Advanced endoscopic features of ulcerative colitis-associated neoplasias: Quantification of autofluorescence imaging

Yoshioka,Shinichiro; Mitsuyama,Keiichi; Takedatsu,Hidetoshi; Kuwaki,Kotaro; Yamauchi,Ryosuke; Yamasaki,Hiroshi; Fukunaga,Shuhei; Akiba,Jun; Kinugasa,Tetsushi; Akagi,Yoshito; Tsuruta,Osamu; Torimura,Takuji

doi:10.3892/ijo.2015.3284

Advanced endoscopic features of ulcerative colitis-associated neoplasias: Quantification of autofluorescence imaging

Authors:
- Shinichiro Yoshioka
- Keiichi Mitsuyama
- Hidetoshi Takedatsu
- Kotaro Kuwaki
- Ryosuke Yamauchi
- Hiroshi Yamasaki
- Shuhei Fukunaga
- Jun Akiba
- Tetsushi Kinugasa
- Yoshito Akagi
- Osamu Tsuruta
- Takuji Torimura
View Affiliations

Affiliations: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan, Department of Pathology, Kurume University School of Medicine, Kurume 830-0011, Japan, Department of Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan
Published online on: December 9, 2015 https://doi.org/10.3892/ijo.2015.3284
Pages: 551-558

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Ulcerative colitis (UC) patients are well known to carry a higher risk of developing colorectal dysplasia/cancer. However, it is hard to detect the lesion in the early phase during colonoscopy. This pilot study was conducted to analyze the endoscopic characteristics of neoplastic lesions associated with UC using advanced imaging techniques. This is a retrospective analysis of 15 colorectal neoplastic lesion obtained from 11 UC patients during remission who underwent white-light- and advanced endoscopic imaging techniques, including chromoendoscopy, narrow-band imaging and autofluorescence imaging (AFI), and were treated with surgery. These lesions were analyzed for histology, location, size, shape, color and endoscopic features. The green/red ratio was also assessed to quantify the AFI intensity. All 11 patients had extensive colitis with the median disease duration of 14.0 years. A total of 15 lesions, consisting of 8 high-grade dysplasia and 7 cancer, was mostly located in the distal colon (86.7%, 13/15) with the mean size of 8.6 mm. The shape was protruding in 46.7% (7/15), flat elevated in 40.0% (6/15) and flat in 13.3% (2/15) and the color was red in 60.0% (9/15), same colored in 33.3% (5/15) and discolored in 6.7% (1/15). The lesion predominantly showed Kudo's neoplastic pit pattern in 86.7% (13/15; 5 type IIIL, 7 type IV and 1 type VI) on chromoendoscopy and Sano's neoplastic capillary pattern (type IIIa) in 63.6% (7/11) on narrow-band imaging, but were colored purple as neoplastic lesions in only 37.5% (3/8) on AFI. Of note, the AFI green/red ratio was significantly lower in the neoplastic lesions than UC-involved areas (p=0.00014) and UC-uninvolved areas (p=0.00651) irrespective of the lesion's size and histological type. In conclusion, endoscopic analysis based on advanced imaging, in particular AFI quantitation, may be helpful to detect early stage neoplastic lesions in long standing UC. Large-scale, prospective studies are needed.

