High resolution chromo-endoscopy: An affordable and accurate non-biopsy technique for predicting histology of colorectal polyps

S. W. Fry, D. E. Fleischer, A. M. Axelrad, R. M. Bashir, E. A. Montgomery, G. M. Eisen, J. H. Lewis, F. H. Al-Kawas, S. B. Benjamin

Research output: Contribution to journalArticle

Abstract

Background: Visual, non-biopsy techniques for predicting histology of diminutive colorectal polyps have not proven reliable. We recently reported our initial experience using a high resolution colonoscope (HRC). the Fujinon EC-400 HM/HL. in combination w/indigo carmine dye (ICD) for the diagnosis of small polyps. The sensitivity and specificity of our technique in distinguishing adenomatous from non-adenomatous polyps was 93% and 95%. respectively. Clinical application of this technique was limited by the cost of the HRC and accompanying video processor ($55K). We now report on our more recent experience utilizing a less expensive 2nd generation HRC (cost of scope/video processor = $25K). Methods: Complete colonoscopy using the Fujinon EC-200LR was performed in patients w/polyps. All polyps <10mm were sprayed w/ 0.4% ICD and subsequently photographed. Histologic diagnosis was predicted based on the polyps surface architecture ("pit pattern"=hyperplastic (HP). "grooves/sulci"=adenomatous (AP)). All polyps were then subjected to either biopsy or polypectomy All histologic diagnosis were reviewed and confirmed by a single blinded pathologist. Results: 58 polyps w/a mean diameter of 4.5mm were evaluated from 34 patients. Actual Histology Predicted Histo: AP Predicted Histo: HP Diagnostic Accuracy AP (n=26) 25 1 96% HP (n=25) 3 22 88% Other (n=7)*3 4 NA*lymphoid aggregate (n=6). fragment w/cautery effect (n= 1) When attempting to separate AP from non-AP (HP+Other) this technique has a sensitivity of 96% and a negative predictive value of 96% (ie., if a polyp is predicted to be hyperplastic there is a 96% (26/27) likelihood that it is not a AP). Retrospective video review of the one mispredicted AP revealed a predominant "pit" or "dot" pattern but also a single central grove. Conclusions: HRC in combination w/ ICD is very effective in separating non-AP form AP. The more affordable 2nd generation Fuinon HRC is equally capable of providing visual data that may allow endoscopists to predict histology w/o biopsy thus reducing the cost of colon cancer screening.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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