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Rectal cancer staging using combined pelvic phased-array and endorectal coil MR imaging
"4281 COLONOSCOPIC FEATURES OF SMALL INVASIVE EARLY COLORECTAL CARCINOMAS Yusuke Saitoh, Mikihiro Fujiya, Jiro Watari, Yasuko Miyoshi, Kaori Fujiya, Atsuo Maemoto, Tokiyoshi Ayabe, Toshifumi Ashida, Tomoyuki Ohta, Yutaka Kohgo, Third Dept of Internal Medicine, Asahikawa Medical Coll, Asahikawa Japan Background: T1 (submucosal) cancers were divided into focally (sml), moderately (sin2) and massively (sin3) extended submucosal cancers according to the degree of cancer extension into the submucosa because sml cancers has no lymphnode metastasis but sin2 and 3 cancers have -10% of lymphnode metastasis (Y.Saitoh et at. GIE 1998, 48:362-70). Tis (tumor in situ) and s m l cancers can be treated by endoscopic resection (ER) as non-invasire cancers and sin2,3 cancers should be surgically treated as invasive cancers. Small colorectal lesions less than 10 mm in size are popularly detected and most of those can be treated by ER. However, in such small lesions, there are some invasive cancers that is not indicatative for ER but requires surgery. Colonoscopic findings characteristic for small invasive cancers has been still unclear. Aim: The aim of this study is to elucidate colonoscopic features of small invasive colorectal cancers for contributing therapeutic strategy. Material and Methods: Between Jan. 1990 and Oct. 2000, a total of 1144 early colorectal carcinomas were detected and treated in our Hospital. Macroscopic type was divided to 772 of polypoid type (pedunculated and sessile) and 304 of flat and depressed (F&D) type (IIa, IIc and IIa+IIc). As for the invasion depth, 798 were Tis and 346 were T1 cancers. We retrospectively reviewed chromoendoscoic findings of small invasive early cancers and compared with those of small non-invasive ones according to our methods (GIE 1998). Results: 1. There were 26 lesions of small invasive cancers in 286 small early colorectal cancers (9.1%) and in 1144 all early cancers (2,3%). 2. Of 26 small invasive cancers, polypoid type were 10 lesions and F&D type were 16 lesions, while polypoid type were 178 lesions and F&D type were 82 lesions in small non-invasive ones. The incidence of F&D type was significantly higher in small invasive cancers than in small non-invasive ones (p=0.004). 3. Among reviewed various colonoscopic findings, the incidence of presence of "depression surface" (p=0.005), "expansion appearance" (p<0.001) and "converging folds toward the tumor" (p=0.003) were significantly more appeared in small invasive cancers than in non-invasive ones. 21 (80.8%) of 26 small invasive cancers appeared at least one of these colonoscopic findings. Conclusion: Small colorectal lesions with colonoscopic findings, presence of "depression surface" or "expansion appearance" or "converging folds toward the tumor" should not be easily treated by ER. Most of those small lesions require surgery.
57%, respectively) (p=0.0004). The sensitivity and specificity of magnifying colonoscopy in differential diagnosis of neoplastic and non-neopalstic lesion were respectively 96% and 86%. Conclusions: Classification of mucosal crypt pattern using magnifying colonoscopy is superior in the differential diagnosis of neoplastic and non-neoplastic lesions than that using nonmagnifying colonoscopy.