View Figures

View References

1	Eaden JA, Abrams KR and Mayberry JF: The risk of colorectal cancer in ulcerative colitis: A meta-analysis. Gut. 48:526–535. 2001. View Article : Google Scholar : PubMed/NCBI
2	Ullman TA and Itzkowitz SH: Intestinal inflammation and cancer. Gastroenterology. 140:1807–1816. 2011. View Article : Google Scholar : PubMed/NCBI
3	Morson BC and Pang LS: Rectal biopsy as an aid to cancer control in ulcerative colitis. Gut. 8:423–434. 1967. View Article : Google Scholar : PubMed/NCBI
4	Bernstein CN, Shanahan F and Weinstein WM: Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis? Lancet. 343:71–74. 1994. View Article : Google Scholar : PubMed/NCBI
5	Blackstone MO, Riddell RH, Rogers BH and Levin B: Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: An indication for colectomy. Gastroenterology. 80:366–374. 1981.PubMed/NCBI
6	Farrell RJ and Peppercorn MA: Ulcerative colitis. Lancet. 359:331–340. 2002. View Article : Google Scholar : PubMed/NCBI
7	Eaden JA and Mayberry JF; British Society for Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease. Gut. 51(Suppl 5): V10–V12. 2002. View Article : Google Scholar : PubMed/NCBI
8	Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, Ganiats T, Levin T, Woolf S, Johnson D, et al; Gastrointestinal Consortium Panel. Colorectal cancer screening and surveillance: Clinical guidelines and rationale - Update based on new evidence. Gastroenterology. 124:544–560. 2003. View Article : Google Scholar : PubMed/NCBI
9	Kornbluth A and Sachar DB: Ulcerative colitis practice guidelines in adults. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 92:204–211. 1997.PubMed/NCBI
10	Rutter MD: Surveillance programmes for neoplasia in colitis. J Gastroenterol. 46(Suppl 1): 1–5. 2011. View Article : Google Scholar
11	Watanabe T, Ajioka Y, Matsumoto T, Tomotsugu N, Takebayashi T, Inoue E, Iizuka B, Igarashi M, Iwao Y, Ohtsuka K, et al: Target biopsy or step biopsy? Optimal surveillance for ulcerative colitis: A Japanese nationwide randomized controlled trial. J Gastroenterol. 46(Suppl 1): 11–16. 2011. View Article : Google Scholar
12	Matsumoto T, Iwao Y, Igarashi M, Watanabe K, Otsuka K, Watanabe T, Iizuka B, Hida N, Sada M, Chiba T, et al: Endoscopic and chromoendoscopic atlas featuring dysplastic lesions in surveillance colonoscopy for patients with long-standing ulcerative colitis. Inflamm Bowel Dis. 14:259–264. 2008. View Article : Google Scholar
13	Basu S, Torigian D and Alavi A: The role of modern molecular imaging techniques in gastroenterology. Gastroenterology. 135:1055–1061. 2008. View Article : Google Scholar : PubMed/NCBI
14	Axelrad AM, Fleischer DE, Geller AJ, Nguyen CC, Lewis JH, Al-Kawas FH, Avigan MI, Montgomery EA and Benjamin SB: High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: Implications for colon cancer screening. Gastroenterology. 110:1253–1258. 1996. View Article : Google Scholar : PubMed/NCBI
15	Fu KI, Sano Y, Kato S, Fujii T, Nagashima F, Yoshino T, Okuno T, Yoshida S and Fujimori T: Chromoendoscopy using indigo carmine dye spraying with magnifying observation is the most reliable method for differential diagnosis between non-neoplastic and neoplastic colorectal lesions: A prospective study. Endoscopy. 36:1089–1093. 2004. View Article : Google Scholar : PubMed/NCBI
16	Sano Y, Muto M, Tajiri H, Ohtsu A and Yoshida S: Optical/digital chromoendoscopy during colonoscopy using narrow-band image system. Dig Endosc. 17(Suppl 1): pp. S43–S48. 2005, http://onlinelibrary.wiley.com/doi/10.1111/j.1443-1661.2005.00511.x/abstract. View Article : Google Scholar
17	Chiu HM, Chang CY, Chen CC, Lee YC, Wu MS, Lin JT, Shun CT and Wang HP: A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut. 56:373–379. 2007. View Article : Google Scholar
18	Arita K, Mitsuyama K, Kawano H, Hasegawa S, Maeyama Y, Masuda J, Akagi Y, Watanabe Y, Okabe Y, Tsuruta O, et al: Quantitative analysis of colorectal mucosal lesions by autofluorescence endoscopy: Discrimination of carcinomas from other lesions. Oncol Rep. 26:43–48. 2011.PubMed/NCBI
19	Panjehpour M, Overholt BF, Vo-Dinh T, Haggitt RC, Edwards DH and Buckley FP III: Endoscopic fluorescence detection of high-grade dysplasia in Barrett's esophagus. Gastroenterology. 111:93–101. 1996. View Article : Google Scholar : PubMed/NCBI
20	Gabbani T, Manetti N, Bonanomi AG, Annese AL and Annese V: New endoscopic imaging techniques in surveillance of inflammatory bowel disease. World J Gastrointest Endosc. 7:230–236. 2015. View Article : Google Scholar : PubMed/NCBI
21	Subramanian V and Bisschops R: Image-enhanced endoscopy is critical in the surveillance of patients with colonic IBD. Gastrointest Endosc Clin N Am. 24:393–403. 2014. View Article : Google Scholar : PubMed/NCBI
22	Efthymiou M, Taylor AC and Kamm MA: Cancer surveillance strategies in ulcerative colitis: The need for modernization. Inflamm Bowel Dis. 17:1800–1813. 2011. View Article : Google Scholar
