Endoscopic Scoring System for T2 Invasion in Colorectal Cancer

Background and Aims

The depth of tumor invasion in colorectal cancer (CRC), especially T1b or T2, is crucial in treatment decision-making. However, their differences are not well-characterized. Thus, this study aimed to investigate the predictive endoscopic findings in tumor invasion of CRC.

Methods

Data from patients with T1b or T2 CRCs resected endoscopically or surgically were reviewed retrospectively. The patients were divided into 2 groups: T1b (n = 298) and T2 (n = 267) tumor invasion. A scoring system was established based on the endoscopic findings in each group, and the accuracy of the system was assessed using a receiver-operating-characteristic (ROC) curve analysis.

Results

T2 invasion was predicted by tumor size, irregular bottom of depression, existence of depression, expansion appearance, convergency of folds, and erosion or white coat. The risk scoring system was developed using the regression coefficient values of the above variables. The area under the ROC curve was 0.894 (95% confidence interval, 0.868-0921). Cases with a score ≥4 had a high risk of T2 (sensitivity, 84.5%; specificity, 78.9%).

Conclusion

Our scoring system was useful for the diagnosis of T1b and T2, and a score ≥4 could predict T2 invasion. Additional studies are warranted to confirm these results before our scoring system can be applied clinically.