecutive patients and presented to three independent observers who expressed opinion about predominant pit pattern. All lesions were excised and sent for histopathological study.

Results

Kappa statistics showed that the general agreement index with respect to the aspects of the pits was good among the three observers (0.561). Regarding prediction of histopathology according to the pit pattern diagnosis, overall accuracy was 84%, sensitivity was 91.4%, specificity was 67.2%, positive predictive value was 86.6%, and negative predictive value was 79.3%.

Conclusion

Although the interobserver reproducibility of the colonic pit pattern is good for experienced endoscopists, MC must not be used to replace the histopathological analysis, since it does not differentiate with the necessary safety neoplastic from nonneoplastic lesions.

Hurlstone DP, Fujii T, Lobo AJ (2002) Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy. Br J Surg 89:272–282CrossRefPubMed

Hawk ET, Limburg PJ, Viner JL (2002) Epidemiology and prevention of colorectal cancer. Surg Clin North Am 82:905–941CrossRefPubMed

Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, WayeJD, Schapiro M, Bond JH, Panish JF et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981CrossRefPubMed

Hixson LS, Fennerty MB, Sampliner RE, McGee D, Garewal H (1990) Prospective study of the frequency and size distribution of polyps missed by colonoscopy. J Natl Cancer Inst 82:1769–1772CrossRefPubMed

Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, Lehman GA, Mark DG (1997) Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 112:24–28CrossRefPubMed

Gorski TF, Rosen L, Riether R, Stasik J, Khubchandani I (1999) Colorectal cancer after surveillance colonoscopy: false-negative examination or fast growth? Dis Colon Rectum 42:877–880CrossRefPubMed

Muto T, Kamiya J, Sawada T, Konishi F, Sugihara K, Kubota Y, Adachi M, Agawa S, Saito Y, Morioka Y, Tanprayoon T (1985) Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum 28:847–851CrossRefPubMed

Adachi M, Muto T, Okinaga K, Morioka Y (1991) Clinicopathologic features of flat adenoma. Dis Colon Rectum 34:981–986CrossRefPubMed

Watanabe T, Sawada T, Kubota Y, Adachi M, Saito Y, Masaki T, Muto T (1993) Malignant potential in flat elevations. Dis Colon Rectum 36:548–553CrossRefPubMed

10.

Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2003) A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom. Am J Gastroenterol 98:2543–2549CrossRefPubMed

11.

Kudo S (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25:455–461CrossRefPubMed

12.

Teixeira CR, Tanaka S, Haruma K, Yoshihara M, Sumii K, Kajiyama G, Shimamoto F (1996) Flat-elevated colorectal neoplasms exhibit a high malignant potential. Oncology 53:89–93CrossRefPubMed

13.

Jaramillo E, Slezak P, Watanabe M, Rubio C (1994) Endoscopic detection and complete removal of a micro-invasive carcinoma present in a flat colonic adenoma. Gastrointest Endosc 40:369–371CrossRefPubMed

14.

Trecca A, Gai F, Di Lorenzo GP, Hreniuc H, Pasciuto A, Antonellis F, Sperone M (2004) Conventional colonoscopy versus chromoendoscopy and magnifying endoscopy for the diagnosis of colorectal lesions: a comparative prospective study in 995 patients. Chir Ital 56:31–36PubMed

15.

Hurlstone DP, Cross SS, Drew K, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) An evaluation of colorectal endoscopic mucosal resection using high-magnification chromoscopic colonoscopy: a prospective study of 1000 colonoscopies. Endoscopy 36:491–498CrossRefPubMed

16.

Kiesslich R, Neurath MF (2004) Surveillance colonoscopy in ulcerative colitis: magnifying chromoendoscopy in the spotlight. Gut 53:165–167CrossRefPubMedPubMedCentral

17.

Tada M, Misaki F, Kawai K (1978) A new approach to the observation of minute changes of the colonic mucosa by means of magnifying colonoscope, type CF-MB-M (Olympus). Gastrointest Endosc 24:146–147CrossRefPubMed

18.

Kudo S, Hirota S, Nakajima T, Hosobe S, Kusaka H, Kobayashi T, Himori M, Yagyuu A (1994) Colorectal tumours and pit pattern. J Clin Pathol 47:880–885CrossRefPubMedPubMedCentral

19.

Fujii T, Rembacken BJ, Dixon MF, Yoshida S, Axon AT (1998) Flat adenomas in the United Kingdom: are treatable cancers being missed? Endoscopy 30:437–443CrossRefPubMed

20.

Kato S, Fujii T, Koba I, Sano Y, Fu KI, Parra-Blanco A, Tajiri H, Yoshida S, Rembacken B (2001) Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: can significant lesions be distinguished? Endoscopy 33:306–310CrossRefPubMed

21.

Liu H, Kudo S, Juch J (2003) Pit pattern analysis by magnifying chromoendoscopy for the diagnosis of colorectal polyps. J Formos Med Assoc 102:178–182PubMed

22.

