indigo-carmine and Carcinoma

Since the adenoma-carcinoma sequence was first proposed by Morson in the 1970s, it has become widely accepted that detection and subsequent removal of polypoid adenomas from the colon reduces the incidence of colorectal cancer. These adenomas are relatively easy to detect by conventional colonoscopy; however, large population studies have shown that despite resection of polypoid adenomas, interval colorectal cancers still occurred. Recent advances in technology have given today's endoscopists access to high-resolution and high-magnification scopes, which has facilitated detection of flat and depressed colorectal lesions. Current data suggest that such morphologically distinct lesions may account for up to 30% of all colorectal adenomas. Furthermore, flat and depressed lesions of the large bowel may confer greater malignant potential compared to polypoid adenomas. The majority of flat lesions show only subtle changes by conventional colonoscopy, but the use of stains, such as indigocarmine, in addition to magnification colonoscopy can enhance their detection significantly. In this paper, we discuss the rationale for detecting flat colorectal lesions. We explore the use of high-magnification colonoscopy and chromoendoscopy, with particular reference to the application of indigocarmine, in this patient group. We also discuss the novel therapeutic techniques now available for these lesions.

Topics: Adenoma; Adenomatous Polyposis Coli; Adult; Carcinoma; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged

Topics: Carcinoma; Colonoscopes; Colonoscopy; Coloring Agents; Electrocoagulation; Female; Humans; Hyaluronic Acid; Indigo Carmine; Intestinal Mucosa; Middle Aged; Rectal Neoplasms; Rectum

In Lynch syndrome, flat and diminutive adenomas are particularly prone to malignant transformation, but they can be missed by standard colonoscopy. It is not known whether chromocolonoscopy is able to detect more adenomas than standard colonoscopy in patients with Lynch syndrome.. We conducted a prospective, multicenter, randomized trial to compare standard colonoscopy with standard colonoscopy followed by pancolonic chromoscopy with indigo carmine in patients with a proven germline mutation in a mismatch-repair gene related to Lynch syndrome and who were undergoing screening or surveillance colonoscopy. Standard colonoscopy was used first to detect visible lesions. Colonoscopy with chromoscopy was then performed by a second gastroenterologist (blinded to the findings of the first colonoscopy) to detect additional lesions. The primary end point was the number of patients in whom at least one adenoma was detected.. A total of 78 eligible patients (median age, 45 years) were enrolled at 10 centers from July 2008 to August 2009. Significantly more patients with at least one adenoma were identified by chromocolonoscopy (32/78 (41%)) than by standard colonoscopy (18/78 (23%); P<0.001). The percentage of patients in whom at least one additional adenoma was detected during the chromoscopy was 31% (24/78). Overall, chromocolonoscopy plus colonoscopy detected a total of 55 adenomas in 32 patients (mean number of adenomas detected per patient: 0.7 vs. standard colonoscopy alone: 0.3; P<0.001).. The results support the proposition that chromocolonoscopy may significantly improve the detection rate of colorectal adenomas in patients undergoing screening or surveillance colonoscopy for Lynch syndrome.

Topics: Adenoma; Adult; Carcinoma; Colon; Colonoscopy; Colorectal Neoplasms; Colorectal Neoplasms, Hereditary Nonpolyposis; Coloring Agents; Early Detection of Cancer; Female; Humans; Indigo Carmine; Male; Middle Aged; Rectum; Single-Blind Method

