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Predictors for underestimated pathology in forceps biopsy compared with resection specimen of colorectal neoplasia; focus on surface appearance

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Author(s)
Yu Jin HahEun Soo KimYoo Jin LeeKyung Sik ParkKwang Bum ChoByoung Kuk JangWoo Jin ChungJae Seok HwangIlseon Hwang
Keimyung Author(s)
Kim, Eun SooLee, Yoo JinPark, Kyung SikCho, Kwang BumJang, Byoung KukChung, Woo JinHwang, Jae SeokHwang, Il Seon
Department
Dept. of Internal Medicine (내과학)
Dept. of Pathology (병리학)
Journal Title
Surgical Endoscopy
Issued Date
2013
Volume
27
Issue
9
Keyword
Colorectal neoplasmDiscrepancyEndoscopic resectionForceps biopsy
Abstract
Background There have been substantial differences in
pathologic results between forceps biopsies (FB) and
resection specimen (RS) of the colorectal neoplasm. The
aim of this study was to investigate predictive factors of the
underestimated pathology in FB compared with RS.
Methods Data from 248 consecutive patients with colorectal
intraepithelial neoplasm C10 mm, which was removed by
endoscopic mucosal resection or endoscopic submucosal
dissection, were reviewed retrospectively. We excluded
patients with no FB on the neoplasm before the resection.
Demographic data and tumor characteristics including size,
locations, surface appearances, and the number of FB fragments
were evaluated as potential factors associated with the
discrepancies by logistic regression analysis.
Results Overall, 179 lesions from 171 patients were
included in the study (size, 28.37 ± 12.00 mm; range
10–80 mm). The overall number of discrepancy cases was
103 (57.5 %), where 90 (50.3 %) were underestimated in
FB and 13 (7.2 %) downgraded in their RS. In the multivariate
analysis, round [odds ratio (OR) 4.46, 95 % confidence
interval (CI) 1.76–11.30, p = 0.002], depressed (OR
3.23, 95 % CI 1.11–9.39, p = 0.031), and mixed type of
surface appearance (OR 5.47, 95 % CI 2.38–12.60,
p\0.001), and tumor size C30 mm (OR 2.14, 95 % CI
1.12–4.10, p = 0.021) were significant predictive factors
for underestimated pathology in FB.
Conclusions Underestimation in FB is remarkable in
colorectal tumors C10 mm in size. This discrepancy is
associated with the tumor characteristics, such as surface
appearance and size. Endoscopic characteristics of tumor
should be carefully examined for an adequate management
strategy of colorectal epithelial neoplasm.
Keywords Colorectal neoplasm Discrepancy
Endoscopic resection Forceps biopsy Colorectal neoplastic lesions are called superficial when
their depth is limited to the mucosa and submucosa [1].
Thus, superficial colorectal neoplasia includes intraepithelial
neoplasia (adenomas, dysplasia, and premalignancy) in
the mucosa and invasive lesions categorized as intramucosal
or submucosal cancers. These lesions can be treated
by endoscopic management such as endoscopic mucosal
resection (EMR) or endoscopic submucosal dissection
(ESD). Although ESD is technically demanding, it results
in a high en bloc complete resection rate and is often the
preferred option for suspicious cancer lesions, which
requires precise histological evaluation [2, 3]. In the case of
superficial cancers with deep submucosal invasion (sm2 or
sm3), surgical treatment should be considered because of
the risk of lymph node metastasis [4]. In addition, it is not
necessary to remove nonneoplastic lesions, such as
hyperplastic or inflammatory polyps. Therefore, it is crucial
to determine histological features or the invasion depth
of tumors for selecting an optimal management strategy. Cold biopsy by forceps before resection still appears to
be used in real clinical practice, particularly for large
tumors, for which a one-stage polypectomy might not be
available. There has been increasing evidence of substantial
difference in the pathologic results between forceps
biopsies (FB) and resection specimen (RS) of gastric epithelial
tumors [5–8]. However, few studies have evaluated
and compared the concordance rate between FB and RS of
large colorectal tumors. Therefore, the aim of this study
was to estimate the discrepant pathologic diagnosis
between FB and RS of colorectal epithelial tumors that are
C10 mm in size and to investigate predictive factors of
these discrepancies with a focus on the surface appearance
of the tumors. In addition, we also evaluated the endoscopic
characteristics of colorectal cancers associated with
submucosal invasiveness.
Keimyung Author(s)(Kor)
김은수
이유진
박경식
조광범
장병국
정우진
황재석
황일선
Publisher
School of Medicine
Citation
Yu Jin Hah et al. (2013). Predictors for underestimated pathology in forceps biopsy compared with resection specimen of colorectal neoplasia; focus on surface appearance. Surgical Endoscopy, 27(9), 3173–3181. doi: 10.1007/s00464-013-2873-z
Type
Article
ISSN
0930-2794
Source
https://link.springer.com/article/10.1007%2Fs00464-013-2873-z
DOI
10.1007/s00464-013-2873-z
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/34434
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
1. School of Medicine (의과대학) > Dept. of Pathology (병리학)
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