Importance of the surrounding colonic mucosa in distinguishing between hyperplastic and adenomatous polyps during acetic acid chromoendoscopy.
OBJECTIVE
To examine the characteristics of colonic polyps, where it is difficult to distinguish adenomatous polyps from hyperplastic polyps, with the aid of acetic acid chromoendoscopy.


METHODS
Acetic acid spray was applied to colonic polyps smaller than 10 mm before complete excision. Endoscopic images were taken before and 15-30 s after the acetic acid spray. Both pre- and post-sprayed images were shown to 16 examiners, who were asked to interpret the lesions as either hyperplastic or adenomatous polyps. Regression analysis was performed to determine which factors were most likely related to diagnostic accuracy.


RESULTS
In 50 cases tested by the 16 examiners, the overall accuracy was 62.4% (499/800). Regression analysis demonstrated that surrounding colonic mucosa was the only factor that was significantly related to accuracy in discriminating adenomatous from hyperplastic polyps (P < 0.001). Accuracy was higher for polyps with linear surrounding colonic mucosa than for those with nodular surrounding colonic mucosa (P < 0.001), but was not related to the shape, location, or size of the polyp.


CONCLUSIONS
The accuracy of predicting histology is significantly related to the pattern of colonic mucosa surrounding the polyp. Making a histological diagnosis of colon polyps merely by acetic acid spray is helpful for colon polyps with linear, regularly patterned surrounding colonic mucosa, and less so for those with nodular, irregularly patterned surrounding colonic mucosa.
Kim
Jeong-Hwan
JH
Department of Internal Medicine, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea.
Lee
Sun-Young
SY
Kim
Byung-Kook
BK
Choe
Won-Hyeok
WH
Kwon
So-Young
SY
Sung
In-Kyung
IK
Park
Hyung-Seok
HS
Jin
Choon-Jo
CJ
D019342:Acetic Acid / Q000494:pharmacology; D018256:Adenomatous Polyps / Q000175:diagnosis / Q000473:pathology; D003111:Colonic Polyps / Q000175:diagnosis / Q000473:pathology; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D006965:Hyperplasia; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies
D019342:Acetic Acid