Type 1
Lacy or no vessels; dark or white spots
Color
Same or lighter than background
Vessels
None, or isolated lacy vessels coursing across the lesion
Surface
Dark or white spots of uniform size, or homogeneous absence of pattern
*
Can be applied using colonoscopes with or without optical (zoom) magnification.
Note: SSA/P is not included in this classification (a limitation of the original paper).
Type 2
Brown vessels around white structures
Color
Browner relative to background (verify color arises from vessels)
Vessels
Brown vessels surrounding white structures
Surface
Oval, tubular or branched white structure surrounded by brown vessels
**
These structures (regular or irregular) may represent the pits and the epithelium of the crypt opening.
***
Type 2 consists of Vienna classification types 3, 4 and superficial 5 (all adenomas with either low or high grade dysplasia, or with superficial submucosal carcinoma). The presence of high grade dysplasia or superficial submucosal carcinoma may be suggested by an irregular vessel or surface pattern, and is often associated with atypical morphology (e.g., depressed area).
Type 3
Disrupted vessels; amorphous surface
Color
Brown to dark brown relative to background; sometimes patchy whiter areas
Vessels
Has area(s) of disrupted or missing vessels
Surface
Amorphous or absent surface pattern
Pathology
Deep submucosal invasive cancer
Note: Deep SM invasion is ≥1000 μm. Consider additional surgery.