Gastrointestinal endoscopy · 2025
Clinical impact of combination of lesion-border findings and pit patterns for identifying invasive versus noninvasive neoplastic lesions in ulcerative colitis.
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Kawabata Yurie, Kudo Shin-Ei, Maeda Yasuharu, Kuroki Takanori, Takishima Kazumi, Takashina Yuki, Minegishi Yosuke, Okumura Taishi, Sakurai Tatsuya, Kouyama Yuta, Ogawa Yushi, Ichimasa Katsuro, Misawa Masashi, Hayashi Takemasa, Wakamura Kunihiko, Sawada Naruhiko, Baba Toshiyuki, Nemoto Tetsuo, Ohtsuka Kazuo, Ogata Noriyuki
Аннотация
BACKGROUND AND AIMS: Patients with ulcerative colitis (UC) have a high incidence of colorectal neoplasia. Kudo's pit pattern is useful for assessing the depth of colorectal neoplasia in the general population; however, its application in UC-associated neoplasia is limited. Inaccurate preoperative depth diagnosis may lead to positive resection margins and perforation. We aimed to determine whether evaluating lesion-border findings can help identify cases in which pit pattern analysis is useful for depth diagnosis in patients with UC.
METHODS: This single-center, retrospective study analyzed 158 colorectal lesions in patients with UC. Lesions were resected endoscopically or surgically after magnifying chromoendoscopy observation and borders were defined as "distinct" or "indistinct." The predictive value of pit patterns for identifying intramucosal lesions was evaluated.
RESULTS: The lesions included the following macroscopic types: pedunculated (1.9%), sessile (13.3%), superficial elevated (82.3%), and depressed (2.5%). The pathologic diagnoses included serrated lesion (18.4%), dysplasia (62.7%), intramucosal carcinoma (9.5%), T1 cancer (5.1%), and T2 or deeper cancer (4.4%). One hundred eighteen lesions were classified with distinct borders and 40 with indistinct borders. The diagnostic sensitivity, specificity, and accuracy of type II/IIIL pit patterns for intramucosal lesions were 75.5%, 80.0%, and 75.9 for all subjects; 14.3%, 75.0%, and 32.5% for indistinct borders; and 90.4%, 100%, and 90.7% for distinct borders, respectively.
CONCLUSIONS: Adding lesion-border findings to pit patterns improved the identification of intramucosal lesions in patients with UC. All lesions with distinct borders and type II or IIIL pit patterns were intramucosal, suggesting lesions suitable for endoscopic resection.
METHODS: This single-center, retrospective study analyzed 158 colorectal lesions in patients with UC. Lesions were resected endoscopically or surgically after magnifying chromoendoscopy observation and borders were defined as "distinct" or "indistinct." The predictive value of pit patterns for identifying intramucosal lesions was evaluated.
RESULTS: The lesions included the following macroscopic types: pedunculated (1.9%), sessile (13.3%), superficial elevated (82.3%), and depressed (2.5%). The pathologic diagnoses included serrated lesion (18.4%), dysplasia (62.7%), intramucosal carcinoma (9.5%), T1 cancer (5.1%), and T2 or deeper cancer (4.4%). One hundred eighteen lesions were classified with distinct borders and 40 with indistinct borders. The diagnostic sensitivity, specificity, and accuracy of type II/IIIL pit patterns for intramucosal lesions were 75.5%, 80.0%, and 75.9 for all subjects; 14.3%, 75.0%, and 32.5% for indistinct borders; and 90.4%, 100%, and 90.7% for distinct borders, respectively.
CONCLUSIONS: Adding lesion-border findings to pit patterns improved the identification of intramucosal lesions in patients with UC. All lesions with distinct borders and type II or IIIL pit patterns were intramucosal, suggesting lesions suitable for endoscopic resection.