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Background: Successful endoscopic management of early colorectal cancer using endoscopicmucosal resection requires the mandatory prediction of invasive depth and lymph node metastasis. Previous data using the Nagata crypt types Vn(B)/(C) as clinical indicators of T2/N+disease have shown low specificity (50%)with a tendency to over stage lesions. New mini probe ultrasound “through the scope“ i maging permits staging of lesions proximal to the rectum using direct endoscopic visualisation. Aim: To compare the staging accuracy of the Nagata crypt type V with mini probe high frequency 20 MHz endoscopic ultrasound. Methods: Sixty two patients with a Paris type II flat cancer were imaged using magnification colono scopy followed by 20/12.5 MHz ultrasound in a “back to back” design. Crystal violet staining (0.05%) at 100×x magnification permitted Nagata crypt criteria to be defined. Submucosal deep invasion (sm3+) was defined at ultrasound by the presence or absence of a dis rupted third sonographic layer. Predicted T0/1∶N0 lesions were resected using e ndoscopic mucosal resection with the remaining referred for surgery. Ultrasound and magnification staging were then compared with the resected histopathological specimens. Results: One patient was excluded from the study due to poor bowel p reparation. Fifty two lesions from 52 patients therefore met inclusion criteria (12 sm1/13 sm2/27 sm3+). Ultrasound (20 MHz) was significantly more accurate fo r invasive depth staging compared with Nagata stage (p< 0.0001) (overall accurac y 93%and 59%, respectively). The sensitivity for lymph node metastasis detecti on using ultrasound and magnification was 80%and 31%, respectively (p< 0.001 ) . The negative predictive value of ultrasound for invasive depth was better than that observed using magnification (88%/47%, respectively). The prevalence of nodal disease overall was 19%(10/52), with 80%(8/10) node positive lesions occ urring in the sm3+lesion group. Conclusions: High frequency 20 MHz ultrasound i s superior to magnification alone when differentiating T1/2 disease with a high positive predictive value for sm3 differentiation. Sm3+invasion was associated with nodal metastasis.
Background: Successful endoscopic management of early colorectal cancer using endoscopic mucosal resection requires the mandatory prediction of invasive depth and lymph node metastasis. Previous data using the Nagata crypt types Vn (B) / (C) as clinical indicators of T2 / N + disease have shown low specificity (50%) with a tendency to over stage lesions. New mini probe ultrasound “through the scope ” i maging permits staging of lesions proximal to the rectum using direct endoscopic visualization. Aim: To compare the staging accuracy of the Nagata crypt type V with mini probe high frequency 20 MHz endoscopic ultrasound. Methods: Sixty two patients with a Paris type II flat cancer were imaged using magnification colono scopy followed by 20 / 12.5 MHz ultrasound in a “back to back” design. Crystal violet staining (0.05%) at 100 × x magnification permitted Nagata crypt criteria to be defined. Submucosal deep invasion (sm3 +) was defined at ultrasound by the presence or absence of a dis rupted thir Results: One patient was excluded from the study due to poor Ultrasound at 20 MHz was significantly more accurate for invasive tumors than staging compared with Nagata stage (p <0.0001) (overall The sensitivity for lymph node metastasis detecti on using ultrasound and magnification was 80% and 31%, respectively (p <0.001). The negative predictive value of ultrasound for invasive depth was better than that The prevalence of nodal disease was 19% (10/52) with 80% (8/10) node positive lesions occ urring in the sm3 + lesion group. Conclusions: High fr equency20 MHz ultrasound i s superior to magnification alone when differentiating T1 / 2 disease with a high positive predictive value for sm3 differentiation. Sm3 + invasion was associated with nodal metastasis.