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New application of endocytoscope for histopathological diagnosis of colorectal lesions

World Journal of Gastrointestinal Endoscopy 2022年第8期14卷 495-501页

作者： Fumihiro Inoue Daizen Hirata Mineo Iwatate Santa Hattori Mikio Fujita Wataru sano Tamotsu Sugai Hiroshi Kawachi Kazuhito Ichikawa yasushi sano Gastrointestinal Center and Institute of Minimally-invasive Endoscopic Care(i-MEC) Sano HospitalKobe 655-0031HyogoJapan Molecular Diagnostic Pathology Iwate Medical University School of MedicineShiwa-gun 028-3694IwateJapan Department of Pathology Cancer Institute Hospital of Japanese Foundation for Cancer ResearchKoto 135-8550TokyoJapan Department of Pathology Noda HospitalNoda 270-0237ChibaJapan

BACKGROUND The endocytoscope with ultra-high magnification(x 520)allows us to observe the cellular structure of the colon epithelium during colonoscopy,known as virtual histopathology.We hypothesized that the endocytoscope could directly observe colorectal histopathological specimens and store them as endocyto-pathological images by the endoscopists without a microscope,potentially saving the burden on histopathologists.AIM To assess the feasibility of endocyto-pathological images taken by an endoscopist as adequate materials for histopathological diagnosis.METHODS Three gastrointestinal pathologists were invited and asked to diagnose 40 cases of endocyto-pathological images of colorectal specimens.Each case contained seven endocyto-pathological images taken by an endoscopist,consisting of one loupe image,three low-magnification images,and three ultra-high magnification images.The participants chose hyperplastic polyp or low-grade adenoma for 20 cases of endocyto-pathological images(10 hyperplastic polyps,and 10 Low-grade adenomas in conventional histopathology)in study 1 and high-grade adenoma/shallow invasive cancer or deep invasive cancer for 20 cases[10 tumor in situ/T1a and 10 T1b]in study 2.We investigated the agreement between the histopathological diagnosis using the endocyto-pathological images and conventional histopathological diagnosis.RESULTS Agreement between the endocyto-pathological and conventional histopathological diagnosis by the three gastrointestinal pathologists was 100%(95%CI:94.0%–100%)in studies 1 and 2.The interobserver agreement among the three gastrointestinal pathologists was 100%,and theκcoefficient was 1.00 in both studies.CONCLUSION Endocyto-pathological images were adequate and reliable materials for histopathological diagnosis.

关键词： Cancer Colon Endocytoscopy Histopathology Specimen

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Sporadic fundic gland polyps with dysplasia or carcinoma:Clinical and endoscopic characteristics

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World Journal of Gastrointestinal Oncology 2021年第7期13卷 662-672页

作者： Wataru sano Fumihiro Inoue Daizen Hirata Mineo Iwatate Santa Hattori Mikio Fujita yasushi sano Gastrointestinal Center Sano HospitalKobe 655-0031HyogoJapan

Fundic gland polyps(FGPs)are the most common gastric polyps and have been regarded as benign lesions with little malignant potential,except in the setting of familial adenomatous polyposis.However,in recent years,the prevalence of FGPs has been increasing along with the widespread and frequent use of proton pump inhibitors(PPIs).To date,several cases of FGPs with dysplasia or carcinoma(FGPD/CAs)have been reported.In this review,we evaluated the clinical and endoscopic characteristics of sporadic FGPD/CAs.Majority of the patients with sporadic FGPD/CAs were middle-aged women receiving PPI therapy and without Helicobacter pylori(H.pylori)infection.Majority of the sporadic FGPD/CAs occurred in the body of the stomach and were sessile and small with a mean size of 5.4 mm.The sporadic FGPs with carcinoma showed redness,irregular surface structure,depression,or erosion during white light observation and irregular microvessels on the lesion surface during magnifying narrow-band imaging.In addition,sporadic FGPs,even with dysplasia,are likely to progress to cancer slowly.Therefore,frequent endoscopy is not required for patients with sporadic FGPs.However,histopathological evaluation is necessary if endoscopic findings different from ordinary FGPs are observed,regardless of their size.In the future,the prevalence of FGPs is expected to further increase along with the widespread and frequent use of PPIs and decreasing infection rate of H.pylori.Currently,it is unclear whether FGPD/CAs will also increase in the same way as FGPs.However,the trends of these lesions warrant further attention in the future.

