**1. Introduction**

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160 Colonoscopy and Colorectal Cancer Screening - Future Directions

review of the literature. BMC Surg 2008;8 17.

Observation of the mucosal crypt patterns using chromoendoscopy with magnification has been reported to be the most reliable method for determining whether a colorectal cancer (CRC) is early or advanced tumour. Moreover, brand-new endoscopic system have the capa‐ bility to enhance visibility by the capillary pattern, which may prove to be reliable for detec‐ tion of deep submucosal invasive CRC.

Early CRC is defined as a tumour whose invasion is limited to the mucosa or submucosa. The endoscopic mucosal resection and endoscopic mucosal dissection (EMR/ESD) have be‐ come useful for early CRC. However, EMR/ESD is applicable only to intramucosal carcino‐ ma, and additional surgery is required if the resected lesion reveals submucosal invasion by pathological diagnosis. Therefore, endoscopist and surgical pathologist considered that it would be very useful to predict the depth of invasion of submucosal invasive CRC before EMR/ESD. On the other hand, desmoplastic reaction (DR) which is characterized by the infiltration of eosinophilic myofibroblasts in the stroma of invasive carcinoma is suggested to be a prognostic marker in CRC patients.

Here we describe that detection of DR in pre-treatment biopsy specimens is useful for pre‐ dicting the depth of submucosal invasion and evaluation of submucosal depth with head in‐ vasion or stalk invasion in post EMR/ESD specimen is useful for predicting the lymph node metastasis and discuss relevant issues in arriving at the correct differential diagnosis based on histological findings for gastrointestinal endoscopist and surgical pathologist.

© 2013 Tomita et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
