Accuracy of high-resolution chromoendoscopy in prediction of histologic findings in diminutive lesions of the rectosigmoid

Gastrointest Endosc. 2006 May;63(6):824-8. doi: 10.1016/j.gie.2005.09.013.

Abstract

Background: The ability to differentiate adenomatous from nonadenomatous colonic polyps by using chromoendoscopy would obviate the need to remove hyperplastic lesions. The aim of this study was to define the accuracy of high-resolution chromoendoscopy for the determination of colonic polyp histology.

Methods: In 158 patients, 273 polyps (<5 mm) in the rectosigmoid were estimated for their histology. The endoscopists, in two steps, predicted the histopathology of each lesion on the basis of its surface characteristics by using high-resolution colonoscope without any staining and after indigo carmine dye according to the Kudo classification.

Results: The resected polyps included 48 adenomatous and 225 nonadenomatous polyps. When histologically confirmed hyperplastic polyps were compared with adenomatous polyps, the prediction of hyperplastic polyps based on endoscopic findings had a sensitivity of 93%, a specificity of 60%, and an overall accuracy of 81%. The corresponding sensitivity, specificity, and overall accuracy after indigo carmine dye were 94%, 64%, and 83%, respectively.

Conclusions: The results suggest that the chromoendoscopy only marginally improves the determination between hyperplastic and adenomatous polyps when using high-resolution colonoscopes. The overall accuracy rate increased after dyeing, from 81% to 83%. The omission of histopathologic analysis cannot yet be achieved by chromoendoscopy.

MeSH terms

  • Adenoma / pathology*
  • Aged
  • Aged, 80 and over
  • Colonic Neoplasms / pathology*
  • Colonic Polyps / pathology*
  • Colonoscopes
  • Colonoscopy
  • Color
  • Coloring Agents / therapeutic use
  • Endoscopy, Gastrointestinal / methods*
  • Female
  • Humans
  • Hyperplasia / pathology
  • Indigo Carmine / therapeutic use
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Sigmoid Neoplasms / pathology*

Substances

  • Coloring Agents
  • Indigo Carmine