Clinical Importance of Magnification in the Assessment of Colorectal Lesions
Bibliographic record
Abstract
A 56-year-old man had a 1.5 cm Paris 1s+2c rectal lesion detected on fecal immunochemical test-positive colonoscopy. Examining the lesion using optical enhancement mode 1 (OE-1), which utilizes wavelengths 415 nm and 540 nm, highlights the microvasculature. This revealed a NICE III lesion, indicating cancer (Figure 1) (1). Rectal Lesion. White light images of lesion: (A) distant view, (B) near view, (C) low magnification. OE-1 images of lesion: (D) distant view, (E) low magnification, (F) medium magnification. Rectal Lesion. White light images of lesion: (A) distant view, (B) near view, (C) low magnification. OE-1 images of lesion: (D) distant view, (E) low magnification, (F) medium magnification. The NICE classification is advantageous in its simplicity and the fact that magnification is unnecessary. However, a drawback is that neoplastic lesions are only classified into two categories: NICE II (adenoma) and NICE III (invasive cancer). To address this limitation, the Japan NBI Expert Team (JNET) created the JNET classification where NICE II lesions are subclassified using magnification: JNET 2A (low-grade adenoma) and JNET 2B (high-grade dysplasia or superficially invasive cancer) (2). Under magnification, the lesion of interest was classified as JNET 2B, which suggests superficial neoplasia that is potentially resectable endoscopically. Considering the central depression along with microvasculature findings, the lesion was staged as a rectal cancer. MRI staged the lesion as a T1-T2, and CT was negative for any metastatic disease. An endoscopic submucosal dissection (ESD) was completed and a curative R0 resection was achieved with final pathology of a well-differentiated adenocarcinoma with superficial submucosal invasion (<_ 1000 µm) without tumor budding or lymphovascular invasion (Figure 2). Resection and pathology: (A) submucosal injection of lesion; (B) ESD: muscularis propria on the left and submucosa/mucosa to the right; (C) defect post-ESD; (D) pined gross specimen; (E) 20× with hematoxylin phloxine saffron (HPS) stain: tubular adenoma with high-grade dysplasia and focus of superficial adenocarcinoma; (F) 40× HPS stain: focus of submucosal cancer with penetration depth of 400 um. Resection and pathology: (A) submucosal injection of lesion; (B) ESD: muscularis propria on the left and submucosa/mucosa to the right; (C) defect post-ESD; (D) pined gross specimen; (E) 20× with hematoxylin phloxine saffron (HPS) stain: tubular adenoma with high-grade dysplasia and focus of superficial adenocarcinoma; (F) 40× HPS stain: focus of submucosal cancer with penetration depth of 400 um.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.004 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".