*4282 EVALUATION OF USEFULNESS OF NON-BIOPSY TECHNIQUE USING MAGNIFYING COLONOSCOPY IN D I F F E R E N T I A T E D DIAGNOSIS OF COLORECTAL LESIONS: A P R O S P E C T I V E STUDY Kazuo Konishi, Kazu-hiro Kaneko, Toshinori Kurahashi, Yasushi Akita, Nozomi Yoshikawa, Keiji Mitamura, Showa Univ Sch of Medicine, Tokyo Japan Background: We are able to observe mucosal crypt pattern of colorectal lesion using nonmagnifying standard colonoscopy in some cases. However, classification of mucosal crypt patterns of colorectal lesions using magnifying colonoscopy is useful to decision of treatment. Aim: In order to evaluate the utility of magnifying colonoscopy in differential diagnosis of colorectal lesions, the diagnostic accuracy of neoplastic or non-neoplastic col,)rectal lesions using magnifying colonoscope was compared with that using nonmagnifying colonoscope. Materials and Methods: A total of 880 patients attending for colonoscopy were screened for colorectal disease at Showa University Hospital from March to October 2000, and 262 eligible patients were enrolled in this study. We used a magnifying colonoscope , CF-240Z; Olympus, Tokyo, Japan) with 131 patients and a nonmagnifying colonoscope (CF-Q240I; Olympus, Tokyo, Japan) with 130 patients. We detected 243 lesions by magnifying colonoscopy and 221 lesions by nonmagnifying colonoscopy. These lesions were identified from their mucosal crypt patterns according to the classification of Kudo (type I-V) after spraying with 0.2% indigo carmine dye. Lesions with type I or type II crypt patterns were defined as non-neoplastic lesions, whereas those with type III, IV or V crypt patterns were neoplastic lesions. All lesions were confirmed histollogically either by biopsy or endoscopic resection. Results: The diagnostic accuracy of neoplastic lesions using magnifying colonoscope was significantly higher than that using nonmagnifying colonoscope (177/190: 93% and 112/154: 73%, respectively) (p<0.0001). The diagnostic accuracy of non-neoplastic lesions using magnifying colonoscope was significantly higher than that using nonmagnifying colonoscope (46/53: 87% and 38/67:
*4284 RECTAL CANCER STAGING U S I N G COMBINED PELVIC PHASED-ARRAY AND ENDORECTAL COIL MR IMAGING Gregory T. Sica, Rajesh Amin, Jeffrey McTavish, Elizabeth Breen, Ronald Bleday, Brigham and Women's Hosp, Boston, MA PURPOSE: To evaluate the utility of MR Imaging in the preoperative staging of rectal cancer. METHODS: Sixty-four patients with rectal masses successfully underwent MR imaging for staging, over a three-year period. All studies were performed with combined endorectal and pelvic-phased arrary coils, and were prospectively interpreted by a single radiologist using the TNM classification. MR findings were correlated with surgicalpathologic findings when available (group 1) and with clincial exam (group 2) in those patients receiving neoadjuvant therapy. Treatment staging (Stage I=Tlfr2/N0; Stage II=T3/N0; Stage HI=T1-4/N1-3) were used to evaluate accuracy. RESULTS: Group 1 consisted of forty-one patients, and comparative results are shown below. Three patients had recurrent disease, all of which were demonstrated on MRI. Group 2 consisted of eight patients undergoing neoadjuvant therapy. In 12 additional patients, followup data is not available at this time. CONCLUSION: MR imaging was accurate in the treatment staging of patients with rectal masses and may be included in a management planning algorithm.
VOLUME 53, NO. 5, 2001
*4283 CLINICOPATHOLOGICAL CHARACTERISTICS OF DEPRESSED CARCINOMAS IN THE LARGE INTESTINE Toshinori Kurahashi, Kuzub.iro Kaneko, Kazuo Konishi, Yasushi Akita, Nozomi Yoshikawa, Keiji Mitamura, Showa Univ Sch of Medicine, Tokyo Japan Background and Aims: The majority of colorectal carcinomas are known to develop from preexisting polypoid adenomas, however, colorectal carcinomas can also develop from fiat or depressed lesions. The aim of this study is to clarify clinicopathologic characteristics of depressed colorectal lesions. Materials and Methods: From January 1993 through March 2000, 2968 colorectal neoplastic lesions containing 316 early carcinomas were detected by total colonoscopy at Showa University Hospital. These lesions were classified into polypoid, fiat, and depressed lesions, according to the criteria of Japanese Research Society for Cancer of the Colon and Rectum. Early carcinoma was defined as high grade dysplagia and carcinoma infiltrating into the submucosa. Results: Of 2968 colorectal lesions composed of carcinomas and adenomas, 40 lesions (1.4%) were depressed lesions. Early colorectal carcinomas were 316 lesions (10.6%) of 2968 lesions and 20 depressed carcinomas (6.3%) were found in 316 early carcinomas. The rate of polypoid lesions invaded into submucosal layer was 0% for those less than 5ram, 1.8% for those 6 to 10ram, 11% for those 11 to 15ram, 30.6% for those 16 to 20ram and 34.9% for those more than 20ram in diameter. This rate of fiat lesions was 0%, 0%, 11.5%, 18.0%, and 50%, respectively. In contrast, the rate of depressed lesions was 0%, 25%, 85%, 100%, and 100%, respectively. In early colorectal carcimomas, submucosal invasive carcinomas were 75% (15/20) of depressed lesions, 20% (7/34) of fiat lesions and 23% (61/262) of polypoid lesions. Approximately 80% of early polypoid carcinomas were situated distal to the splenic flexure , however, 50% of depressed carcinomas were located in the proximal colon. Conclusions: Malignant potential of depressed colorectal lesions was higher than those of polypoid or flat lesions. Since early depressed carcimomas were frequently detected in the proximal colon, half of depressed carcinomas would be missed in sigmoidscopy.
