Endoscopic classification of the capillary-vessel pattern of colorectal lesions by spectral estimation technology and magnifying zoom imaging

BackgroundColonoscopy with spectral estimation technology and magnifying zoom imaging allows the characterization of the fine superficial capillary pattern of normal mucosa and of colorectal lesions. The endoscopic distinction of the capillary pattern of colorectal lesions might contribute to the differential diagnosis among normal, hyperplastic, and neoplastic lesions.ObjectiveBy means of these latest technologic advances, the objective is to define a classification of the capillary-vessel pattern of colorectal lesions diagnosed during routine colonoscopy.DesignA total of 309 colorectal lesions endoscopically or surgically resected were prospectively examined. The capillary pattern was divided into 5 subtypes according to the number, morphology, and distribution of the fine blood vessels. Capillary patterns types I and II were characterized by a few short, straight, and sparsely distributed vessels; types III to V were of numerous, elongated, and tortuous capillaries irregularly distributed.ResultsThe overall accuracy of the capillary-vessel classification in determining the neoplastic or non-neoplastic nature of the colorectal lesions was 98.3% (304/309 lesions). Among 59 non-neoplastic lesions, 56 (94.9%) that showed patterns I or II were diagnosed as normal, inflammatory, or hyperplastic polyps. Of the 250 neoplastic lesions, 248 (99.2%) that had capillary pattern types III, IV, and V were diagnosed as adenomatous or carcinoma. The sensitivity of the capillary pattern classification for distinguishing neoplasia was 99.2% (95% CI, 98.2%-100%), and the specificity was 94.9% (95% CI, 92.5%-97.4%).LimitationA single-center study.ConclusionThe endoscopic classification of the superficial capillary-vessel pattern of colorectal lesions is an accurate method of predicting the histopathologic findings.