关键词： Sporadic Fundic gland polyp Dysplasia Carcinoma Proton pump inhibitor Helicobacter pylori

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Serrated polyps of the colon and rectum:Remove or not?

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World Journal of Gastroenterology 2020年第19期26卷 2276-2285页

作者： Wataru sano Daizen Hirata Akira Teramoto Mineo Iwatate Santa Hattori Mikio Fujita yasushi sano Gastrointestinal Center Sano HospitalHyogo 655-0031Japan

In recent years,the serrated neoplasia pathway where serrated polyps arise as a colorectal cancer has gained considerable attention as a new carcinogenic pathway.Colorectal serrated polyps are histopathologically classified into hyperplastic polyps(HPs),sessile serrated lesions,and traditional serrated adenomas;in the serrated neoplasia pathway,the latter two are considered to be premalignant.In western countries,all colorectal polyps,including serrated polyps,apart from diminutive rectosigmoid HPs are removed.However,in Asian countries,the treatment strategy for colorectal serrated polyps has remained unestablished.Therefore,in this review,we described the clinicopathological features of colorectal serrated polyps and proposed to remove HPs and sessile serrated lesions≥6 mm in size,and traditional serrated adenomas of any size.

关键词： Hyperplastic polyp Sessile serrated adenoma/polyp Sessile serrated lesion Traditional serrated adenoma Cytological dysplasia Cryptal dysplasia

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Post-colonoscopy colorectal cancer rate in the era of highdefinition colonoscopy

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World Journal of Gastroenterology 2017年第42期23卷 7609-7617页

作者： Mineo Iwatate Tomoyuki Kitagawa Yasumi Katayama Naohiko Tokutomi Shinichi Ban Santa Hattori Noriaki Hasuike Wataru sano yasushi sano Masaya Tamano Gastrointestinal Center and Institute of Minimally-Invasive Endoscopic Care Sano Hospital Department of Gastroenterology Dokkyo Medical University Koshigaya Hospital Department of Pathology Dokkyo Medical University Koshigaya Hospital

AIM To investigate the post-colonoscopy colorectal cancer(PCCRC) rate for high-definition(HD) colonoscopy compared with that for standard-definition colonoscopy reported previously.METHODS Using medical records at sano Hospital(SH) and Dokkyo Medical University Koshigaya Hospital(DMUKH), we retrospectively obtained data on consecutive patients diagnosed as having CRC between January 2010 andDecember 2015. The definition of PCCRC was diagnosis of CRC between 7 and 36 mo after initial high-definition colonoscopy that had detected no cancer, and patients were divided into a PCCRC group and a non-PCCRC group. The primary outcome was the rate of PCCRC for HD colonoscopy. The secondary outcomes were factors associated with PCCRC and possible reason for occurrence of early and advanced PCCRC.RESULTS Among 892 CRC patients, 11 were diagnosed as having PCCRC and 881 had non-PCCRC. The PCCRC rate was 1.7%(8/471) at SH and 0.7%(3/421) at DMUKH. In comparison with the non-PCCRC group, the PCCRC group had a significantly higher preponderance of smaller tumors(39 mm vs 19 mm, P = 0.002), a shallower invasion depth(T1 rate, 25.4% vs 63.6%, P = 0.01), a non-polypoid macroscopic appearance(39.0% vs 85.7%, P = 0.02) and an earlier stage(59.7% vs 90.9%, P = 0.03). Possible reasons for PCCRC were "missed or new" in 9 patients(82%), "incomplete resection" in 1(9%), and "inadequate examination'" in 1(9%). Among 9 "missed or new" PCCRC, the leading cause was non-polypoid shape for early PCCRC and blinded location for advanced PCCRC.CONCLUSION The PCCRC rate for HD colonoscopy was 0.7%-1.7%, being lower than that for standard-definition colonoscopy(1.8%-9.0%) reported previously employing the same methodology.

