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. 2023 Nov;27(11):1047-1056.
doi: 10.1007/s10151-023-02773-7. Epub 2023 Mar 12.

Magnifying chromoendoscopy is a reliable method in the selection of rectal neoplasms for local excision

C M S Kimura  1   2 , F S Kawaguti  3 , N Horvat  4 , C S R Nahas  1 , C F S Marques  1 , R A Pinto  1 , D T de Rezende  5 , V Segatelli  6 , A V Safatle-Ribeiro  5 , U R Junior  1 , F Maluf-Filho  5 , S C Nahas  1
Affiliations

Magnifying chromoendoscopy is a reliable method in the selection of rectal neoplasms for local excision

C M S Kimura et al. Tech Coloproctol. 2023 Nov.

Abstract

Purpose: Adequate staging of early rectal neoplasms is essential for organ-preserving treatments, but magnetic resonance imaging (MRI) frequently overestimates the stage of those lesions. We aimed to compare the ability of magnifying chromoendoscopy and MRI to select patients with early rectal neoplasms for local excision.

Methods: This retrospective study in a tertiary Western cancer center included consecutive patients evaluated by magnifying chromoendoscopy and MRI who underwent en bloc resection of nonpedunculated sessile polyps larger than 20 mm, laterally spreading tumors (LSTs) [Formula: see text] 20 mm, or depressed-type lesions of any size (Paris 0-IIc). Sensitivity, specificity, accuracy, and positive and negative predictive values of magnifying chromoendoscopy and MRI to determine which lesions were amenable to local excision (i.e., [Formula: see text] T1sm1) were calculated.

Results: Specificity of magnifying chromoendoscopy was 97.3% (95% CI 92.2-99.4), and accuracy was 92.7% (95% CI 86.7-96.6) for predicting invasion deeper than T1sm1 (not amenable to local excision). MRI had lower specificity (60.5%, 95% CI 43.4-76.0) and lower accuracy (58.3%, 95% CI 43.2-72.4). Magnifying chromoendoscopy incorrectly predicted invasion depth in 10.7% of the cases in which the MRI was correct, while magnifying chromoendoscopy provided a correct diagnosis in 90% of the cases in which the MRI was incorrect (p = 0.001). Overstaging occurred in 33.3% of the cases in which magnifying chromoendoscopy was incorrect and 75% of the cases in which MRI was incorrect.

Conclusion: Magnifying chromoendoscopy is reliable for predicting invasion depth in early rectal neoplasms and selecting patients for local excision.

Keywords: Magnetic resonance imaging; Magnifying chromoendoscopy; Rectal cancer; Rectal neoplasms.

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Conflict of interest statement

Disclosure statement: the authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
67 year-old male patient who underwent rectal MRI for baseline staging. (A and B) Oblique axial and (C and D) sagittal T2WI show a lower rectal polypoid tumor contained by the muscularis propria, consistent with T1/T2 lesion.
Figure 2.
Figure 2.
Same patient of Figure 1 was assessed and treated by colonoscopy. A. High-definition white light image (retroflexion view) shows a laterally spreading tumor, granular type, located in distal rectum, close to the dentine line. B. Lesion margins delineated with 0.4% índigo carmine dye spraying. C and D. Magnifying chromoendoscopy reveals Vi pit pattern, a noninvasive aspect that would correspond to either intramucosal adenocarcinoma or adenocarcinoma with superficial invasion of the submucosa (T1sm1). Endoscopic submucosal dissection (ESD) was indicated. E. Lesion partially dissected during the ESD procedure. F. The ulcer bed after the sucessfull en bloc resection. G. Resected specimen (115 × 110 mm). Histology revealed an intramucosal well diferentiated carcinoma without lymphovascular invasion and free margins. H and I. Four-year follow-up colonoscopy presenting a scar in the distal rectum with no signs of recurrence (H. Frontal view; I. Retroflexion view).
Figure 3.
Figure 3.
Included cases
See this image and copyright information in PMC

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