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CLASSIFICATION
Classification
Colorectal EC classification (endocytoscopy)
Ultra-magnifying endocytoscopy (EC) of colorectal lesions: EC1a–EC3b after methylene blue staining (crypt and nuclear pattern), and EC-V1–V3 with EC-NBI (surface microvessels). Separate from pit pattern, NICE, and JNET.
Classification overview
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EC (stained)
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EC1a · Roundish lumens
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EC1b · Serrated lumens
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EC2 · Slit-like lumens
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EC3a · Irregular lumens
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EC3b · Unclear lumens
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EC-V (EC-NBI)
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EC-V1 · Obscure microvessels
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EC-V2 · Uniform microvessel network
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EC-V3 · Irregular dilated microvessels
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Method
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Observation · How to obtain EC images
EC (stained)
EC1a
Roundish lumens
Misawa 2021, Fig. 2, Not original, CC BY-NC
Crypt
Small round crypt openings clearly visible; smooth crypt margins
Nuclei
Small, uniform round or slightly spindle-shaped nuclei arranged radially from the crypt margin; or no staining pattern
Histology
Normal colonic mucosa
EC1b
Serrated lumens
Misawa 2021, Fig. 2, Not original, CC BY-NC
Crypt
Serrated (saw-tooth) crypt pattern; fine cytoplasmic granules suggesting mucin
Nuclei
Small, uniform round nuclei near the crypt margin
Histology
Hyperplastic polyp
Note: EC1b is a key discriminator between non-neoplastic (hyperplastic) and neoplastic lesions.
EC2
Slit-like lumens
Misawa 2021, Fig. 2, Not original, CC BY-NC
Crypt
Clear slit-like crypt openings; smooth crypt margins
Nuclei
Mildly enlarged spindle-shaped or oval nuclei
Histology
Adenoma (including low- and high-grade dysplasia) to intramucosal adenocarcinoma
Note: Dysplasias are mainly EC2; depth is assessed with EC3 subtypes.
EC3a
Irregular lumens
Misawa 2021, Fig. 2, Not original, CC BY-NC
Crypt
Irregular crypt openings; round nuclei stain densely with methylene blue
Histology
Intramucosal cancer to slightly invasive submucosal cancer (SMs)
Note: SMs = slightly invasive submucosal cancer (low nodal risk in Kudo SM classification).
EC3b
Unclear lumens
Misawa 2021, Fig. 2, Not original, CC BY-NC
Crypt
Crypt openings obscure or indistinct
Nuclei
Irregular, enlarged nuclei; desmoplastic reaction may appear as fine granular structures
Histology
Massively invasive submucosal cancer (SMm) or deeper — metastatic risk
Note: SMm or deeper. Fine granular structures may reflect exposed desmoplastic reaction.
EC-V (EC-NBI)
EC-V1
Obscure microvessels
Misawa 2021, Fig. 3, Not original, CC BY-NC
Vessels
Surface microvessels very fine and obscure
Histology
Mainly hyperplastic polyp / non-neoplasia
Method
EC-NBI without methylene blue staining
EC-V2
Uniform microvessel network
Misawa 2021, Fig. 3, Not original, CC BY-NC
Vessels
Surface microvessels clearly seen; regular network with uniform caliber and arrangement
Histology
Adenoma to intramucosal cancer
Method
EC-NBI without methylene blue staining
EC-V3
Irregular dilated microvessels
Misawa 2021, Fig. 3, Not original, CC BY-NC
Vessels
Surface microvessels thick; non-homogeneous caliber or arrangement
Histology
Invasive cancer (including SMm)
Method
EC-NBI without methylene blue staining; faster than EC with dye
Note: Predicts invasive cancer including SMm; faster workflow than methylene blue EC.
Method
Observation
How to obtain EC images
EC (stained)
Apply methylene blue (or crystal violet + methylene blue double stain) after washing; contact the EC lens to the lesion and pull the magnification lever
EC-NBI
Switch to NBI on the endocytoscope; no dye required for EC-V
Magnification
Contact-type ultra-high magnification (approximately 380–520× on current scopes)
Note: GIF-H290EC / CF-H290ECI integrated scopes. Often combined with pit pattern and JNET for depth.
Misawa 2021, Fig. 2, Not original, CC BY-NC
Misawa 2021, Fig. 3, Not original, CC BY-NC
Reference
Original article
Kudo SE et al. Endoscopy 2011;43:869-875. Kudo SE et al. Gastrointest Endosc 2015;82:912-923
Related tools
NICE classification (colorectal NBI, non-magnifying)
NICE classification
CLASSIFICATION
NICE
→
Kudo–Tsuruta classification (pit pattern)
Pit pattern (Kudo–Tsuruta)
CLASSIFICATION
pit pattern
→
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Decision support only. Follow current guidelines and local protocols. Classification definitions and terminology follow the original publication language.