High-resolution colonoscopy with chromoscopy (HRC) is a technique designed to improve the detection of colonic neoplasias. We prospectively compared standard colonoscopy (SC) and HRC in a randomized multicenter trial.. Patients (n = 203; age, 58 +/- 10 years; sex ratio, 1) were recruited according to the following criteria: (1) a history of either familial or personal colonic neoplasia or (2) alarm symptoms after the age of 60 years. After randomization, an SC was performed in 100 patients (resolution, < or = 410,000 pixels) and a HRC in 103 patients (Fujinon EC485ZW, 850,000 pixels). In the HRC group, each colonic segment was examined before and after spraying with indigo carmine 0.4%.. Two hundred seventy-six polyps were detected in 198 patients. One hundred sixty of them were hyperplastic polyps, 116 were adenomas, and 2 were carcinomas. The numbers of hyperplastic polyps and purely flat adenomas were significantly higher in the HRC group than in the SC group (1.1 +/- 1.6 vs 0.5 +/- 1.4 and 0.22 +/- 0.68 vs 0.07 +/- 0.29, respectively; P = .01 and P = .04), but there was no significant difference in the total number of adenomas per patient (primary end point) detected between the HRC and the SC groups (0.6 +/- 1.0 vs 0.5 +/- 0.9, respectively).. Although HRC improves detection of purely flat adenomas and hyperplastic polyps, the overall detection of colonic adenomas in a population at increased risk of neoplasia is not significantly improved. These findings do not support the routine use of HRC in clinical practice.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Carcinoma; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Coloring Agents; Female; France; Humans; Image Enhancement; Indigo Carmine; Male; Middle Aged; Prospective Studies

Identification and removal of small, non-palpable tumors located within previous surgical scar tissue is challenging and time consuming and may be associated with increased risk in patients with recurrent papillary thyroid carcinoma (PTC). The purpose of the present study was to present our surgeon-performed technique and to evaluate the usefulness of ultrasound-guided intratumoral indigo carmine injection (US-III) for intraoperative tumor localization in patients with recurrent PTC.. Sixteen patients with recurrent PTC in which tumors were <1.5 cm and not palpable were enrolled in this prospective study from January 2012 through March 2013.. The mean size of the target tumors was 0.85 cm (range 0.4-1.3 cm) on preoperative US. The average time required for the US-III procedure was 7.7 min (range 5-11 min). The mean volume of injected indigo carmine was 0.56 mL (range 0.3-1.0 mL); this injection expanded the tumors by a mean of 0.2 cm (23.5% increase compared with the initial tumor size; range 0.0-0.4 cm), increasing the mean size of the target tumors to 1.05 cm (range 0.5-1.5 cm). In 15 (93.8%) of the 16 patients, the recurrent tumors were successfully removed with the aid of US-III. No complications occurred in any of the patients as a result of the US-III or subsequent surgeries.. US-III is a safe and effective technique that can be performed by the surgeon for the intraoperative localization of small non-palpable tumors within previous scar tissue in patients with recurrent PTC.

Topics: Adult; Aged; Carcinoma; Carcinoma, Papillary; Chronic Disease; Coloring Agents; Female; Humans; Indigo Carmine; Injections; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Prospective Studies; Surgery, Computer-Assisted; Thyroid Cancer, Papillary; Thyroid Neoplasms; Ultrasonography; Young Adult

The agreement between Italian and Japanese endoscopists and pathologists on endoscopic and histopathological diagnoses of superficial gastric lesions is verified with the use of Paris and Vienna classifications. The correlations between Paris endoscopic types and Vienna histopathological categories is high in both the independent Italian and Japanese evaluations. However, the agreement between Italian and Japanese endoscopists is moderate due to the difficult evaluation of the height of the lesions, in particular when they are mixed. The agreement on the size of the lesions is fairly good. The probability of the same allocation to the Vienna categories of a single case is 87 per cent, disagreements remaining in dysplasia grading, between dysplasia, not only high-grade but also low-grade, and in situ carcinoma, and on cancer invasion of the lamina propria. The results indicate that use of the Paris and Vienna classifications has reduced the discrepancies between Western and Japanese endoscopists and pathologists in the diagnosis of these lesions.

