Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia

Cancers

Anna Arnau¹  Jesús M. González-Santiago²  Pablo Vega³  Luisa de Castro⁴  Eva Martínez-Bauer⁵  Ángel Ferrández⁶  Óscar Nogales⁷  Aurora Burgos⁸  Beatriz Peñas⁹  Pilar Diez-Redondo^1,10  Antonio Z. Gimeno-García^1,11  Francisco Javier García-Alonso^1,12  Daniel Rodríguez-Alcalde^1,13  Jorge López-Vicente^1,13  Marco Bustamante-Balén^1,14  Marco A. Álvarez-González^1,15  Miquel Serra-Burriel^1,16  María López-Cerón^1,17  Maria Pellisé^1,17  Liseth Rivero-Sánchez^1,17  Marta Hernández-Conde^1,18  Alberto Herreros-de-Tejada^1,18  Ignasi Puig^1,19  João Pedro da Costa-Seixas^1,19  Òria Rosiñol^2,20  Miriam Cuatrecasas^2,21 

[1] Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain;Digestive Diseases Department, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), 37007 Salamanca, Spain;Digestive Diseases Department, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;Digestive Diseases Department, Complexo Hospitalario Universitario de Vigo, 36213 Vigo, Spain;Digestive Diseases Department, Corporació Sanitària Parc Taulí, 08208 Barcelona, Spain;Digestive Diseases Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;Digestive Diseases Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;Digestive Diseases Department, Hospital Universitario La Paz, 28046 Madrid, Spain;Digestive Diseases Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;Digestive Diseases Department, Hospital Universitario Río Hortega, 47012 Valladolid, Spain;Digestive Diseases Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain;Digestive Diseases Department, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain;Digestive Diseases Department, Hospital Universitario de Móstoles, 28935 Madrid, Spain;Digestive Diseases Department, Hospital Universitario y Politécnico de La Fe, 46026 Valencia, Spain;Digestive Diseases Department, Hospital del Mar, 08003 Barcelona, Spain;Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland;Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, 08036 Barcelona, Spain;Gastroenterology Department, Research Institute Segovia Arana, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain;Gastrointestinal Oncology and Endoscopy Research Group, Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain;Pathology Department, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain;Pathology Department, Hospital Clínic, 08036 Barcelona, Spain;

关键词: early colorectal cancer;    NBI;    optical diagnosis;    Paris classification;    NICE classification;    ESD;   

DOI  :  10.3390/cancers13215302

来源: DOAJ

【 摘 要 】

Background: The major limitation of piecemeal endoscopic mucosal resection (EMR) is the inaccurate histological assessment of the resected specimen, especially in cases of submucosal invasion. Objective: To classify non-pedunculated lesions ≥20 mm based on endoscopic morphological features, in order to identify those that present intramucosal neoplasia (includes low-grade neoplasia and high-grade neoplasia) and are suitable for piecemeal EMR. Design: A post-hoc analysis from an observational prospective multicentre study conducted by 58 endoscopists at 17 academic and community hospitals was performed. Unbiased conditional inference trees (CTREE) were fitted to analyse the association between intramucosal neoplasia and the lesions’ endoscopic characteristics. Result: 542 lesions from 517 patients were included in the analysis. Intramucosal neoplasia was present in 484 of 542 (89.3%) lesions. A conditional inference tree including all lesions’ characteristics assessed with white light imaging and narrow-band imaging (NBI) found that ulceration, pseudodepressed type and sessile morphology changed the accuracy for predicting intramucosal neoplasia. In ulcerated lesions, the probability of intramucosal neoplasia was 25% (95%CI: 8.3–52.6%; p < 0.001). In non-ulcerated lesions, its probability in lateral spreading lesions (LST) non-granular (NG) pseudodepressed-type lesions rose to 64.0% (95%CI: 42.6–81.3%; p < 0.001). Sessile morphology also raised the probability of intramucosal neoplasia to 86.3% (95%CI: 80.2–90.7%; p < 0.001). In the remaining 319 (58.9%) non-ulcerated lesions that were of the LST-granular (G) homogeneous type, LST-G nodular-mixed type, and LST-NG flat elevated morphology, the probability of intramucosal neoplasia was 96.2% (95%CI: 93.5–97.8%; p < 0.001). Conclusion: Non-ulcerated LST-G type and LST-NG flat elevated lesions are the most common non-pedunculated lesions ≥20 mm and are associated with a high probability of intramucosal neoplasia. This means that they are good candidates for piecemeal EMR. In the remaining lesions, further diagnostic techniques like magnification or diagnostic +/− therapeutic endoscopic submucosal dissection should be considered.

【 授权许可】

Unknown