title: Magnification endoscopy with acetic acid enhancement and a narrow-band imaging system for pit pattern diagnosis of colorectal neoplasms.
abstract: OBJECTIVE
  Pit pattern (PP) analysis of colorectal neoplasms using magnification chromoendoscopy with crystal violet (CV-MCE) is useful for predicting histologic features, but it is time consuming. Capillary pattern analysis by magnification endoscopy with narrow-band imaging (NBIME) is a useful and simpler procedure, but its diagnostic accuracy may be inferior to CV-MCE. NBIME with acetic acid enhancement (A-NBIME) is effective for rapid visualization of gastric mucosal microstructures. We performed a prospective study to compare the diagnostic reliability and feasibility of A-NBIME and CV-MCE in PP diagnosis of colorectal neoplasms.
  
  
  METHODS
  The present study consisted of 3 protocols: Study-1 assessed 56 colorectal lesions photographed with A-NBIME and CV-MCE, and the endoscopic images were reviewed by 3 experts to compare the diagnostic concordance; study-2 assessed 202 colorectal lesions photographed with A-NBIME in 116 consecutive patients and the correlation between PP and histologic findings; study-3 randomly allocated 100 patients with colorectal lesions equally to A-NBIME and CV-MCE, and compared the procedure time and visible ratio of PP.
  
  
  RESULTS
  The κ value for interobserver agreement for A-NBIME and CV-MCE was 0.71 (0.66 to 0.75) and 0.80 (0.75 to 0.85), respectively. Intraobserver agreement between modalities for each reviewer was 0.79 (0.70 to 0.88), 0.80 (0.71 to 0.90), and 0.74 (0.67 to 0.82). Non-neoplastic polyps and massively invasive submucosal adenocarcinomas were statistically related to type II and type VI-H/VN. The procedure time was statistically shorter with A-NBIME than with CV-MCE (31 vs. 81 s), and the visible ratio of PP was equivalent (98.9% vs. 98.3%).
  
  
  CONCLUSIONS
  A-NBIME is comparable with CV-MCE in PP diagnosis of colorectal neoplasms and is a simpler technique.
authors.affiliation: Departments of *Gastroenterology ∥Pathology, Tottori Municipal Hospital, Tottori †Division of Endoscopy, Kaken Hospital, International University of Health and Welfare, Ichikawa ‡Department of Gastroenterology, Faculty of Medicine, Shimane University §Division of Endoscopy, Shimane University Hospital, Izumo, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Shibagaki
authors.forename: Yuji
authors.initials: Y
authors.lastname: Amano
authors.forename: Norihisa
authors.initials: N
authors.lastname: Ishimura
authors.forename: Takafumi
authors.initials: T
authors.lastname: Yuki
authors.forename: Hideaki
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Hiraku
authors.initials: H
authors.lastname: Fujita
authors.forename: Keita
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
mesh_terms: D019342:Acetic Acid; D000230:Adenocarcinoma / Q000473:pathology; D000368:Aged; D003111:Colonic Polyps / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods*; D015588:Observer Variation; D061646:Operative Time; D011446:Prospective Studies; D011858:Radiographic Magnification / Q000379:methods*; D015203:Reproducibility of Results
chemical_list: D019342:Acetic Acid