Prospective real-time evaluation of diagnostic performance using endocytoscopy in differentiating neoplasia from non-neoplasia for colorectal diminutive polyps (≤ 5 mm)

Figure 1 Technology of light contact microscopy, endocytoscope.

Figure 2 Typical images of endocytoscopic (EC) 1b and EC2. A: EC1b shows narrow serrated lumina and small roundish nuclei; B: EC2 shows slit-like smooth lumina and uniform fusiform or roundish nuclei.

Figure 3 A case of disagreement between endocytoscopic (EC) 1b diagnosis and histopathologic diagnosis (adenoma). A: Flat-type lesion (0-IIa) 3 mm in size; B: The polyp was located in the sigmoid colon. The EC images showed slit-like smooth lumina; C: The EC images showed roundish lumina; D: The nuclei were not clear due to inadequate staining. An endoscopist diagnosed the polyp as EC1b. Histologic examination revealed an adenomatous polyp.

Figure 4 A case of disagreement between endocytoscopic (EC) 2 diagnosis and histopathologic diagnosis (hyperplastic polyp). A: Flat-type lesion (0-IIa) with a shallow depressed area, 3 mm in size; B: The polyp was located in the transverse colon. Endoscopic imaging in the shallow depressed area showed typical EC2 features with slit-like smooth lumina and uniform fusiform and roundish nuclei; C: The polyp was diagnosed as EC2. Histologic examination revealed a hyperplastic polyp without a depressed area.