Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8505, Japan.
Int J Colorectal Dis. 2011 Dec;26(12):1531-40. doi: 10.1007/s00384-011-1246-0. Epub 2011 May 24.
The number of patients suffering from colorectal cancer is increasing. According to Japanese guidelines, lesions with a submucosal invasive depth >1,000 μm should be treated with radical proctocolectomy. We propose and evaluate a new clinical classification for pit patterns that uses endoscopy to assess lesion depth for determination of the appropriate therapeutic approach for early colorectal cancers and adenomas.
Endoscopic images of colorectal adenomas and early cancer cases with type V(I) pit pattern, resected surgically or endoscopically from April 2002 to April 2007 at Showa University Yokohama Northern Hospital, were utilized for analysis. Each image was retrospectively analyzed for (A) pit narrowness, (B) irregular pit margins, and (C) indistinct stromal staining. Sensitivity, specificity, and predictive value were evaluated as major outcomes, using pathological results as the standard.
In total, 186 cases were assessed. With all features considered (A, B, and C), the sensitivity, specificity, and positive and negative predictive values were 47.8%, 86.3%, 66.0%, and 74.2%, respectively. When limited to two features (A and B), these values were 75.3%, 81.2%, 70.2%, and 84.8%, respectively.
Our results suggest that the established criteria can, to a certain degree, distinguish between high and low irregularity in colorectal lesions with V(I) pit pattern indicating submucosal cancer infiltration of more or less than 1,000 μm with the clinical consequence of surgery versus endoscopic mucosal resection/endoscopic mucosal dissection.
患有结直肠癌的患者人数正在增加。根据日本指南，黏膜下浸润深度>1000μm的病变应采用根治性直肠结肠切除术进行治疗。我们提出并评估了一种新的pit 模式临床分类，该分类使用内镜评估病变深度，以确定早期结直肠癌和腺瘤的适当治疗方法。
利用昭和大学横滨北方医院 2002 年 4 月至 2007 年 4 月期间经手术或内镜切除的具有 V(I)型 pit 模式的结直肠腺瘤和早期癌病例的内镜图像进行分析。每个图像均进行回顾性分析，以评估(A)pit 狭窄度、(B)不规则 pit 边缘和(C)不明显的基质染色。主要结果为评估敏感性、特异性和预测值，以病理结果为标准。
共评估了 186 例病例。综合所有特征（A、B 和 C），敏感性、特异性、阳性预测值和阴性预测值分别为 47.8%、86.3%、66.0%和 74.2%。当仅限于两个特征（A 和 B）时，这些值分别为 75.3%、81.2%、70.2%和 84.8%。
我们的结果表明，所建立的标准可以在一定程度上区分 V(I)型 pit 模式的结直肠病变的高低不规则性，表明黏膜下癌症浸润深度超过或不足 1000μm，其临床后果为手术与内镜黏膜切除/内镜黏膜下剥离。
