High magnification chromoscopic colonoscopy or high Frequency 20 MHz mini probe endoscopic ultrasound staging for early colorectal neoplasia: a comparative prospective analysis

Hurlstone, D. P.; Brown, S.; Cross, S. S.; Shorthouse, A. J.; Sanders, D. S.
November 2005
Gut;Nov2005, Vol. 54 Issue 11, p1585
Academic Journal
Background: Successful endoscopic management of early colorectal cancer using endoscopic mucosal resection requires the mandatory prediction of invasive depth and lymph node metastasis. Previous data using the Nagata crypt types Vn(B)/(C) as clinical indicators of T2/N+ disease have shown low specificity (50%) with a tendency to over stage lesions. New mini probe ultrasound "through the scope" imaging permits staging of lesions proximal to the rectum using direct endoscopic visualisation. Aim: To compare the staging accuracy of the Nagata crypt type V with mini probe high frequency 20 MHz endoscopic ultrasound. Methods: Sixty two patients with a Paris type II flat cancer were imaged using magnification colonoscopy followed by 20/12.5 MHz ultrasound in a "bock to back" design. Crystal violet staining (0.05%) at 100x magnification permitted Nagata crypt criteria to be defined. Submucosal deep invasion (sm3+) was defined at ultrasound by the presence or absence of a disrupted third sonographic layer. Predicted T0/i: N0 lesions were resected using endoscopic mucosal resection with the remaining referred for surgery. Ultrasound and magnification staging were then compared with the resected histopathological specimens. Results: One patient was excluded from the study due to poor bowel preparation. Fifty two lesions from 52 patients therefore met inclusion criteria (12 sm1 /13 sm2/27 sm3+). Ultrasound (20 MHz) was significantly more accurate for invasive depth staging compared with Nagata stage (p < 0.0001) (overall accuracy 93% and 59%, respectively). The sensitivity for lymph node metastasis detection using ultrasound and magnification was 80% and 31%, respectively (p<0.001). The negative predictive value of ultrasound for invasive depth was better than that observed using magnification (88%/47%, respectively). The prevalence of nodal disease overall was 19% (10/52), with 80% (8/10) node positive lesions occurring in the sm3+ lesion group. Conclusions: High frequency 20 MHz ultrasound is superior to magnification alone when differentiating T1 /2 disease with a high positive predictive value for sm3 differentiation. Sm3+ invasion was associated with nodal metastasis.


Related Articles

  • Early Invasive Colorectal Carcinomas Metastatic to the Lymph Node with Attention to Their Nonpolypoid Development. Minamoto, Toshinari; Mai, Masayoshi; Ogino, Tomomi; Sawaguchi, Kiyoshi; Ohta, Takahito; Fujimoto, Toshihiro; Takahashi, Yutaka // American Journal of Gastroenterology;Jul1993, Vol. 88 Issue 7, p1035 

    Clinicopathologic study of six cases of early invasive colorectal carcinoma metastatic to lymph node was performed in order to elucidate possible characteristics relating to the risk of metastasis, with particular attention to the growth pattern of the primary tumor. All of the cases had at...

  • The Prediction of Lymph Node Metastases in Colorectal Cancer by Expression of the Nucleoside Diphosphate Kinase/nm23-H1 and Histopathological Variables. Tannapfel, Andrea; Katalinic, Alexander; Köckerling, Ferdinand; Wittekind, Christian // American Journal of Gastroenterology;Jul1997, Vol. 92 Issue 7, p1182 

    Objective: To ascertain the risk of locoregional lymph node metastases from colorectal cancer, we compared microscopic pathological characteristics of the primary tumor with the expression of the nm23-H1 protein. Methods: The nm23-H1 expression of 100 colorectal carcinomas and corresponding...

