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CLASSIFICATION
Classification
Kudo–Tsuruta classification (pit pattern)
Chromoendoscopic pit-pattern classification of colorectal neoplasia (I / II / IIIs / IIIL / IV / VI / VN).
Classification overview
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Non-neoplastic
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Type I · Round pit
•
Type II · Asteroid pit
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Adenoma
•
Type IIIs · Small tubular pits
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Type IIIL · Large tubular pits
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Type IV · Gyrus-like / dendritic pit
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Carcinoma
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Type VI · Irregular pits
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Type VN · Non-structure
Non-neoplastic
Type I
Round pit
GI Calc, Not original, CC BY
Pit
Round pit (normal pit); round and regular
Histology
Normal glands or inflammatory mucosa
Type II
Asteroid pit
GI Calc, Not original, CC BY
Pit
Asteroid pit; star-shaped or onion-like, larger than normal
Histology
Hyperplastic polyp
Adenoma
Type IIIs
Small tubular pits
GI Calc, Not original, CC BY
Pit
Tubular or round pit that is smaller than the normal pit (Type I)
Note
S stands for small or short. Compactly arranged. Typical of depressed tumors.
Histology
Adenoma, high-grade dysplasia, or intramucosal cancer (de novo precursor)
Type IIIL
Large tubular pits
GI Calc, Not original, CC BY
Pit
Tubular or round pit that is larger than the normal pit (Type I)
Note
L stands for long or large. Typical of polypoid tubular adenoma.
Histology
Tubular adenoma
Type IV
Gyrus-like / dendritic pit
GI Calc, Not original, CC BY
Pit
Dendritic or gyrus-like pit; branch-like
Histology
Tubulovillous or villous adenoma; may include intramucosal cancer
Carcinoma
Type VI
Irregular pits
GI Calc, Not original, CC BY
Pit
Irregular arrangement and sizes of IIIS, IIIL, and IV type pit pattern
Note
I stands for irregular (structural atypism).
Histology
Intramucosal cancer or superficial submucosal invasive cancer
Type VN
Non-structure
GI Calc, Not original, CC BY
Pit
Loss or decrease of pits with an amorphous (non-structural) structure
Note
N stands for non-structure. Exposes the desmoplastic reaction of deeply invasive SM cancer.
Histology
Deep submucosal invasive cancer
Kim 2025, Fig. 4, Not original
GI Calc, Not original, CC BY
Reference
Original article
Kudo S et al. Gastrointest Endosc 1996;44:8-14; Endoscopy 2001;33:367-373
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Decision support only. Follow current guidelines and local protocols. Classification definitions and terminology follow the original publication language.