Intest Res.  2020 Jan;18(1):107-114. 10.5217/ir.2019.00061.

Microvascular density under magnifying narrow-band imaging endoscopy in colorectal epithelial neoplasms

• Gonai T
• Kawasaki K
• Nakamura S
• Yanai S
• Akasaka R
• Sato K
• Toya Y
• Asakura K
• Urushikubo J
• Fujita Y
• Eizuka M
• Uesugi N
• Sugai T
• Matsumoto

• KMID: 2501372
• DOI: http://doi.org/10.5217/ir.2019.00061

Abstract

Background/Aims
Magnifying endoscopic classification systems, such as the Japan narrow-band imaging (NBI) Expert Team (JNET) classification, have been widely used for predicting the histologic diagnosis and invasion depth of colorectal epithelial tumors. However, disagreement exists among observers regarding magnifying endoscopic diagnosis, because these classification systems are subjective. We herein investigated the utility of endoscopic microvascular density (eMVD) calculated from magnifying NBI endoscopic images in colorectal tumors.
Methods
We reviewed magnifying NBI endoscopic images from 169 colorectal epithelial tumors (97 adenomas, 72 carcinomas/high-grade dysplasias) resected endoscopically or surgically. The eMVD on magnifying NBI endoscopic images was evaluated using image-editing software, and relationships between eMVD and clinical, endoscopic, and pathological findings were retrospectively analyzed.
Results
The eMVD in carcinomas (0.152 ± 0.079) was significantly higher than that in adenomas (0.119 ± 0.059, P< 0.05). The best cutoff value for distinguishing carcinoma from adenoma was 0.133. Sensitivity, specificity, and accuracy were 56.9%, 67.0%, and 62.7%, respectively. In addition, JNET type 2B tumors showed significantly higher eMVD (0.162 ± 0.079) compared to type 2A tumors (0.111 ± 0.050, P< 0.05).
Conclusions
The eMVD as determined by magnifying NBI endoscopy is considered to be a possible objective indicator for differentiating colorectal carcinomas from adenomas.

Keyword

Microvascular density; Narrow band imaging; Colorectal neoplasms; Colonoscopy

Figure

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  Fig. 1. Examples of white light, magnifying narrow-band imaging (NBI) endoscopic, and magnifying monochrome images. (A) A laterally spreading tumor in the sigmoid colon. A depressed area (white square) is subsequently observed by magnifying endoscopy. (B) A magnifying NBI endoscopic image in the tumor. Microvessels at the surface are thin and uniform. (C) Edited image from (B) using ImageJ (monochrome image). Black vascular areas and white avascular areas can be seen. The calculated endoscopic microvascular density (eMVD) of this image is 0.103. The histological diagnosis was tubular adenoma. (D) Laterally spreading tumor in the ascending colon. A depressed area (white square) is subsequently observed by magnifying endoscopy. (E) Magnifying NBI endoscopic image of the tumor. Microvessels in the surface are thick and meandering. (F) Edited image from (E) using ImageJ. The calculated eMVD of this image is 0.176. The histological diagnosis was shallow submucosal carcinoma.

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  Fig. 2. Receiver operator characteristic (ROC) curve for distinguishing carcinoma/high-grade dysplasia from adenoma. ROC for endoscopic microvascular density to predict histologic carcinoma. The best cutoff value for distinguishing adenoma and carcinoma was calculated to be 0.133, with a sensitivity of 56.9%, a specificity of 67.0%, and an accuracy of 62.7%.

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  Fig. 3. Endoscopic microvascular density (eMVD) of tumors by JNET classification. Relationship between eMVD and JNET classification. A significant difference in eMVD is observed between JNET type 2A and 2B tumors (P<0.001). NBI, narrow-band imaging; JNET, Japan NBI Expert Team.

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