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Russian Journal of Gastroenterology, Hepatology, Coloproctology

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Endoscopic Biopsy in Differential Diagnosis of Colorectal Serrated Lesions

https://doi.org/10.22416/1382-4376-2020-30-3-42-48

Abstract

Background. Preoperative biopsy is recommended for morphological verification of colorectal epithelial neoplasms prior to their endoscopic resection. However, histological reports for endoscopic biopsy and resected lesions are not reliably consistent.

Aim. Assessment of sensitivity, specificity and accuracy of endoscopic biopsy in differential diagnosis of colorectal serrated adenomas and risk factors for variance between biopsy results and morphological examination of completely resected lesions.

Materials and methods. The assay used data on 56 morphologically verified serrated adenomas diagnosed and resected in 50 patients (14 men, 36 women; average age 66.9 ± 10.5 years). Biopsy was taken from all tumours before endoscopic resection. Results of morphological examination of biopsy samples and resected tumours were analysed and compared. Sensitivity, specificity and accuracy of biopsy was assessed, with the tumour size and type and biopsy forceps system taken as criteria.

Results. The identified cases included 22 (39.3%) right-colon, 21 (37.5%) left-colon and 13 (23.2%) rectal lesions of 28.5 ± 2.6 mm average size. Polypoid were 17 (30.3%), non-polypoid — 6 (10.7%) and spreading — 33 (59%) of the tumours. Full consistency of morphological examination was observed for 12 cases (21.4%). In 9 cases (16%), dysplasia was established as mild-graded with biopsy, whilst the eradicated tumours contained severe dysplastic foci. Foci of adenocarcinoma were detected in 10 tumours (including 2 with submucosal invasion), but only 2 cases were correctly diagnosed for malignant adenoma with biopsy. Tumour morphology was misidentified in 32 cases (57.1%).

Conclusions. Preoperative forceps biopsy is shown to possess low sensitivity in differential diagnosis of serrated colorectal lesions and very low sensitivity to predict malignant serrated adenomas.

About the Authors

K. D. Khalin
Clinical Hospital “RZhD-Medicine”; Pacific State Medical University
Russian Federation

Konstantin D. Khalin — Clinical Doctor (endoscopy), Department of Endoscopy; Postgraduate Student, Institute of Surgery.

690002, Vladivostok, Ostryakova avenue, 2.



M. Yu. Agapov
St. Petersburg City Clinical Oncology Dispensary
Russian Federation

Mikhail Yu. Agapov — Dr. Sci. (Med.), Cninical Doctor (endoscopy), Department of Endoscopy.

198255, St. Petersburg, Veteranov avenue, 56.



L. V. Zvereva
Clinical Hospital “RZhD-Medicine”
Russian Federation

Lyudmila V. Zvereva — Pathologist, Head of the Department of Pathology.

690003, Vladivostok, Verkhneportovaya str., 25.



K. V. Stegniy
Pacific State Medical University; Far Eastern Federal University
Russian Federation

Kirill V. Stegniy — Dr. Sci. (Med.), Prof., Corresponding Member of the Russian Academy of Sciences, Director, Institute of Surgery, Pacific State Medical University; Director, Surgery Centre, Far Eastern Federal University.

690002, Vladivostok, Ostryakova avenue, 2.



References

1. Kaprin A.D., Starinsky V.V., Petrova G.V. Malignant neoplasms in Russia in 2017 (incidence and mortality). Moscow: P.A. Herzen Moscow Oncology Research Center — branch of FSBI NMRRC of the Ministry of Health of Russia, 2018:250 (In Russ.)

2. Rapovka V.G., Gavrina S.E., Ponomarev A.F., Rogatkina E.S., Denisenko L.S., Shkuratov O.K. et al. Methods for improving planned surgical treatment of colorectal cancer in elder patients. Pacific Medical Journal.2012;4:39–42 (In Russ.)

3. Singh R., Zorrón Cheng Tao Pu L., Koay D., Burt A. Sessile serrated adenoma/polyps: Where are we at in 2016? World J Gastroenterol. 2016;25(3):279–83. DOI: 10.3748/wjg.v22.i34.7754

4. Bateman A.C. Pathology of serrated colorectal lesions. J Clin Pathol. 2014;67(10):865–74. DOI: 10.1136/jclin-path-2014-202175

5. Erichsen R., Baron J.A., Hamilton-Dutoit S.J., Snover D.C., Torlakovic E.E., Pedersen L., et al. Increased risk of colorectal cancer development among patients with serrated polyps. Gastroenterology. 2016;150(4):895–902.e5. DOI: 10.1053/j.gastro.2015.11.046

6. Veselov V.V., Maynovskaya O.A., Merkulov E.S., Veselov V.V. Serrated colonic adenomas: diagnosis and treatment. Evidential Gastroenterology. 2016;4:3–14 (In Russ.)

7. Nechipay A.M., Zobnina M.V., Cherkasova L.M., Perfilyev I.B., Krivopuskov V.A. Morphological and endoscopic diagnostic criteria of serrated adenomas of the colon. Rus J Gastroenterol Hepatol Coloproctol. 2016;26(1):107–15 (In Russ.) DOI: 10.22416/1382-4376-2016-26-1-107-115

8. Kondratenko P.G., Stukalo A.A., Radenko E.E. Gastrointestinal endoscopy. Practical guidelines. Donetsk State Medical University, Donetsk, 2007:374 (In Russ.)

