Effective Combination of Conventional, Magnifying and Ultrasonographic Endoscopies in the Diagnosis of Invasion Depth of Early Colorectal Cancer Takeshi Toubaru 1 , Osamu Tsuruta 1 , Hiroshi Kawano 1 , Kenichi Yoshimori 1 , Atsushi Toyonaga 2 1Department of Internal Medicine II, Kurume University School of Medicine 2Division of Gastroenterology, Kurume University School of Medicine Keyword: 通常内視鏡 , 拡大内視鏡 , 超音波内視鏡 , 深達度診断 , 肉眼型 pp.1387-1398
Published Date 2004/9/25
DOI https://doi.org/10.11477/mf.1403100570
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 We studied the diagnostic ability and characteristics of the combination of conventional, magnifying and ultrasonographic endoscopies for protruded and superficial types of early colorectal cancers.

 The following results were obtained :

 ① Diagnostic inability was mostly noted in endoscopic ultrasonography for both of the types of cancers.

 ② Conventional endoscopy had high accuracy, specificity and positive predictive value especially in the protruded type lesions in which the carcinoma had invaded the submucosal layer by more than1,000μm. Magnifying endoscopy also showed high sensitivity, but the diagnostic ability of endoscopic ultrasonography was inferior to the former two types of endoscopy.

 ③ For superficial-type lesions, accuracy of conventional endoscopy, in particular, was superior to the other two endoscopic methods in diagnostic ability of invasion depth. Magnifying endoscopy had low specificity but it had positive predictive value of superficial type carcinoma in which submucosal invasion was more than1,000μm. Endoscopic ultrasonography showed low sensitivity and low positive predictive value.

 On the basis of our result ①, ② and ③, a flowchart was established for effective combination of endoscopic examinations in order to obtain higher diagnostic ability.

 Supposing that diagnosis of invasion depth and treatment for cancer were performed according to this flowchart, the rate of false treatment would have been11.6% for protruded type lesions and4.8% for superficial type lesions. These rates of false treatment were lower than those of independent conventional endoscopic diagnosis(20.9% and7.1% respectively).

 1) Department of Internal Medicine II, Kurume University School of Medicine, Kurume, Japan

 2) Division of Gastroenterology, Kurume University School of Medicine, Kurume, Japan

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