Bruno MJ (2003) Magnification endoscopy, high resolution endoscopy, and chromoscopy; towards a better optical diagnosis. Gut 52(suppl IV):iv7–11PubMedPubMedCentral

23.

Christie JP, Marrazzo J 3rd (1991) “Mini-perforation” of the colon—not all postpolypectomy perforations require laparotomy. Dis Colon Rectum 34:132–135CrossRefPubMed

24.

Waye JD, Lewis BS, Yessayan S (1992) Colonoscopy: a prospective report of complications. J Clin Gastroenterol 15:347–351CrossRefPubMed

25.

Waye JD, Kahn O, Auerbach ME (1996) Complications of colonoscopy and flexible sigmoidoscopy. Gastrointest Endosc Clin N Am 6:343–377PubMed

26.

Altman DG (1991) Practical statistics for medical research. Chapman & Hall, London, p 611

27.

Trowbridge B, Burt RW (2002) Colorectal Cancer Screening. Surg Clin North Am 82:943–957CrossRefPubMed

28.

Saitoh Y, Waxman I, West AB, Popnikolov NK, Gatalica Z, Watari J, Obara T, Kohgo Y, Pasricha PJ (2001) Prevalence and distinctive biologic features of flat and colorectal adenomas in a North American population. Gastroenterology 120:1657–1665CrossRefPubMed

29.

Kiesslich R, Ohlerth C, Graebner H, Machate M, Nadar BJT, Hahn M, Herrmann G, Koehler H, Neurath M, Gaele P, Jung M (2002) Early detection od colorectal adenoma and early cancer: benefit of chromo, magnification and conventional colonoscopy? A multicenter prospective trial. Gastrointest Endosc 55:AB90–AB91

30.

Togashi K, Konishi F, Ishizuka T, Sato T, Senba S, Kanazawa K (1999) Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel. Dis Colon Rectum 42:1602–1608CrossRefPubMed

31.

Tung SY, Wu CS, Su MY (2001) Magnifying colonoscopy in differentiating neoplastic from nonneoplastic colorectal lesions. Am J Gastroenterol 96:2628–2632CrossRefPubMed

32.

Huang Q, Fukami N, Kashida H, Takeuchi T, Kogure E, Kurahashi T, Stahl E, Kudo Y, Kimata H, Kudo S (2004) Interobserver and intra-observer consistency in the endoscopic assessment of colonic pit patterns. Gastrointest Endosc 60:520–526CrossRefPubMed

33.

Kiesslich R, Jung M, DiSario JA, Galle PR, Neurath MF (2004) Perspectives of Chromo and magnifying endoscopy? How, How much, when, and whom should we stain? J Clin Gastroenterol 38:7–13CrossRefPubMed

34.

Coelho JCCGP, Savi D, Coelho JRGP, Araújo SEA, Habr-Gama A, Gama-Rodrigues J (2005) Assessment of magnifying colonoscopy with chromoscopy in the differential diagnosis of neoplastic and non-neoplastic lesions of the large bowel. ABCD Arq Bras Cir Dig 8:64–70

35.

Eisen GM, Kim CY, Fleischer DE, Kozarek RA, Carr-Locke DL, Li TC, Gostout CJ, Heller SJ, Montgomery EA, Al-Kawas FH, Lewis JH, Benjamin SB (2002) High-resolution chromoendoscopy for classifying colonic polyps: a multicenter study. Gastrointest Endosc 55:687–694CrossRefPubMed

36.

Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) Efficacy of high magnification chromoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis. Gut 53:284–290CrossRefPubMedPubMedCentral

Title: Magnifying colonoscopy: interobserver agreement in the assessment of colonic pit patterns and its correlation with histopathological findings
Authors: Esdras Camargo Andrade Zanoni
Raul Cutait
Marcelo Averbach
Lix Alfredo Reis de Oliveira
Cláudio Rolim Teixeira
Paulo Alberto Falco Pires Corrêa
José Luiz Paccos
Giulio F. Rossini
Luiz H. Câmara Lopes
Publication date: 01-11-2007
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 11/2007
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-007-0336-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Magnifying colonoscopy: interobserver agreement in the assessment of colonic pit patterns and its correlation with histopathological findings

Abstract

Background and study aims

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and study aims

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2007

Ethnical differences in HLA-II genotyping results of North-Eastern Polish ulcerative colitis patients

Jejunal Dieulafoy lesion with massive lower intestinal bleeding

Depressed type of inflammatory fibroid polyp of the colon

Laparoscopic colonoscopic rendezvous procedures for the treatment of polyps and early stage carcinomas of the colon

Effect of neoadjuvant chemoradiation on postoperative fecal continence and anal sphincter function in rectal cancer patients

A case of cytomegalovirus-associated multiple gastric ulcers in ulcerative colitis