Diagnostic accuracy of endoscopic optical evaluation and forceps biopsy in comparison with pathohistological findings of colorectal laterally spreading tumors
DOI:
https://doi.org/10.14739/2310-1237.2024.2.302882Keywords:
colonoscopy, optical biopsy, laterally spreading tumor, target biopsy, colorectal neoplasmsAbstract
Following the principles of image-enhanced endoscopy and using standardized endoscopic classifications, it is possible to predict the morphological diagnosis of colorectal neoplasms with high accuracy. The large size and uneven surface of lesion significantly complicates a thorough examination, and routine biopsy is still widely practiced, despite its drawbacks. This makes it necessary to compare the results of optical and forceps biopsy and determine the expediency of performing the latter for different types of colorectal laterally spreading tumors (LST).
Aim. To compare the pit and vascular pattern, determined endoscopically, with histopathological findings in LST, with the calculation of the diagnostic accuracy of optical evaluation and forceps biopsy. To ascertain the relationship between lesion size, morphological type, and the presence of malignant changes.
Materials and methods. 80 LST ≥20 mm were included in the study. Expert image-enhanced endoscopy with NBI and utilizing Paris, Kudo, JNET and Hiroshima classifications was employed for optical evaluation and stratification of lesions. Target forceps biopsy was obtained from areas showing the most progressive changes. The data from optical biopsy and the pathohistology of forceps biopsy specimens were compared with the results of the pathohistological findings of removed LST. Statistics were calculated in the Statistica 13.
Results. Group 1 comprised 30 patients with non-granular type LST, while group 2 consisted of 50 patients with granular type LST. The median diameter was 20 mm (IQR, 20; 25) and 40 mm (IQR, 25; 50), adenocarcinoma loci were found in 10 % and 32 % in the first and second groups, respectively. Correlations between lesion localization and LST subtype were assessed, as well as between the presence of malignant changes and the size and morphological type of the lesions. Comparative indicators of sensitivity (80.0 % / 81.8 % in the first and 76.7 % / 80.0 % in the second group), diagnostic accuracy (93.3 % for both methods in the first and 84.0 % / 86.0 % in the second group), and also predictive values were revealed for optical evaluation / forceps biopsy, respectively. The specificity was identical and amounted to 100 % in the first and 95 % in the second group. In all cases, p < 0.01.
Conclusions. Mixed type LST-G lesions occur more often in the rectum, whereas flat elevated LST-NG lesions – in the transverse colon. The presence of adenocarcinoma correlates with the morphological type of tubulovillous adenoma and the larger size of the tumor; larger LSTs are more frequently tubulovillous adenomas. Optical and forceps biopsies demonstrate higher accuracy for non-granular types of LST compared to granular types. Forceps biopsy does not confer any advantages over optical biopsy and is not recommended for routine use.
References
Lambert R, Tanaka S. Laterally spreading tumors in the colon and rectum. Eur J Gastroenterol Hepatol. 2012;24(10):1123-34. doi: https://doi.org/https://doi.org/10.1097/MEG.0b013e328355e2d9
Khalaf K, Fujiyoshi MR, Spadaccini M, Rizkala T, Ramai D, Colombo M, et al. From Staining Techniques to Artificial Intelligence: A Review of Colorectal Polyps Characterization. Medicina (Kaunas). 2024;60(1):89. doi: https://doi.org/https://doi.org/10.3390/medicina60010089
Barua I, Mori Y, Bretthauer M. Colorectal polyp characterization with endocytoscopy: Ready for widespread implementation with artificial intelligence? Best Pract Res Clin Gastroenterol. 2021;52-53:101721. doi: https://doi.org/https://doi.org/10.1016/j.bpg.2020.101721
