Background and study aim: A catheter-type endocytoscope has recently been developed that is able to provide in vivo cellular images of gastrointestinal mucosa. Aberrant crypt foci (ACF) represent the earliest precursor of colorectal cancer featuring the dysplasia-carcinoma sequence. The aim of the current study was to assess the potential of the endocytoscopy system (ECS) in the “in vivo” detection of dysplasia in colorectal ACF.
Patients and methods: Consecutive patients with colorectal ACF were studied with endocytoscopy. Blinded endoscopic and histological assessments were obtained. Lesions were excised en bloc for histology.
Results: A total of 48 colorectal lesions were examined in 41 patients. The mean duration of the ECS procedure was 44 ± 12 minutes (range 31 – 62 minutes). The quality of ECS images was rated as good in 39/48, medium in six, and poor in three (6.2 %). It was possible to observe lesions at the cellular level and evaluate both cellular and structural atypia in vivo. In normal mucosa, crypts had preserved individuality and round-shaped contours. Nuclei were located at the basal third of the crypt in a single line, and the lumen was circular. In dysplastic ACF, crypt contours were polygonal, cell nuclei were elongated with pseudostratification toward the luminal half of the crypt and irregularly arranged, and the lumen was linear. In all, 23 endocytoscopic images were labeled as dysplastic and 25 as nondysplastic. Histology confirmed low-grade dysplasia in 21/23 cases (91.4 % sensitivity). Absence of dysplasia was confirmed in the remaining 25 cases (100 % specificity). Interobserver agreement between trained endoscopist and pathologist was good (wK 0.68; 95 % CI 0.59 – 0.78).
Conclusions: Endocytoscopy provides real-time histological images in vivo, with clear visualization of cellular details and features of dysplasia in colorectal ACF.
References
1
Inoue H, Kazawa T, Sato Y. et al .
In vivo observation of living cancer cells in the esophagus, stomach, and colon using catheter-type contact endoscope, “Endo-Cytoscopy system”.
Gastrointest Endosc Clin N Am.
2004;
14
589-594
2
Inoue H, Sasajima K, Kaga M. et al .
Endoscopic in vivo evaluation of tissue atypia in the esophagus using a newly designed integrated endocytoscope: a pilot trial.
Endoscopy.
2006;
38
891-895
3
Sasajima K, Kudo S E, Inoue H. et al .
Real-time in vivo virtual histology of colorectal lesions when using the endocytoscopy system.
Gastrointest Endosc.
2006;
63
1010-1017
5
Meroni E, Gatteschi B, Fasoli A. et al .
Detection of tissue abnormalities in normal mucosa surrounding colorectal cancer using an endocytoscopy system.
Endoscopy.
2007;
39
369-370
6
Takayama T, Ohi M, Hayashi T. et al .
Analysis of K-ras, APC, and beta-catenin in aberrant crypt foci in sporadic adenoma, cancer, and familial adenomatous polyposis.
Gastroenterology.
2001;
121
599-611
8
Seike K, Koda K, Oda K. et al .
Assessment of rectal aberrant crypt foci by standard chromoscopy and its predictive value for colonic advanced neoplasms.
Am J Gastroenterol.
2006;
101
1362-1369
9
Kodashima S, Fujishiro M, Takubo K. et al .
Ex-vivo study of high-magnification chromoendoscopy in the gastrointestinal tract to determine the optimal staining conditions for endocytoscopy.
Endoscopy.
2006;
38
1115-1121
12
Pohl H, Koch M, Khalifa A. et al .
Evaluation of endocytoscopy in the surveillance of patients with Barrett’s esophagus.
Endoscopy.
2007;
39
492-496
14
Hurlstone D P, Baraza W, Brown S. et al .
In vivo real-time confocal laser scanning endomicroscopic colonoscopy for the detection and characterization of colorectal neoplasia.
Br J Surg.
2008;
95
636-645
15
Hurlstone D P, Kiesslich R, Thomson M. et al .
Confocal chromoscopic endomicroscopy is superior to chromoscopy alone for the detection and characterisation of intraepithelial neoplasia in chronic ulcerative colitis.
Gut.
2008;
57
196-204
16
Kiesslich R, Goetz M, Lammersdorf K. et al .
Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis.
Gastroenterology.
2007;
132
874-882
17
Hurlstone D P, Tiffin N, Brown S R. et al .
In vivo confocal laser scanning chromo-endomicroscopy of colorectal neoplasia: changing the technological paradigm.
Histopathology.
2008;
5
417-426