关键词： Post-colonoscopy colorectal cancer Highdefinition Post-colonoscopy colorectal cancer rate Associated factor Possible explanation

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Effective use of the Japan Narrow Band Imaging Expert Team classification based on diagnostic performance and confidence level

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World Journal of Clinical Cases 2019年第18期7卷 2658-2665页

作者： Daizen Hirata Hiroshi Kashida Mineo Iwatate Tomomasa Tochio Akira Teramoto yasushi sano Masatoshi Kudo Gastrointestinal Center and Institute of Minimally-invasive Endoscopic Care Sano HospitalKobe 6550031Japan Department of Gastroenterology and Hepatology Kindai UniversityOsaka 5895811Japan

Five years have passed since the Japan Narrow Band Imaging Expert Team (JNET) classification was proposed in 2014. However, the diagnostic performance of this classification has not yet been established. We conducted a retrospective study and a systematic search of Medical Literature Analysis and Retrieval System On-Line. There were three retrospective single center studies about the diagnostic performance of this classification. In order to clarify this issue, we reviewed our study and three previous studies. This review revealed the diagnostic performance in regards to three important differentiations.(1) Neoplasia from non-neoplasia;(2) malignant neoplasia from benign neoplasia;and (3) deep submucosal invasive cancer (D-SMC) from other neoplasia. The sensitivity in differentiating neoplasia from non-neoplasia was 98.1%-99.8%. The specificity in differentiating malignant neoplasia from benign neoplasia was 84.7%-98.2% and the specificity in the differentiation D-SMC from other neoplasia was 99.8%-100.0%. This classification would enable endoscopists to identify almost all neoplasia, to appropriately determine whether to perform en bloc resection or not, and to avoid unnecessary surgery. This article is the first review about the diagnostic performance of the JNET classification. Previous reports about the diagnostic performance have all been retrospective single center studies. A large-scale prospective multicenter evaluation study is awaited for the validation.

关键词： Japan Narrow Band Imaging Expert Team Classification Magnifying endoscopy Narrow-band imaging Validation Diagnostic performance Colonoscopy Colorectal neoplasms

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Prospective real-time evaluation of diagnostic performance using endocytoscopy in differentiating neoplasia from nonneoplasia for colorectal diminutive polyps(≤ 5 mm)

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World Journal of Gastrointestinal Oncology 2018年第4期10卷 96-102页

作者： Takahiro Utsumi yasushi sano Mineo Iwatate Hironori Sunakawa Akira Teramoto Daizen Hirata Santa Hattori Wataru sano Noriaki Hasuike Kazuhito Ichikawa Takahiro Fujimori Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC) Sano Hospital Department of Pathology Shinko Hospital

AIM To clarify the diagnostic performance of endocytoscopy for differentiation between neoplastic and nonneoplastic colorectal diminutive polyps.METHODS Patients who underwent endocytoscopy between October and December 2016 at sano Hospital were prospectively recruited. When diminutive polyps(≤5 mm) were detected, the lesions were evaluated by endocytoscopy after being stained with 0.05% crystal violet and 1% methylene blue. The diminutivepolyps were classified into five categories(EC 1 a, 1 b, 2, 3 a, and 3 b). Endoscopists were asked to take a biopsy from any lesion diagnosed as EC1 b(indicator of hyperplastic polyp) or EC2(indicator of adenoma). We have assessed the diagnostic performance of endocytoscopy for EC2 and EC1 b lesions by comparison with the histopathology of the biopsy specimen. RESULTS A total of 39 patients with 63 diminutive polyps were analyzed. All polyps were evaluated by endocytoscopy. The mean polyp size was 3.3 ± 0.9 mm. Among the 63 diminutive polyps, 60 were flat and 3 were pedunculated. The mean time required for EC observation, including the time for staining with crystal violet and methylene blue, was 3.0 ± 1.9 min. Histopathologic evaluation showed that 13 polyps were hyperplastic and 50 were adenomas. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of EC2 for adenoma compared with EC1 b for hyperplastic polyp were 98.0%, 92.3%, 96.8%, 98.0% and 92.3%, respectively. There were only two cases of disagreement between the endoscopic diagnosis made by endocytoscopy and the corresponding histopathological diagnosis.CONCLUSION Endocytoscopy showed a high diagnostic performance for differentiating between neoplastic and non-neoplastic colorectal diminutive polyps, and therefore has the potential to be used for "real-time histopathology".

