title: Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias.
abstract: OBJECTIVE
  To prospectively investigate the efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplastic lesions in cold biopsy specimens.
  
  
  METHODS
  Patients were selected for inclusion if they had colorectal epithelial lesions that were not considered suitable for direct endoscopic resection. These included colorectal polyps > or = 10 mm and lesions suspected of being carcinomas capable of invading the colorectal submucosa or beyond, including strictures, based on the cold biopsies obtained from each lesion prior to resection. We investigated the relationship between diagnoses based on cold biopsy samples using the revised Vienna Classification and resected specimens of the same lesions, and the therapeutic implications of diagnoses made using the revised Vienna Classification. The same cold biopsy specimens were also examined using the Japanese Group Classification guidelines, and compared with the resected specimens of the same lesions for reference.
  
  
  RESULTS
  A total of 179 lesions were identified. The sensitivity, specificity, positive and negative predictive values of the revised Vienna Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 22.2%, 100%, 100%, and 71.4%, respectively, and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 59.7%, 100%, 100%, and 37.6%, respectively. The sensitivity, specificity, positive and negative predictive values of the Japanese Group Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 83.3%, 91.4%, 83.3%, and 91.4%, respectively, and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 95.1%, 91.4%, 97.9%, and 82.1%, respectively. A total of 137 of 144 carcinomas that had invaded the submucosa or beyond and three high-grade intraepithelial neoplasias were diagnosed as "carcinoma" using the Japanese Group Classification system.
  
  
  CONCLUSIONS
  The revised Vienna Classification for cold biopsy specimens has high positive predictive value in the diagnosis of colorectal carcinoma invasive to the submucosa or beyond.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, Japan. ktominaga@oha.toho-u.ac.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Tominaga
authors.forename: Sumio
authors.initials: S
authors.lastname: Fujinuma
authors.forename: Takuro
authors.initials: T
authors.lastname: Endo
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Saida
authors.forename: Kei
authors.initials: K
authors.lastname: Takahashi
authors.forename: Iruru
authors.initials: I
authors.lastname: Maetani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002277:Carcinoma / Q000145:classification* / Q000473:pathology; D015179:Colorectal Neoplasms / Q000145:classification* / Q000473:pathology; D005260:Female; D006801:Humans; D007420:Intestine, Large / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011446:Prospective Studies