23	Hasegawa S, Mitsuyama K, Kawano H, Arita K, Maeyama Y, Akagi Y, Watanabe Y, Okabe Y, Tsuruta O and Sata M: Endoscopic discrimination of sessile serrated adenomas from other serrated lesions. Oncol Lett. 2:785–789. 2011.
24	Kudo S, Hirota S, Nakajima T, Hosobe S, Kusaka H, Kobayashi T, Himori M and Yagyuu A: Colorectal tumours and pit pattern. J Clin Pathol. 47:880–885. 1994. View Article : Google Scholar : PubMed/NCBI
25	Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H and Watanabe H: Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. 44:8–14. 1996. View Article : Google Scholar : PubMed/NCBI
26	Uraoka T, Saito Y, Ikematsu H, Yamamoto K and Sano Y: Sano's capillary pattern classification for narrow-band imaging of early colorectal lesions. Dig Endosc. 23(Suppl 1): pp. 112–115. 2011, http://dx.doi.org/10.1111/j.1443-1661.2011.01118.x. View Article : Google Scholar
27	Sakamoto T, Saito Y, Nakajima T and Matsuda T: Comparison of magnifying chromoendoscopy and narrow-band imaging in estimation of early colorectal cancer invasion depth: a pilot study. Dig Endosc. 23:pp. 118–123. 2011, http://dx.doi.org/10.1111/j.1443-1661.2010.01049.x. View Article : Google Scholar
28	Inomata H, Tamai N, Aihara H, Sumiyama K, Saito S, Kato T and Tajiri H: Efficacy of a novel auto-fluorescence imaging system with computer-assisted color analysis for assessment of colorectal lesions. World J Gastroenterol. 19:7146–7153. 2013. View Article : Google Scholar : PubMed/NCBI
29	Sada M, Igarashi M, Yoshizawa S, Kobayashi K, Katsumata T, Saigenji K, Otani Y, Okayasu I and Mitomi H: Dye spraying and magnifying endoscopy for dysplasia and cancer surveillance in ulcerative colitis. Dis Colon Rectum. 47:1816–1823. 2004. View Article : Google Scholar : PubMed/NCBI
30	Hata K, Watanabe T, Motoi T and Nagawa H: Pitfalls of pit pattern diagnosis in ulcerative colitis-associated dysplasia. Gastroenterology. 126:374–376. 2004. View Article : Google Scholar : PubMed/NCBI
31	Hata K, Watanabe T, Kazama S, Suzuki K, Shinozaki M, Yokoyama T, Matsuda K, Muto T and Nagawa H: Earlier surveillance colonoscopy programme improves survival in patients with ulcerative colitis associated colorectal cancer: Results of a 23-year surveillance programme in the Japanese population. Br J Cancer. 89:1232–1236. 2003. View Article : Google Scholar : PubMed/NCBI
32	Hata K, Watanabe T, Shinozaki M, Kojima T and Nagawa H: To dye or not to dye? That is beyond question! Optimising surveillance colonoscopy is indispensable for detecting dysplasia in ulcerative colitis. Gut. 53:17222004.PubMed/NCBI
33	Matsumoto T, Nakamura S, Jo Y, Yao T and Iida M: Chromoscopy might improve diagnostic accuracy in cancer surveillance for ulcerative colitis. Am J Gastroenterol. 98:1827–1833. 2003. View Article : Google Scholar : PubMed/NCBI
34	Pellisé M, López-Cerón M, Rodríguez de Miguel C, Jimeno M, Zabalza M, Ricart E, Aceituno M, Fernández-Esparrach G, Ginès A, Sendino O, et al: Narrow-band imaging as an alternative to chromoendoscopy for the detection of dysplasia in long-standing inflammatory bowel disease: A prospective, randomized, crossover study. Gastrointest Endosc. 74:840–848. 2011. View Article : Google Scholar : PubMed/NCBI
35	Günther U, Kusch D, Heller F, Bürgel N, Leonhardt S, Daum S, Siegmund B, Loddenkemper C, Grünbaum M, Buhr HJ, et al: Surveillance colonoscopy in patients with inflammatory bowel disease: Comparison of random biopsy vs. targeted biopsy protocols. Int J Colorectal Dis. 26:667–672. 2011. View Article : Google Scholar : PubMed/NCBI
36	Kiesslich R, Goetz M, Lammersdorf K, Schneider C, Burg J, Stolte M, Vieth M, Nafe B, Galle PR and Neurath MF: Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology. 132:874–882. 2007. View Article : Google Scholar : PubMed/NCBI
37	Kiesslich R, Fritsch J, Holtmann M, Koehler HH, Stolte M, Kanzler S, Nafe B, Jung M, Galle PR and Neurath MF: Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology. 124:880–888. 2003. View Article : Google Scholar : PubMed/NCBI
38	Rubin DT and Turner JR: Surveillance of dysplasia in inflammatory bowel disease: The gastroenterologist-pathologist partnership. Clin Gastroenterol Hepatol. 4:pp. 1309–1313. 2006, http://europepmc.org/abstract/MED/17110299. View Article : Google Scholar
39	Matsumoto T, Moriyama T, Yao T, Mibu R and Iida M: Autofluorescence imaging colonoscopy for the diagnosis of dysplasia in ulcerative colitis. Inflamm Bowel Dis. 13:640–641. 2007. View Article : Google Scholar : PubMed/NCBI
40	Zonios GI, Cothren RM, Arendt JT, Wu J, Van Dam J, Crawford JM, Manoharan R and Feld MS: Morphological model of human colon tissue fluorescence. IEEE Trans Biomed Eng. 43:113–122. 1996. View Article : Google Scholar : PubMed/NCBI
41	Marchesini R, Pignoli E, Tomatis S, Fumagalli S, Sichirollo AE, Di Palma S, Dal Fante M, Spinelli P, Croce AC and Bottiroli G: Ex vivo optical properties of human colon tissue. Lasers Surg Med. 15:351–357. 1994. View Article : Google Scholar : PubMed/NCBI