Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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White spots around colorectal tumors are cancer-related findings and may aid endoscopic diagnosis: a prospective study in Japan

  • Kai Korekawa (Division of Gastroenterology, Tohoku University Graduate School of Medicine) ;
  • Yusuke Shimoyama (Division of Gastroenterology, Tohoku University Graduate School of Medicine) ;
  • Fumiyoshi Fujishima (Department of Pathology, Tohoku University Graduate School of Medicine) ;
  • Hiroshi Nagai (Division of Gastroenterology, Tohoku University Graduate School of Medicine) ;
  • Takeo Naito (Division of Gastroenterology, Tohoku University Graduate School of Medicine) ;
  • Rintaro Moroi (Division of Gastroenterology, Tohoku University Graduate School of Medicine) ;
  • Hisashi Shiga (Division of Gastroenterology, Tohoku University Graduate School of Medicine) ;
  • Yoichi Kakuta (Division of Gastroenterology, Tohoku University Graduate School of Medicine) ;
  • Yoshitaka Kinouchi (Student Healthcare Center, Institute for Excellence in Higher Education, Tohoku University) ;
  • Atsushi Masamune (Division of Gastroenterology, Tohoku University Graduate School of Medicine)
  • Received : 2024.02.07
  • Accepted : 2024.04.28
  • Published : 2024.09.30
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Abstract

Background/Aims: During endoscopy, white spots (WS) are sometimes observed around benign or malignant colorectal tumors; however, few reports have investigated WS, and their significance remains unknown. Therefore, we investigated the significance of WS from clinical and pathological viewpoints and evaluated its usefulness in endoscopic diagnosis. Methods: Clinical data of patients with lesions diagnosed as epithelial tumors from January 1, 2019, to December 31, 2020, were analyzed (n=3,869). We also performed a clinicopathological analysis of adenomas or carcinomas treated with endoscopic resection (n=759). Subsequently, detailed pathological observations of the WS were performed. Results: The positivity rates for WS were 9.3% (3,869 lesions including advanced cancer and non-adenoma/carcinoma) and 25% (759 lesions limited to adenoma and early carcinoma). Analysis of 759 lesions showed that the WS-positive lesion group had a higher proportion of cancer cases and larger tumor diameters than the WS-negative group. Multiple logistic analysis revealed the following three statistically significant risk factors for carcinogenesis: positive WS, flat lesions, and tumor diameter ≥5 mm. Pathological analysis revealed that WS were macrophages that phagocytosed fat and mucus and were white primarily because of fat. Conclusions: WS are cancer-related findings and can become a new criterion for endoscopic resection in the future.

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References

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