  • Can Modified Dukes' Classification be Used in Gastric Cancer Staging? ÖZgüç, Halil; Öztürk, Ersin; Kirdak, Türkay; Yercİ, ÖMer; Sönmez, Yalçın; BaǦçivan, Erol; Korun, Nusret // Turkish Journal of Medical Sciences;2006, Vol. 36 Issue 5, p271 

    Aim: Dukes' staging system is a simple system used widely in the staging of colorectal cancer. This study was designed to analyze the applicability of the modified Dukes' classification system in gastric cancer cases. Methods: The prognostic factors affecting survival in 139 gastric cancer cases...

  • Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT. Sang Soo Shin; Yong Yeon Jeong; Jung Jun Min; Hyeong Rok Kim; Tae Wook Chung; Heoung Keun Kang // Abdominal Imaging;May/Jun2008, Vol. 33 Issue 3, p270 

    Accurate preoperative staging is essential in determining the optimal therapeutic planning for individual patients. The computed tomography (CT) in the preoperative staging of colorectal cancer, even if controversial, may be useful for planning surgery and/or neoadjuvant therapy, particularly...

  • The extramural metastasis might be categorized in lymph node staging for colorectal cancer.  // BMC Cancer;2011, Vol. 11 Issue 1, p414 

    The article presents a study that examines the clinical significance and prognostic impact of extramural metastasis in colorectal carcinoma. It is mentioned that some patients with colorectal cancer were examined to determine the frequency and prognostic significance of extramural metastasis. It...

  • Whole-body PET/CT-colonography: a possible new concept for colorectal cancer staging. Kinner, Sonja; Antoch, Gerald; Bockisch, Andreas; Veit-Haibach, Patrick // Abdominal Imaging;Sep/Oct2007, Vol. 32 Issue 5, p606 

    Colorectal cancer (CRC) is a leading cause of death, and necessitates a conjointly performed staging. Until now, a multi-step-examination including optical colonoscopy, cross-sectional and functional imaging is recommended. However, a single examination for whole-body staging with a dedicated...

  • The Activity of RhoA is Correlated with Lymph Node Metastasis in Human Colorectal Cancer. Yoji Takami; Morihiro Higashi; Shinpei Kumagai; Paul Kuo; Hidetada Kawana; Keiji Koda; Masaru Miyazaki; Kenichi Harigaya // Digestive Diseases & Sciences;Feb2008, Vol. 53 Issue 2, p467 

    Abstract  Rho family GTPases play a pivotal role in the regulation of numerous cellular functions associated with malignant transformation and metastasis. To evaluate the role of these GTPases in colorectal cancer, the protein expression levels and activities of these proteins in...

  • Prognostic Factors Affecting Survival and Recurrence of Patients with pT1 and pT2 Colorectal Cancer. Chok, Kenneth S. H.; Wai Lun Law // World Journal of Surgery;Jul2007, Vol. 31 Issue 7, p1485 

    Data on the prognostic factors of survival and recurrence in patients with colorectal cancers confined to the bowel wall (T1 and T2) are limited. The aim of the present study was to determine factors that might predict the survival and recurrence of patients who had T1 and T2 colorectal cancers....

  • Correlations between cytoplasmic CSE1L in neoplastic colorectal glands and depth of tumor penetration and cancer stage. Cheng-Jeng Tai; Tzu-Cheng Su; Ming-Chung Jiang; Hung-Chang Chen; Shing-Chuan Shen; Woan-Ruoh Lee; Ching-Fong Liao; Ying-Chun Chen; Shu-Hui Lin; Li-Tzu Li; Ko-Hung Shen; Chung-Min Yeh; Kun-Tu Yeh; Ching-Hsiao Lee; Hsin-Yi Shih; Chun-Chao Chang // Journal of Translational Medicine;2013, Vol. 11 Issue 1, p1 

    Background: Colorectal carcinomas spread easily to nearby tissues around the colon or rectum, and display strong potential for invasion and metastasis. CSE1L, the chromosome segregation 1-like protein, is implicated in cancer progression and is located in both the cytoplasm and nuclei of tumor...


Read the Article


Sign out of this library

Other Topics