RECTAL CANCER TREATMENT STAGING SURGICAL/PATH STAGE
MR STAGE
8 - TIS 17 - Stage I 3 - Stage II 13 Stage III
7-TIS, 1- Stage I 15-Stagel, 2- Stage II 2 - Stage II, 1 - Stage I 12 - Stage III, 1 - Stage II
GASTROINTESTINAL ENDOSCOPY
AB191
57%, respectively) (p=0.0004). The sensitivity and specificity of magnifying colonoscopy in differential diagnosis of neoplastic and non-neopalstic lesion were respectively 96% and 86%. Conclusions: Classification of mucosal crypt pattern using magnifying colonoscopy is superior in the differential diagnosis of neoplastic and non-neoplastic lesions than that using nonmagnifying colonoscopy.
*4282 EVALUATION OF USEFULNESS OF NON-BIOPSY TECHNIQUE USING MAGNIFYING COLONOSCOPY IN D I F F E R E N T I A T E D DIAGNOSIS OF COLORECTAL LESIONS: A P R O S P E C T I V E STUDY Kazuo Konishi, Kazu-hiro Kaneko, Toshinori Kurahashi, Yasushi Akita, Nozomi Yoshikawa, Keiji Mitamura, Showa Univ Sch of Medicine, Tokyo Japan Background: We are able to observe mucosal crypt pattern of colorectal lesion using nonmagnifying standard colonoscopy in some cases. However, classification of mucosal crypt patterns of colorectal lesions using magnifying colonoscopy is useful to decision of treatment. Aim: In order to evaluate the utility of magnifying colonoscopy in differential diagnosis of colorectal lesions, the diagnostic accuracy of neoplastic or non-neoplastic col,)rectal lesions using magnifying colonoscope was compared with that using nonmagnifying colonoscope. Materials and Methods: A total of 880 patients attending for colonoscopy were screened for colorectal disease at Showa University Hospital from March to October 2000, and 262 eligible patients were enrolled in this study. We used a magnifying colonoscope , CF-240Z; Olympus, Tokyo, Japan) with 131 patients and a nonmagnifying colonoscope (CF-Q240I; Olympus, Tokyo, Japan) with 130 patients. We detected 243 lesions by magnifying colonoscopy and 221 lesions by nonmagnifying colonoscopy. These lesions were identified from their mucosal crypt patterns according to the classification of Kudo (type I-V) after spraying with 0.2% indigo carmine dye. Lesions with type I or type II crypt patterns were defined as non-neoplastic lesions, whereas those with type III, IV or V crypt patterns were neoplastic lesions. All lesions were confirmed histollogically either by biopsy or endoscopic resection. Results: The diagnostic accuracy of neoplastic lesions using magnifying colonoscope was significantly higher than that using nonmagnifying colonoscope (177/190: 93% and 112/154: 73%, respectively) (p<0.0001). The diagnostic accuracy of non-neoplastic lesions using magnifying colonoscope was significantly higher than that using nonmagnifying colonoscope (46/53: 87% and 38/67:
*4284 RECTAL CANCER STAGING U S I N G COMBINED PELVIC PHASED-ARRAY AND ENDORECTAL COIL MR IMAGING Gregory T. Sica, Rajesh Amin, Jeffrey McTavish, Elizabeth Breen, Ronald Bleday, Brigham and Women's Hosp, Boston, MA PURPOSE: To evaluate the utility of MR Imaging in the preoperative staging of rectal cancer. METHODS: Sixty-four patients with rectal masses successfully underwent MR imaging for staging, over a three-year period. All studies were performed with combined endorectal and pelvic-phased arrary coils, and were