Detailed Observation of the Surface Structures of Colorectal Neoplasm Using a High-resolution Videocolonoscope in Comparison with those Observed by a Magnifying Videocolonoscope Shinji Tanaka 1 , Ken Haruma 2 , Yuichi Hirota 2 1Department of Endoscopy, Hiroshima University School of Medicine 2The First Department of Internal Medicine, Hiroshima University School of Medicine Keyword: 大腸腫瘍 , pit pattern , 実体顕微鏡 , 拡大観察 pp.1635-1644
Published Date 1999/12/25
DOI https://doi.org/10.11477/mf.1403102894
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 Recent advances of videoendoscopy have enabled the detailed observation of colorectal tumor surfaces. In order to clarify the clinical significance of the pit pattern diagnosis for colorectal tumors using a high-resolution or a magnifying videocolonoscope, we examined the pit pattern of tumor surfaces in 342 colorectal adenomas and early cancers in relation to the pathologic features. The cancer rate (submucosal cancer rate) in each of the pit pattern findings obtained by magnifying colonoscopic observation was Ⅱ 6/29: 21% (4%), ⅢL 49/150: 33% (2%), ⅢS 15/36: 42% (3%), Ⅳ 16/30: 53% (3%), ⅤA 53/58: 91% (19%), ⅤN 37/39: 95% (90%), respectively. The incidence of submucosal massive cancer rate in Ⅴ pit pattern was ⅤA 3/58 (5%), ⅤN 31/39 (80%), respectively. On the other hand, the corresponding rate between results obtained by magnifying colonoscopic observation and those obtained by ordinary observation using a high-resolution colonoscope were 23/25 (92%) in Ⅱ,85/103 (82%) in ⅢL,0/72 (0%) in ⅢS,15/16 (94%) in Ⅳ,7/42 (17%) in ⅤA,27/42 (64%) in ⅤN, respectively. The number of accurate pit pattern diagnoses from ordinary observation using the high-resolution colonoscope is very low especially in ⅢS and ⅤA pit patterns. Furthermore, even if the pit pattern is ⅤN, about 36 % of lesions can't be detected. These results indicate that pit pattern diagnosis using a magnifying videocolonoscope for colorectal tumors is useful for histologic diagnosis and invasion depth prediction. The results also clarified that although ordinary observation using a high-resolution colonoscope is fairly useful in the diagnosis of relatively large pit pattern (Ⅱ, ⅢL, Ⅳ), magnifying observation is essential for the correct pit pattern diagnosis of the whole range of lesions including ⅢS and ⅤA pit patterns.

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