关键词： Endocytoscopy Diagnostic performance Diminutive polyp Endocytoscopic classification Realtime histopathology

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Size does not determine the grade of malignancy of early invasive colorectal cancer

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World Journal of Gastroenterology 2009年第22期15卷 2708-2713页

作者： Takahisa Matsuda Yutaka Saito Takahiro Fujii Toshio Uraoka Takeshi Nakajima Nozomu Kobayashi Fabian Emura Akiko Ono Tadakazu Shimoda Hiroaki Ikematsu Kuang-I Fu yasushi sano Takahiro Fujimori Endoscopy Division National Cancer Center Hospital Clinical Laboratory Division National Cancer Center Hospital Division of Digestive Endoscopy and Gastrointestinal Oncology National Cancer Center Hospital East Department of Surgical and Molecular Pathology Dokkyo University School of Medicine

AIM:To clarify the clinicopathological characteristics of small and large early invasive colorectal cancers(EI-CRCs),and to determine whether malignancy grade depends on size.METHODS:A total of 583 consecutive EI-CRCs treated by endoscopic mucosal resection or surgery at the National Cancer Center Hospital between 1980 and 2004 were enrolled in this study.Lesions were classified into two groups based on size:small(≤10mm) and large(>10mm).Clinicopathological features,incidence of lymph node metastasis(LNM) and risk factors for LNM,such as depth of invasion,lymphovascular invasion(LVI) and poorly differentiated adenocarcinoma(PDA) were analyzed in all resected specimens.RESULTS:There were 120(21%) small and 463(79%) large lesions.Histopathological analysis of the small lesion group revealed submucosal deep cancer(sm:≥1000 μm) in 90(75%) cases,LVI in 26(22%) cases,and PDA in 12(10%) cases.Similarly,the large lesion group exhibited submucosal deep cancer in 380(82%) cases,LVI in 125(27%) cases,and PDA in 79(17%) cases.The rate of LNM was 11.2% and 12.1% in the small and large lesion groups,respectively.CONCLUSION:Small EI-CRC demonstrated the same aggressiveness and malignant potential as large cancer.

关键词：恶性肿瘤大肠癌侵入性早期病理特征康复中心病理特点危险因素

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Alpha-fetoprotein-producing colon cancer with atypical bulky lymph node metastasis

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World Journal of Gastroenterology 2006年第47期12卷 7715-7716页

作者： Kuangi Fu Akihiro Kobayashi Norio Saito yasushi sano Shigeharu Kato Hiroaki Ikematsu Takahiro Fujimori yasushi Kaji Shigeaki Yoshida Department of Radiology Dokkyo University School of Medicine 880 Kitakobaysashi Mibu Shimotuga Tochigi 321-0293 Japan Department of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East Kashiwa Chiba 277-8577 Japan Department of Surgery National Cancer Center Hospital East Kashiwa Chiba 277-8577 Japan Department of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East Kashiwa Chiba 277-8577 Japan Department of Surgical and Molecular Pathology Dokkyo University School of Medicine 880 Kitakobaysashi Mibu Shimotuga Tochigi 321-0293 Japan Department of Radiology Dokkyo University School of Medicine 880 Kitakobaysashi Mibu Shimotuga Tochigi 321-0293 Japan

Alpha-fetoprotein (AFP)-producing colorectal cancer is extremely rarely reported until now. All of the reported cases harboring synchronous hematogenous spread including liver and/or lung metastasis had a poor prognosis and died within 12 mo. We here describe a 71-year old man with AFP-producing colon cancer who presented with an unusual bulky lymph node metastasis instead of hematogenous spread. He underwent adjuvant chemotherapy in addition to curative surgical resection, which prolonged his survival.

