Endoscopic features of high‐risk T1 colorectal cancer: A case report with literature review

摘要

Abstract Colorectal cancer is the third leading cause of cancer death in Taiwan. Endoscopic resection is the treatment of choice for stage I colorectal cancer without risk of lymph node metastases. Unfavorable histological features predict high‐risk neoplasm; in addition, surface change of T1 cancer under image‐enhanced endoscopy also help recognition of high‐risk neoplasm. Through the case presentation, we aim to demonstrate how to discriminate the high‐risk T1 cancer from the low‐risk counterpart by image‐enhanced endoscopy. A 35‐year‐old woman without systemic diseases received screening colonoscopy, and one 1?cm IIa + IIc neoplasm was found at the transverse colon. The image‐enhanced endoscopy showed JNET type 3 under narrow band imaging, and Kudo type VI with demarcation line and focal VN at central depressed area under chromoendoscopy with crystal violet. Under an impression of high‐risk T1 cancer, laparoscopic right hemicolectomy was performed, and the pathology showed well to moderately differentiated adenocarcinoma with lymph node metastasis, pT1N1M0. A multidiscipline approach integrating gross morphological features, NBI, and magnifying chromoendoscopy should be applied in regular daily practice. Molecular diagnosis may aid to increase the specificity of prediction of lymph node metastases in the future. Further investigations using artificial intelligence, machine learning, or other new techniques to improve the accuracy is still warranted.