Topics: Analysis of Variance; Carcinoma; Endoscopy; Gastrointestinal Neoplasms; Humans; Indigo Carmine; International Cooperation; Statistics, Nonparametric

The development of magnifying chromoendoscopy has facilitated the observation of mucosal pit patterns. This study investigated the value of this technology in predicting the histologic findings of colorectal lesions.. A total of 954 colorectal polyps were included. After identifying the lesions at colonoscopy, 0.2% indigocarmine solution was sprayed and then the zoom apparatus was switched to make a magnified view of the stained crypt orifice at a maximum 100 times magnification. The observed pit patterns were classified into 6 categories (I, II, IIIL, IIIS, IV, and V) according to Kudo's classification. Type I and II were designated as non-neoplastic patterns whereas other types were neoplastic. Correlation of the pit pattern with the findings of histologic examinations of resected or biopsied polyps was performed.. There were 678 diminutive (

Topics: Adenoma; Carcinoma; Clinical Competence; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Humans; Indigo Carmine; Prospective Studies; Sensitivity and Specificity

We have introduced magnifying colonoscopy into clinical practice and analyzed its diagnostic efficacy, especially regarding the ability to distinguish neoplastic from non-neoplastic polyps.. The materials consisted of 923 polyps. After identifying the lesions during normal colonoscopy, a dye was sprayed, and then the zoom apparatus of the colonoscope was used to make a magnified observation at a maximum 100 times magnification. We classified the crypt orifices into six categories and labeled them A to F as follows: A, a medium round appearance; B, an asteroid appearance; C, an elliptic appearance; D, a small, round appearance; E, a cerebriform appearance; F, no apparent structural appearance.. Forty-two of 923 polyps did not reveal any clear images of crypt patterns. The percentage of histologically neoplastic change in the lesions classified as A, B, C, D, E, and F were 10, 15.9, 93.7, 100, 94.8, and 87.5 percent, respectively. When we considered types A and B to represent a crypt pattern of non-neoplastic lesions, and types C, D, E, and F to represent neoplastic lesions, and when the lesions that did not show any clear images were classified as a misjudgment, the diagnostic accuracy of neoplastic lesions (sensitivity) was 92 percent and that of non-neoplastic lesions (specificity) was 73.3 percent. Overall, the diagnostic accuracy in differentiating neoplastic from non-neoplastic lesions was 88.4 percent. Twenty-three neoplastic lesions that were misjudged to be non-neoplastic were histologically adenoma with mild atypia in 22 and adenoma with moderate atypia in 1.. Magnifying colonoscopy was considered to be useful in determining the indications for colonoscopic removal.

Topics: Adenomatous Polyps; Biopsy; Carcinoma; Chi-Square Distribution; Colonic Polyps; Colonoscopes; Colonoscopy; Coloring Agents; Diagnosis, Differential; Gentian Violet; Humans; Hyperplasia; Image Enhancement; Indigo Carmine; Intestinal Mucosa; Peutz-Jeghers Syndrome; Sensitivity and Specificity

To follow up the chronological change of tubal function in patients with nasopharyngeal carcinoma for 10 years after irradiation.. Patients with nasopharyngeal carcinoma were subjected to eustachian tube function tests before irradiation and 6 months, 5 years, and 10 years after irradiation.. University hospital.. Ten patients (20 ears), 7 men and 3 women.. Twelve (60%) of the ears had patulous tubes 10 years after irradiation, which might result from atrophy of peritubal tissues. The occurrence of a patulous tube was independent of the radiation dosage, but it was related to the interval since irradiation.. Development of a patulous tube is associated with correction of organic obstruction of the eustachian tube. Resolution of the inflammatory reaction plays the most important role in recovery of function of the tube. Therefore, the prevalence of middle ear complications is low 10 years after irradiation.

Topics: Adult; Aged; Atrophy; Carcinoma; Coloring Agents; Eustachian Tube; Female; Follow-Up Studies; Humans; Indigo Carmine; Longitudinal Studies; Male; Middle Aged; Nasopharyngeal Neoplasms; Otitis Media; Otitis Media with Effusion; Pressure; Prevalence; Radiotherapy Dosage; Time Factors