High-resolution chromoendoscopy for classifying colonic polyps: a multicenter study.

BACKGROUND Chromoendoscopy may reliably separate adenomatous from nonadenomatous polyps. The aim of this multicenter trial was to determine the accuracy of high-resolution chromoendoscopy for the determination of colonic polyp histology. METHODS This multicenter trial included 4 academic centers and a primary care practice. In 299 patients referred for routine colonoscopy or sigmoidoscopy, 520 polyps 10 mm in size were sprayed with indigo carmine dye. Using a high-resolution endoscope, the endoscopist predicted the histology of each polyp based on its surface characteristics. Hyperplastic polyps had a "pitted" surface pattern of orderly arranged "dots" that resembled surrounding normal mucosa. Adenomatous polyps had at least one surface "groove" or "sulcus." Each polyp was subsequently resected for histopathologic evaluation. RESULTS The resected polyps were comprised by 193 adenomas (37%), 225 hyperplastic polyps (43%), and 102 "other" types (20%). Forty polyps (7.7%) could not be classified by high resolution chromoendoscopy with indigo carmine dye. For the remaining polyps, the sensitivity, specificity, and negative predictive value of indigo carmine dye staining for adenomatous polyps were, respectively, 82%, 82%, and 88%. The results were consistent among the academic centers and the primary care practice. CONCLUSIONS High-resolution chromoendoscopy with indigo carmine dye demonstrates morphologic detail of diminutive colorectal polyps that can reliably be used to separate adenomatous from nonadenomatous polyps.

[1]  C. Mulrow,et al.  Colorectal cancer screening: clinical guidelines and rationale. , 1997, Gastroenterology.

[2]  T. Byers,et al.  American Cancer Society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: Update 1997 , 1997 .

[3]  M. Tatsuta,et al.  Early depressed adenocarcinomas of the large intestine , 1992, Cancer.

[4]  Sigmoidoscopic screening in the 1990s , 1993, JAMA.

[5]  M. Fujishima,et al.  Small nonpolypoid neoplastic lesions of the colon: endoscopic features with emphasis on their progression. , 1995, Gastrointestinal endoscopy.

[6]  B. Flehinger,et al.  Screening for colorectal cancer with fecal occult blood testing and sigmoidoscopy. , 1993, Journal of the National Cancer Institute.

[7]  C. Rubio,et al.  Small, flat colorectal neoplasias in long-standing ulcerative colitis detected by high-resolution electronic video endoscopy. , 1996, Gastrointestinal endoscopy.

[8]  M. Sivak,et al.  Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy. , 1991, Gastroenterology.

[9]  D. Fleischer,et al.  Hyperplastic colonic polyps as a marker for adenomatous colonic polyps. , 1989, The American journal of gastroenterology.

[10]  P. Foutch,et al.  The sentinel hyperplastic polyp: a marker for synchronous neoplasia in the proximal colon. , 1991, The American journal of gastroenterology.

[11]  D. Rex,et al.  Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects. , 1992, Gastroenterology.

[12]  Taylor Murray,et al.  Cancer statistics, 1998 , 1998, CA: a cancer journal for clinicians.

[13]  E. Montgomery,et al.  High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: implications for colon cancer screening. , 1996, Gastroenterology.

[14]  M. Fujishima,et al.  Minute non-polypoid adenoma of the colon detected by colonoscopy: correlation between endoscopic and histologic findings. , 1992, Gastrointestinal endoscopy.

[15]  D. Lieberman,et al.  Screening for colon malignancy with colonoscopy. , 1991, The American journal of gastroenterology.

[16]  Payne Ra.  The incidence and clinical significance of rectal polyps. , 1976, Annals of the Royal College of Surgeons of England.

[17]  J. Ray,et al.  Diminutive colonic polyps: An indication for colonoscopy , 1992, Diseases of the colon and rectum.

[18]  B E Storer,et al.  Screening sigmoidoscopy and colorectal cancer mortality. , 1992, Journal of the National Cancer Institute.

[19]  C. Rubio,et al.  Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy. , 1995, Gastrointestinal endoscopy.

[20]  A. Zauber,et al.  Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. , 1993 .

[21]  T. Fujimori,et al.  Chromoscopy of the colon using indigo carmine dye with electrolyte lavage solution. , 1992, Gastrointestinal endoscopy.

[22]  M. Fujishima,et al.  Small flat cancer of the rectum: clinicopathologic and endoscopic features. , 1995, Gastrointestinal endoscopy.

[23]  G. Friedman,et al.  A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. , 1992, The New England journal of medicine.

[24]  J. Bond,et al.  Is the small colorectal polyp clinically diminutive? , 1993, Gastrointestinal endoscopy.

[25]  T. Muto,et al.  The evolution of cancer of the colon and rectum , 1974, Cancer.

[26]  A. Weston,et al.  Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications. , 1995, The American journal of gastroenterology.

[27]  S. Maeda,et al.  Minute flat depressed neoplastic lesions of the colon detected by contrast chromoscopy using an indigo carmine capsule. , 1995, Gastrointestinal endoscopy.

[28]  P. Brady,et al.  Diminutive polyps: histopathology, spatial distribution, and clinical significance. , 1982, Gastrointestinal endoscopy.

[29]  S. McClave,et al.  Are hyperplastic rectosigmoid polyps associated with an increased risk of proximal colonic neoplasms? , 1993, Gastrointestinal endoscopy.

[30]  E. Montgomery,et al.  High resolution chromo-endoscopy: An affordable and accurate non-biopsy technique for predicting histology of colorectal polyps , 1996 .

[31]  J. Waye,et al.  Small colon polyps. , 1988, The American journal of gastroenterology.

[32]  S. Kudo,et al.  Endoscopic Mucosal Resection of Flat and Depressed Types of Early Colorectal Cancer , 1993, Endoscopy.

[33]  O. Dent,et al.  Clinical accuracy in the diagnosis of small polyps using the flexible fiberoptic sigmoidoscope , 1982, Diseases of the colon and rectum.

[34]  T. Muto,et al.  Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features , 1985, Diseases of the colon and rectum.

[35]  A. Neale,et al.  Physician accuracy in diagnosing colorectal polyps , 1987, Diseases of the colon and rectum.

[36]  Y Morioka,et al.  Clinicopathologic features of the flat adenoma , 1991, Diseases of the colon and rectum.

[37]  K. Okita,et al.  Endoscopic diagnosis and resection treatment for flat adenoma with severe dysplasia. , 1993, The American journal of gastroenterology.

[38]  H. Iishi,et al.  Diagnosis of colorectal tumors by the endoscopic Congo red-methylene blue test , 1994, Surgical Endoscopy.

[39]  M. Itoh,et al.  Endoscopic and clinicopathologic evaluation of four cases of minute flat invasive colorectal carcinoma. , 1996, Gastrointestinal endoscopy.

[40]  D. Fleischer,et al.  Colonic chromoscopy. A new perspective on polyps and flat adenomas. , 1997, Gastrointestinal endoscopy clinics of North America.