**7. Conclusion**

After retorospective study [22], same study group confirmed verification of patients SICRC with 112 nonpedunculated (non-Ip type) cases. Finally, nonpedunculated (non-Ip type) case of the prevalence of DR was significantly correlated with submucosal depth. The sensitivity and specificity of detection of DR for prediction of pSM2 (tumor invasion <1000 µm) in non‐

Additionally, receiver operating characteristic (ROC), analysis confirmed 950 µm as the best diagnostic cut-off value of submucosal depth for DR detection, and 50 µm, which is the dif‐ ference between the value of 950 µm as determined by cut off value (COV) and 1000 µm, the

In statistics and diagnostic testing, positive predictive value (PPV) is the proportion of pa‐ tients with positive test results who are correctly diagnosed, on the other hand, negative predictive value (NPV) is negative test results. Both of PPV and NPV are critical measure of the performance of a diagnostic method. In this studies revealed that PPV:0.93, NPV:0.59 in pedunculated and PPV:0.95, NPV:0.59 in nonpedunculated type. These results provide a ba‐

**Depth of submucosal invasion Number of patients DR–negative DR–positive**

**Depth of submucosal invasion Number of patients DR–negative DR–positive**

pSM2 51 16 35

pM+ pSM1 25 23 2

**Table 8.** Relationship between depth of submucosal invasion and DR in biopsy specimens of patients with pedunculated (upper part) and nonpedunculated (lower part) type - prospective study - (adapted from [22])

pSM2 54 17 37

pM+ pSM1 27 24 3

pedunculated SICRC were 68.6% and 92.0%, respectively.

172 Colonoscopy and Colorectal Cancer Screening - Future Directions

defining value of pSM2, is an acceptable measurement error range.

sis for assessment of DR as a good indicator of pSM2. (Table 8).

pSM2, SM invasion ≧1000 µm; pM + pSM1, SM invasion < 1000 µm.

pSM2, SM invasion ≧1000 µm; pM + pSM1, SM invasion < 1000 µm.

Sensitivity: (37/37+ 17) x 100 = 68.5%. Specificity: (24/24+ 3) x 100 = 88.9%.

Sensitivity: (35/35+ 16) x100 = 68.6%. Specificity: (23/23+ 2) x 100 = 92.0%.

DR, desmoplastic reaction.

DR, desmoplastic reaction.

In this issue, we have discussed the a critical role of pathological assessment for T1 stage color‐ ectal cancer, several problems related to the pathological diagnosis of early CRC at increased risk of lymph node metastasis and submucosal invasion. A new endoscopic systems which may prove to be reliable for detection of deep submucosal invasive CRC. Moreover, current en‐ doscopic resection (EMR/ESD) have become useful for early CRC, but, these resection is appli‐ cable only to intramucosal carcinoma, and additional surgery is required if the resected lesion reveals submucosal invasion by pathological diagnosis, because prevalence rates of lymph node metastasis about 10% of all patients with submucosal invasive colorectal carcinoma.

We believe that curative endoscopic management for early CRC may be need to accurately pathological diagnosis of submucosal depth. Assessment of DR in pretreatment biopsy specimen nonpedunculated (non-Ip type) and submucosal depth with head invasion or stalk invasion in pedunculated (Ip type) for post endoscopic resection (EMR/ESD) specimen may be useful for the clinicopathological diagnosis of colorectal carcinoma with invasion in‐ to the submucosal layer.