Takamaru H, Wu SY, Saito Y. Endocytoscopy: technology and clinical application in the lower GI tract. Transl Gastroenterol Hepatol. 2020;5:40. doi: https://doi.org/https://doi.org/10.21037/tgh.2019.12.04
Rath T, Morgenstern N, Vitali F, Atreya R, Neurath MF. Advanced Endoscopic Imaging in Colonic Neoplasia. Visc Med. 2020;36(1):48-59. doi: https://doi.org/https://doi.org/10.1159/000505411
Shahsavari D, Waqar M, Thoguluva Chandrasekar V. Image enhanced colonoscopy: updates and prospects-a review. Transl Gastroenterol Hepatol. 2023;8:26. doi: https://doi.org/https://doi.org/10.21037/tgh-23-17
Sano Y, Chiu HM, Li XB, Khomvilai S, Pisespongsa P, Co JT, et al. Standards of diagnostic colonoscopy for early-stage neoplasia: Recommendations by an Asian private group. Dig Endosc. 2019;31(3):227-44. doi: https://doi.org/https://doi.org/10.1111/den.13330
Bisschops R, East JE, Hassan C, Hazewinkel Y, Kamiński MF, Neumann H, et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy. 2019;51(12):1155-79. doi: https://doi.org/https://doi.org/10.1055/a-1031-7657
Kaltenbach T, Anderson JC, Burke CA, Dominitz JA, Gupta S, Lieberman D, et al. Endoscopic Removal of Colorectal Lesions-Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc. 2020;91(3):486-519. doi: https://doi.org/https://doi.org/10.1016/j.gie.2020.01.029
Pouw RE, Bisschops R, Gecse KB, de Hertogh G, Iacucci M, Rutter M, et al. Endoscopic tissue sampling - Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021;53(12):1261-73. doi: https://doi.org/https://doi.org/10.1055/a-1671-6336
Pimentel-Nunes P, Dinis-Ribeiro M. Endoscopic Submucosal Dissection in the Treatment of Gastrointestinal Superficial Lesions: Follow the Guidelines! GE Port J Gastroenterol. 2015;22(5):184-6. doi: https://doi.org/https://doi.org/10.1016/j.jpge.2015.08.002
Vosko S, Shahidi N, Sidhu M, van Hattem WA, Bar-Yishay I, Schoeman S, et al. Optical Evaluation for Predicting Cancer in Large Nonpedunculated Colorectal Polyps Is Accurate for Flat Lesions. Clin Gastroenterol Hepatol. 2021;19(11):2425-34.e4. doi: https://doi.org/https://doi.org/10.1016/j.cgh.2021.05.017
Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2020;32(2):219-39. doi: https://doi.org/https://doi.org/10.1111/den.13545
Kudo Se, Lambert R, Allen JI, Fujii H, Fujii T, Kashida H, et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008;68(4 Suppl):S3-47. doi: https://doi.org/https://doi.org/10.1016/j.gie.2008.07.052
The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(6 Suppl):S3-43. doi: https://doi.org/https://doi.org/10.1016/s0016-5107(03)02159-x
Kudo S, Hirota S, Nakajima T, Hosobe S, Kusaka H, Kobayashi T, et al. Colorectal tumours and pit pattern. J Clin Pathol. 1994;47(10):880-5. doi: https://doi.org/https://doi.org/10.1136/jcp.47.10.880
Sano Y, Tanaka S, Kudo SE, Saito S, Matsuda T, Wada Y, et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc. 2016;28(5):526-33. doi: https://doi.org/https://doi.org/10.1111/den.12644
Kanao H, Tanaka S, Oka S, Hirata M, Yoshida S, Chayama K. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc. 2009;69(3 Pt 2):631-6. doi: https://doi.org/https://doi.org/10.1016/j.gie.2008.08.028
Shahidi N, Vosko S, van Hattem WA, Sidhu M, Bourke MJ. Optical evaluation: the crux for effective management of colorectal neoplasia. Therap Adv Gastroenterol. 2020;13:1756284820922746. doi: https://doi.org/https://doi.org/10.1177/1756284820922746
Rai S, Singh MP, Srivastava S. Integrated Analysis Identifies Novel Fusion Transcripts in Laterally Spreading Tumors Suggestive of Distinct Etiology Than Colorectal Cancers. J Gastrointest Cancer. 2023;54(3):913-26. doi: https://doi.org/https://doi.org/10.1007/s12029-022-00881-5
Lee BI, Matsuda T. Estimation of Invasion Depth: The First Key to Successful Colorectal ESD. Clin Endosc. 2019;52(2):100-6. doi: https://doi.org/https://doi.org/10.5946/ce.2019.012
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