TITLE

IN VIVO ANTICIPATION OF SUBMUCOSAL INVASION IN FLAT AND DEPRESSED COLORECTAL LESIONS: CLINICAL IMPLICATIONS OF SUBTYPE ANALYSIS OF THE KUDO TYPE V PIT PATTERN USING HIGH RESOLUTION CHROMOSCOPIC COLONOSCOPY

AUTHOR(S)
Hurlstone, D.P.; Shorthouse, A.J.; Adam, I.; Brown, S.; Cross, S.S.; Lobo, A.J.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA24
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Focal submucosal invasive colorectal cancers (Iocalised to the upper third of the submucosa, ie sm1) can be managed by endoscopic mucosal resection (EMR) as local lymph node metastasis (LLNM) are rare. Morphologically, these lesions are usually flat, depressed, or mixed — Japanese Research Society Classification (JRSC) Ila/b/c. In deeper vertical submucosaJ invasion (ie sm2/3) LLNM rates exceed 10-15%. EMR within this group can be complicated with perforation and non-curative resection. It is thus essential to differentiate accurately focal sm1 disease from submucosal sm2/3 disease. Aim: To evaluate the relationship between the Kudo type Vn (A-C) crypt pattern and submucosal invasion depth for flat type (JRSC type II) colorectal lesions. Methods: 600 consecutive patients were colonoscoped, by a singJe endoscopist using the Olympus CF240Z, from 01/02 to 09/02. Kudo type V pits were identified using 0.5% crystal violet (CV) applied directly to the lesion with a steel tipped catheter. Type V pits were graded into class Va or Vn as per the modified Kudo class. Vn pits were subsequently subtyped as grades A,B,C according to Vn appearance as described by Tanaka. Morphology was documented using the JRSC. Histological analysis was performed on all lesions. Results: 47 JRSC class II lesions had a type V(n) pit pattern (see Table). Conclusions: High resolution chromoscopy is a predictor of invasive depth. The safety of EMR can be greatly enhanced using th s technique.
ACCESSION #
9747416

 

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