9. Samedov B.H., Kuzmin-Krutetsky M.I., Grinevich V.B., Kochetkov A.V., Filin A.V., Shevyakov M.A. Endoscopic diagnosis and treatment of gastrointestinal diseases. Methodological recommendations. St. Petersburg: IPSEN. Health Committee of the Government of St. Petersburg. Military Medical Academy. 2006:178 (In Russ.)

10. Fukunaga S., Nagami Y., Shiba M., Sakai T, Maruyama H, Ominami M, et al. Impact of preoperative biopsy sampling on severe submucosal fibrosis on endoscopic submucosal dissection for colorectal laterally spreading tumors: a propensity score analysis. Gastrointest Endosc. 2019;89(3):470–8. DOI: 10.1016/j.gie.2018.08.051

11. Kim E.K., Han D.S., Ro Y., Eun C.S., Yoo K.S., Oh Y.H. The submucosal fibrosis: what does it mean for colorectal endoscopic submucosal dissection? Intest Res. 2016;14(4):358–64. DOI: 10.5217/ir.2016.14.4.358

12. Axon A., Diebold M., Fujino M., Fujita R., Genta R., Gonvers J-J., et al. Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005;37:570–8. DOI: 10.1055/s-2005-861352

13. Bosman F.T., Carneiro F., Hruban R.H., Theise N.D. (Ed.) WHO Classification of Tumours of the Digestive System (WHO Classification of Tumours) 4th Edition. The International Agency for Research on Cancer. Lyon, 2010:417.

14. Obuch J.C., Pigott C.M., Ahnen D.J. Sessile Serrated Polyps: Detection, Eradication, and Prevention of the Evil Twin. Curr Treat Options Gastroenterol. 2015;13(1):156–70. DOI: 10.1007/s11938-015-0046-y

15. Rex K.D., Ahnen D.J., Baron J.A., Batts K.P., Burke C.A., Burt R.W., et al. Serrated Lesions of the Colorectum: Review and Recommendations From an Expert Panel. Am J Gastroenterol. 2012;107(9):1315–29; quiz 1314, 1330. DOI: 10.1038/ajg.2012.161

16. Bordaçahar B., Barret M., Terris B., Dhooge M., Dreanic J., Prat F., et al. Sessile serrated adenoma: From identification to resection. Dig Liver Dis. 2015;47(2):95–102. DOI: 10.1016/j.dld.2014.09.006

17. Murakami T., Sakamoto N., Nagahara A. Endoscopic diagnosis of sessile serrated adenoma/polyp with and without dysplasia/carcinoma. World J Gastroenterol. 2018;24(29):3250–9. DOI: 10.3748/wjg.v24.i29.3250

18. Elmunzer B.J., Higgins P.D., Kwon Y.M., Golembeski C., Greenson J.K., Korsnes S.J., Elta G.H. Jumbo forceps are superior to standard large-capacity forceps in obtaining diagnostically adequate inflammatory bowel disease surveillance biopsy specimens. Gastrointest Endosc. 2008;68(2):273–8. DOI: 10.1016/j.gie.2007.11.023

19. Komanduri S., Swanson G., Keefer L., Jakate S. Use of a new jumbo forceps improves tissue acquisition of Barrett’s esophagus surveillance biopsies. Gastrointest Endosc. 2009;70(6):1072–8.e1. DOI: 10.1016/j.gie.2009.04.009

20. Ferlitsch M., Moss A., Hassan C., Bhandari P., Dumonceau J.M., Paspatis G., et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2017;49(3):270–97. DOI: 10.1055/s-0043-102569

21. Pimentel-Nunes P., Dinis-Ribeiro M., Ponchon T., Repici A., Vieth M., De Ceglie A., et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(9):829–54. DOI: 10.1055/s-0034-1392882

22. Tanaka S., Kashida H., Saito Y., Yahagi N., Yamano H., Saito S., et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27(4):417–34. DOI: 10.1111/den.12456

23. Tatomirovic Z., Skuletić V., Tufegdzic I., Tomic L., Dzambas J., Tarabar D. The value of brush cytology and biopsy for the diagnosis of colorectal cancer. Vojnosanitetski pregled. Military-medical and pharmaceutical review. 2016;74(00):115. DOI: 10.2298/VSP160112115T

24. Bonnington S.N., Rutter M.D. Surveillance of colonic polyps: Are we getting it right? World J Gastroenterol. 2016;22(6):1925–34. DOI: 10.3748/wjg.v22.i6.1925

25. Calderwood A.H., Lasser K.E., Roy H.K. Colon adenoma features and their impact on risk of future advanced adenomas and colorectal cancer. World J Gastrointest Oncol. 2016;8(12):826–34. DOI: 10.4251/wjgo.v8.i12.826

26. Toll A.D., Fabius D., Hyslop T., Pequignot E., DiMarino A.J., Infantolino A., Palazzo J.P. Prognostic significance of high-grade dysplasia in colorectal adenomas. Colorectal Dis. 2011;13(4):370–3. DOI: 10.1111/j.1463-1318.2010.02385.x

27. Rubio C.A., Delinassios J.G. Invasive carcinomas may arise in colorectal adenomas with high-grade dysplasia and with carcinoma in situ. Int J Clin Exp Med. 2010;3(1):41–7.


Review

For citations:


Khalin K.D., Agapov M.Yu., Zvereva L.V., Stegniy K.V. Endoscopic Biopsy in Differential Diagnosis of Colorectal Serrated Lesions. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(3):42-48. (In Russ.) https://doi.org/10.22416/1382-4376-2020-30-3-42-48

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