High-resolution chromoendoscopy for classifying colonic polyps: a multicenter study.
BACKGROUND
Chromoendoscopy may reliably separate adenomatous from nonadenomatous polyps. The aim of this multicenter trial was to determine the accuracy of high-resolution chromoendoscopy for the determination of colonic polyp histology.


METHODS
This multicenter trial included 4 academic centers and a primary care practice. In 299 patients referred for routine colonoscopy or sigmoidoscopy, 520 polyps 10 mm in size were sprayed with indigo carmine dye. Using a high-resolution endoscope, the endoscopist predicted the histology of each polyp based on its surface characteristics. Hyperplastic polyps had a "pitted" surface pattern of orderly arranged "dots" that resembled surrounding normal mucosa. Adenomatous polyps had at least one surface "groove" or "sulcus." Each polyp was subsequently resected for histopathologic evaluation.


RESULTS
The resected polyps were comprised by 193 adenomas (37%), 225 hyperplastic polyps (43%), and 102 "other" types (20%). Forty polyps (7.7%) could not be classified by high resolution chromoendoscopy with indigo carmine dye. For the remaining polyps, the sensitivity, specificity, and negative predictive value of indigo carmine dye staining for adenomatous polyps were, respectively, 82%, 82%, and 88%. The results were consistent among the academic centers and the primary care practice.


CONCLUSIONS
High-resolution chromoendoscopy with indigo carmine dye demonstrates morphologic detail of diminutive colorectal polyps that can reliably be used to separate adenomatous from nonadenomatous polyps.
Eisen
Glenn M
GM
Division of Gastroenterology, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
Kim
Christopher Y
CY
Fleischer
David E
DE
Kozarek
Richard A
RA
Carr-Locke
David L
DL
Li
Theodore C M
TC
Gostout
Christopher J
CJ
Heller
Stephen J
SJ
Montgomery
Elizabeth A
EA
Al-Kawas
Firas H
FH
Lewis
James H
JH
Benjamin
Stanley B
SB
D000236:Adenoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy; D004396:Coloring Agents; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013194:Staining and Labeling
D004396:Coloring Agents; D007203:Indigo Carmine