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Role of Magnification Chromoendoscopy in the Management of Colorectal Neoplastic Lesions Suspicious for Submucosal Invasion

Kawaguti, Fabio S., M.D.1; Franco, Matheus C., M.D., M.Sc.1; Martins, Bruno C., M.D., Ph.D.1; Segateli, Vanderlei, Ph.D.2; Marques, Carlos F. S., M.D., Ph.D.3; Nahas, Caio S. R., Ph.D.3; Pinto, Rodrigo A., M.D., Ph.D.3; Safatle-Ribeiro, Adriana V., M.D., Ph.D.1; Ribeiro-Junior, Ulysses, Ph.D.3; Nahas, Sergio C., Ph.D.3; Maluf-Filho, Fauze, M.D., Ph.D.1

Diseases of the Colon & Rectum: April 2019 - Volume 62 - Issue 4 - p 422–428
doi: 10.1097/DCR.0000000000001343
Original Contributions: Colorectal Cancer
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BACKGROUND: Correctly predicting the depth of tumor invasion in the colorectal wall is crucial for successful endoscopic resection of superficial colorectal neoplasms.

OBJECTIVE: The aim of this study was to assess the accuracy of magnifying chromoendoscopy in a Western medical center to predict the depth of invasion by the pit pattern classification in patients with colorectal neoplasms with a high risk of submucosal invasion.

DESIGN: This single-center retrospective study, from a prospectively collected database, was conducted between April 2009 and June 2015.

SETTINGS: The study was conducted at a single academic center.

PATIENTS: Consecutive patients with colorectal neoplasms with high risk of submucosal invasion were included. These tumors were defined by large (≥20 mm) sessile polyps (nonpedunculated), laterally spreading tumors, or depressed lesions of any size.

INTERVENTIONS: Patients underwent magnifying chromoendoscopy and were classified according to the Kudo pit pattern. The therapeutic decision, endoscopic or surgery, was defined by the magnification assessment.

MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of magnifying chromoendoscopy for assessment of these lesions were determined.

RESULTS: A total of 123 lesions were included, with a mean size of 54.0 ± 37.1 mm. Preoperative magnifying chromoendoscopy with pit pattern classification had 73.3% sensitivity, 100% specificity, 100% positive predictive value, 96.4% negative predictive value, and 96.7% accuracy to predict depth of invasion and consequently to guide the appropriate treatment. Thirty-three rectal lesions were also examined by MRI, and 31 were diagnosed as T2 lesions. Twenty two (70.1%) of these lesions were diagnosed as noninvasive by magnifying colonoscopy, were treated by endoscopic resection, and met the curative criteria.

LIMITATIONS: This was a single-center retrospective study with a single expert endoscopist experience.

CONCLUSIONS: Magnifying chromoendoscopy is highly accurate for assessing colorectal neoplasms suspicious for submucosal invasion and can help to select the most appropriate treatment. See Video Abstract at

1 Division of Endoscopy, Cancer Institute of University of São Paulo Medical School, São Paulo, Brazil

2 Division of Pathology, Cancer Institute of University of São Paulo Medical School, São Paulo, Brazil

3 Division of Gastrointestinal Surgery, Cancer Institute of University of São Paulo Medical School, São Paulo, Brazil

Funding/Support: None reported.

Financial Disclosure: None reported.

Presented in part at the meeting of United European Gastroenterology Week 2015, Barcelona, Spain, October 24 to 28, 2015, and the poster was awarded a National Scholar Award–Brazil.

Correspondence: Fabio S. Kawaguti, M.D., Cancer Institute of University of Sao Paulo, Dr Arnaldo Av, 251, 2o Andar, 01246-000 São Paulo, Brazil. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons