Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel

PURPOSE: We have introduced magnifying colonoscopy into clinical practice a nd analyzed its diagnostic efficacy, especially regarding the ability to di stinguish neoplastic from non-neoplastic polyps, METHODS: The materials con sisted of 923 polyps. After identifying the lesions during normal colonosco py, a dye was sprayed, and then the zoom apparatus of the colonoscope was u sed to make a magnified observation at a maximum 100 times magnification. W e 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 appear ance; F, no apparent structural appearance. RESULTS: Forty-two of 923 polyp s did not reveal any clear images of crypt patterns. The percentage of hist ologically neoplastic change in the lesions classified as A, B, C, D, E, an d 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 le sions, and types C, D, E, and F to represent neoplastic lesions, and when t he lesions that did not show any clear images were classified as a misjudgm ent, the diagnostic accuracy of neoplastic lesions (sensitivity) was 92 per cent and that of non-neoplastic lesions (specificity) was 73.3 percent. Ove rall, the diagnostic accuracy in differentiating neoplastic from non-neopla stic lesions was 88.4 percent. Twenty-three neoplastic lesions that were mi sjudged to be non-neoplastic were histologically adenoma with mild atypia i n 22 and adenoma with moderate atypia in 1. CONCLUSION: Magnifying colonosc opy was considered to be useful in determining the indications for colonosc opic removal.