prospectively interpreted by a single radiologist using the TNM classification. MR findings were correlated with surgicalpathologic findings when available (group 1) and with clincial exam (group 2) in those patients receiving neoadjuvant therapy. Treatment staging (Stage I=Tlfr2/N0; Stage II=T3/N0; Stage HI=T1-4/N1-3) were used to evaluate accuracy. RESULTS: Group 1 consisted of forty-one patients, and comparative results are shown below. Three patients had recurrent disease, all of which were demonstrated on MRI. Group 2 consisted of eight patients undergoing neoadjuvant therapy. In 12 additional patients, followup data is not available at this time. CONCLUSION: MR imaging was accurate in the treatment staging of patients with rectal masses and may be included in a management planning algorithm.
VOLUME 53, NO. 5, 2001
*4283 CLINICOPATHOLOGICAL CHARACTERISTICS OF DEPRESSED CARCINOMAS IN THE LARGE INTESTINE Toshinori Kurahashi, Kuzub.iro Kaneko, Kazuo Konishi, Yasushi Akita, Nozomi Yoshikawa, Keiji Mitamura, Showa Univ Sch of Medicine, Tokyo Japan Background and Aims: The majority of colorectal carcinomas are known to develop from preexisting polypoid adenomas, however, colorectal carcinomas can also develop from fiat or depressed lesions. The aim of this study is to clarify clinicopathologic characteristics of depressed colorectal lesions. Materials and Methods: From January 1993 through March 2000, 2968 colorectal neoplastic lesions containing 316 early carcinomas were detected by total colonoscopy at Showa University Hospital. These lesions were classified into polypoid, fiat, and depressed lesions, according to the criteria of Japanese Research Society for Cancer of the Colon and Rectum. Early carcinoma was defined as high grade dysplagia and carcinoma infiltrating into the submucosa. Results: Of 2968 colorectal lesions composed of carcinomas and adenomas, 40 lesions (1.4%) were depressed lesions. Early colorectal carcinomas were 316 lesions (10.6%) of 2968 lesions and 20 depressed carcinomas (6.3%) were found in 316 early carcinomas. The rate of polypoid lesions invaded into submucosal layer was 0% for those less than 5ram, 1.8% for those 6 to 10ram, 11% for those 11 to 15ram, 30.6% for those 16 to 20ram and 34.9% for those more than 20ram in diameter. This rate of fiat lesions was 0%, 0%, 11.5%, 18.0%, and 50%, respectively. In contrast, the rate of depressed lesions was 0%, 25%, 85%, 100%, and 100%, respectively. In early colorectal carcimomas, submucosal invasive carcinomas were 75% (15/20) of depressed lesions, 20% (7/34) of fiat lesions and 23% (61/262) of polypoid lesions. Approximately 80% of early polypoid carcinomas were situated distal to the splenic flexure , however, 50% of depressed carcinomas were located in the proximal colon. Conclusions: Malignant potential of depressed colorectal lesions was higher than those of polypoid or flat lesions. Since early depressed carcimomas were frequently detected in the proximal colon, half of depressed carcinomas would be missed in sigmoidscopy.
RECTAL CANCER TREATMENT STAGING SURGICAL/PATH STAGE
MR STAGE
8 - TIS 17 - Stage I 3 - Stage II 13 Stage III
7-TIS, 1- Stage I 15-Stagel, 2- Stage II 2 - Stage II, 1 - Stage I 12 - Stage III, 1 - Stage II
GASTROINTESTINAL ENDOSCOPY
AB191