Clin Endosc > Epub ahead of print
White Opaque Substance, a New Optical Marker on Magnifying Endoscopy: Usefulness in Diagnosing Colorectal Epithelial Neoplasms
Kazutomo Yamasaki1 , Takashi Hisabe1 , Kenshi Yao2 , Hiroshi Ishihara1 , Kentaro Imamura1 , Tatsuhisa Yasaka1 , Hiroshi Tanabe3 , Akinori Iwashita3 , Toshiharu Ueki1
1Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
2Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
3Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
Correspondence :  Takashi Hisabe ,Tel: +81-92-921-1011, Fax: +81-92-928-0856, Email:
Received: July 30, 2020  Revised: October 7, 2020   Accepted: October 22, 2020

A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowband imaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimed to determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectal adenoma and carcinoma.
A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resection or surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before the histopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a marker of colorectal carcinoma.
The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 were adenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was 86%.
This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differential diagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms.
Key Words: Colorectal neoplasms; Magnifying endoscopy; Narrow band imaging; White opaque substance
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