Real-time in vivo virtual histology of colorectal lesions when using the endocytoscopy system

• Published in: Gastrointestinal endoscopy 2006-06, Vol.63 (7), p.1010-1017
• Main Authors: Sasajima, Keita, MD, Inoue, Haruhiro, MD, Takeuchi, Tsukasa, MD, Kashida, Hiroshi, MD, Hidaka, Eiji, MD, Kawachi, Hiroshi, MD, Sakashita, Masanori, MD, Tanaka, Junichi, MD, Kudo, Shin-ei, MD, Shiokawa, Akira, MD
• Format: Article
• Language: English
• Subjects: Adenoma - diagnostic imaging; Adenoma - pathology; Biological and medical sciences; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - pathology; Digestive system. Abdomen; Endoscopy; Endoscopy, Gastrointestinal - methods; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Middle Aged; Prospective Studies; Ultrasonography
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2006.01.021

Background The histologic findings of GI lesions are based on light-microscopic examination of H&E-stained thin-slice specimens. The endocytoscopy (E-C) system, a novel “ultrahigh” magnifying endoscopy, enables cellular level microscopic observation in vivo and can be applied clinically. A study of the observation of colorectal lesions when using E-C to obtain real-time histologic images in vivo during endoscopy was performed. Design The study materials, 75 colorectal lesions, were examined by using E-C. After spraying 1% methylene blue dye, the instrument was passed through the working channel of the colonoscope. To obtain real-time images of the lesions at the cellular level in vivo, the tip of the instrument needs to touch the target. In 75 lesions, the diagnoses of E-C images was done by a pathologist who was blinded to the histologic diagnoses. All lesions were resected endoscopically or surgically after E-C observation was made. The E-C images for each lesion were compared with H&E-stained horizontal cross-sections. Results With E-C, it was possible to observe lesions at the cellular level and to evaluate cellular atypia in addition to structural atypia in vivo. The correlation was statistically significant between the E-C diagnosis and the histologic diagnosis. Conclusions It was possible to distinguish neoplastic lesions from non-neoplastic ones, and it also was possible to distinguish invasive cancer from adenoma. The “ultrahigh” magnifying endoscopy, E-C system, provides real-time histologic images in vivo, which correspond well with those of H&E stained microscopic images.