Characteristics and diagnostic value of preoperative biopsy in colorectal laterally spreading tumors

Kim SI, Paratovskaya AA, Belinskaya NA, et al. . Characteristics and diagnostic value of preoperative biopsy in colorectal laterally spreading tumors. Russian Journal of Evidence-Based Gastroenterology. 2024;13(4):16‑24. (In Russ.)
https://doi.org/10.17116/dokgastro20241304116

Подписка 2025-2 (Russian Journal of Evidence-Based Gastroenterology)

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OBJECTIVE

To characterize laterally spreading tumors (LST) of the rectum and colon measuring ≥20 mm and to evaluate the effectiveness of endoscopic biopsy in preoperative diagnosis of dysplasia grade and the presence of adenocarcinoma.

MATERIAL AND METHODS

A retrospective analysis was conducted on LSTs measuring ≥20 mm, removed en bloc using endoscopic submucosal dissection from 2021 to 2023. Dysplasia grade (low-grade dysplasia — LGD, high-grade dysplasia — HGD) and/or the presence and size of adenocarcinoma were assessed based on preoperative biopsy (the “preliminary” group) and final morphological examination (the “final” group).

RESULTS

The study included 153 LSTs with an average lesion size of 49.01±1.93 mm. Locations were as follows: rectum — 46.4%, left colon — 18.9%, right colon — 34.7%. According to the Paris classification: LST-G-H — 10.5%, LST-G-NM — 69.9%, LST-NG-FE — 5.9%, LST-NG-PD — 13.7%. Adenocarcinoma foci were identified in 22.2% of cases, more frequently in the non-granular LST group (p=0.0057). Risk factors for malignancy in LSTs included non-granular type, rectal localization, and lesion size ≥31 mm for the granular type. In 97% of cases, there was a single adenocarcinoma focus with an average size of 10.8±1.02 mm, with a tendency to be larger in the non-granular type group. Histological concordance did not depend on the average tumor size, macroscopic type, or localization. The sensitivity and specificity of preoperative biopsy in diagnosing high-grade dysplasia and adenocarcinoma were 17.5% and 8.8%, and 84.0% and 100%, respectively.

CONCLUSION

The main risk factors for the presence of adenocarcinoma are non-granular LST type, rectal localization, and LST size ≥31 mm for the granular type. Preoperative biopsy from large LSTs has low sensitivity and positive predictive value for detecting early cancer and high-grade dysplasia and should not be the basis for determining the method of endoscopic resection.

Keywords:

laterally spreading tumors

colorectal cancer

endoscopic dissection

preoperative biopsy

colonic polyps

Authors:

Kim S.I.

City Clinical Oncology Hospital

ORCID: 0000-0002-4574-5845

Paratovskaya A.A.

City Clinical Oncology Hospital

ORCID: 0000-0003-0692-4696

Belinskaya N.A.

City Clinical Oncology Hospital

ORCID: 0009-0006-3049-2466

Alyoshina N.V.

City Clinical Oncology Hospital

ORCID: 0000-0003-4595-7781

Savostyanov T.F.

City Clinical Oncology Hospital

ORCID: 0000-0001-8202-3385

Ogurchyenok N.E.

City Clinical Oncology Hospital

ORCID: 0000-0002-9299-8706

Topuzov E.E.

City Clinical Oncology Hospital

ORCID: 0000-0002-1700-1128

Agapov M.Yu.

City Clinical Oncology Hospital

ORCID: 0000-0002-6322-6782

Received:

13.03.2024

Accepted:

19.09.2024

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