关键词：结肠癌淋巴细胞胎蛋白 X线断层摄影术

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Narrow-band imaging observation of colorectal lesions using NICE classification to avoid discarding significant lesions

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World Journal of Gastrointestinal Endoscopy 2014年第12期6卷 600-605页

作者： Santa Hattori Mineo Iwatate Wataru sano Noriaki Hasuike Hidekazu Kosaka Taro Ikumoto Masahito Kotaka Akihiro Ichiyanagi Chikara Ebisutani Yasuko Hisano Takahiro Fujimori yasushi sano Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care Sano Hospital Department of Gastroenterology Kobe Minimally Invasive Treatment Center of Cancer Medical Oncology/Hematology Kobe University Graduate School of Medicine Department of Pathology Shinko Hospital

AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the "resect and discard" policy.METHODS: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancersand their endoscopic features were assessed. RESULTS: In total, we found 681 cases of diminutive(1-5 mm) lesions in 402 patients and 197 cases of small(6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal(SM) scanty invasive carcinomas, 1 and 1 were SM deeply invasive carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 endoscopically.CONCLUSION: The risk of failing to detect diminutive and small colorectal invasive cancer with the "resect and discard" strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.

关键词： Image-enhanced endoscopy Narrowband imaging Resect and discard NICE classification Magnifying endoscope Colonoscopy Submucosal deeply

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Magnifying colonoscopy as a non-biopsy technique for differential diagnosis of non-neoplastic and neoplastic lesions

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World Journal of Gastroenterology 2006年第9期12卷 1416-1420页

作者： Shigeharu Kato Kuang I Fu yasushi sano Takahiro Fujii Yutaka Saito Takahisa Matsuda Ikuro Koba Shigeaki Yoshida Takahiro Fujimori Division of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East KashiwaChiba 277-8577Japan Division of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East KashiwaChiba 277-8577Japan Department of Surgical and Molecular PathologyDokkyo University School of Medicine880 KitakobaysashiMibuShimotugaTochigi 321-0293Japan Division of Endoscopy National Cancer Center Hospital TsukijiTokyo 104-0045Japan Department of Surgical and Molecular Pathology Dokkyo University School of Medicine 880 KitakobaysashiMibuShimotugaTochigi 321-0293Japan

瞄准：为了澄清与放大结肠镜检查观察的粘膜地窟模式是否对可行，把非肿瘤的息肉与肿瘤的息肉区分开来。方法：从通过 2000 年 3 月的 1999 年 6 月，有 210 损害的 180 个连续病人与放大结肠镜诊断了(CF-200Z，天堂光有限公司，东京，... 详细信息

瞄准：为了澄清与放大结肠镜检查观察的粘膜地窟模式是否对可行，把非肿瘤的息肉与肿瘤的息肉区分开来。方法：从通过 2000 年 3 月的 1999 年 6 月，有 210 损害的 180 个连续病人与放大结肠镜诊断了(CF-200Z，天堂光有限公司，东京，日本) 被注册。有 0.2% 靛青洋红染料的放大和多彩石印版内视镜检查法为粘膜地窟观察被用于每损害。损害出现打字我和 II 地窟模式被活体检视组织学地认为非肿瘤、检验，而损害证明到 V 地窟模式的类型 III 被移开内视镜的联盟者或通过手术。内视镜的诊断和 histologic 诊断的关联然后被调查。结果：在内视镜检查法， 24 损害证明我或 II 坑模式，和 186 损害显示出的一种类型打 III 到 V 坑模式。与 histologic 检查， 26 损害作为非肿瘤的息肉被诊断，并且 184 损害作为肿瘤的息肉被诊断。全面诊断精确性是 99.1%(208/210 ) 。敏感和特性是 92.3%(24/26 ) 并且 99.8%(184/186 ) 分别地。结论：放大结肠镜检查能作为一种非活体检视技术被使用区分肿瘤、非肿瘤的息肉。

关键词：结肠镜检查活组织检查肿瘤检查方法

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