Clinical significance and validity of the subclassification for colorectal laterally spreading tumor granular type. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Shigita, Kenjiro; Oka, Shiro; Tanaka, Shinji; Sumimoto, Kyoku; Hirano, Daiki; Tamaru, Yuzuru; Ninomiya, Yuki; Asayama, Naoki; Hayashi, Nana; Nagata, Shinji; Arihiro, Koji; Chayama, Kazuaki
• Is Part Of: Journal of gastroenterology and hepatology. Volume 31:Issue 5(2016:May)
• Page Start: 973
• Page End: 979
• Publication Date: 2016-05
• Subjects: diagnostic accuracy -- kappa value -- LST granular type -- size of nodule -- subclassification; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.13238
• Languages: English
• ISSNs: 0815-9319

Abstract

Abstract: Background and Aim: Colorectal laterally spreading tumor granular type (LST‐G) is generally divided into two subtypes based on morphology. Here, we retrospectively investigated the clinical significance of a concrete, objective LST‐G subclassification. Methods: This study examined 636 consecutive cases that were resected endoscopically or surgically. LST‐G was subclassified as follows: Type 1, a lesion with homogenous uniform granules with uniform (<5 mm) nodules; Type 2, a lesion with granules and small nodules (≥5 mm, <10 mm); or Type 3, a lesion accompanied by large nodules (≥10 mm). For the validation study, 194 images were compiled from 97 cases investigated using conventional colonoscopy and chromoendoscopy with indigo carmine dye spraying. Images were distributed in a randomized order to students without prior endoscopy experience, less‐experienced endoscopists (LEE group), and highly experienced endoscopists (HEE group). Diagnostic accuracy and interobserver agreement were then evaluated. Results: There was no submucosal invasion in Type 1 lesions. The incidence of deep submucosal invasive carcinoma was higher for Type 3 lesions than for Type 2 lesions. Interobserver agreement was good in each group. Diagnostic accuracy was higher in the HEE group than in the student and LEE groups. Chromoendoscopy had a higher accuracy rate than conventional colonoscopy in the LEE and HEE groups (LEE, 0.74 vs 0.69, P < 0.05; HEE, 0.84 vs 0.78, P < 0.05). Conclusions: This subclassification of LST‐G according to the diameters of granules and nodules was both useful for choosing therapeutic strategies in the clinical setting and universally applicable.