Clinical significance of type VI pit pattern subclassification in determining the depth of invasion of colorectal neoplasms

AIM: To clarify whether subclassification of the type Vi pit pattern on the basis of magnifying colonoscopy findings is useful in determining the type and depth of invasion of colorectal neoplasms. METHODS: We retrospectively analyzed 272 colorectal neoplasms (117 dysplasias and 155 submucosal invasive carcinomas; 228 patients) with a type V pit pattern [type V-I, n = 202; type V-N, n = 70 (Kudo and Tsuruta classification system)]. We divided lesions with a type Vi pit pattern into two subclasses, mildly irregular lesions and severely irregular lesions, according to the prominent and detailed magnifying colonoscopy findings. We examined the relation between these two subclasses and histology/invasion depth. RESULTS: One hundred and four lesions (51.5%) were judged to be mildly irregular, and 98 lesions (48.5%) were judged to be severely irregular. Ninety-seven (93.3%) mildly irregular lesions showed dysplasias or submucosal invasion of less than 1000 mu m (SM < 1000 mu m). Fifty-five (56.1%) severely irregular lesions showed submucosal invasion equal to or deeper than 1000 gm (SM >= 1000 gm). Mild irregularity was found significantly more often in dysplasias or lesions with SM < 1000 gm than in lesions with SM >= 1000 pm (P < 0.01). CONCLUSION: Subclassification of the type Vi pit pattern is useful for identifying dlysplasias or lesions with SM < 1000 Pm. (c) 2008 WJG. All rights reserved.