Clinical significance and validity of the subclassification for colorectal laterally spreading tumor granular type

Shigita, Kenjiro; Oka, Shiro; Tanaka, Shinji; Sumimoto, Kazuo; Hirano, Daiki; Tamaru, Yuzuru; Asayama, Naoki; Hayashi, Nana; Nagata, Shinji; Arihiro, Koji; Chayama, Kazuaki

doi:10.1111/jgh.13238

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…Our study showed LSTs localized mostly in the right colon, similar to those of previous studies in different countries [12][13][14][15][16][17]. LST-G-M was the most common subtype, which contradicted the data from Western countries [3].…”

Section: Discussionsupporting

confidence: 65%

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

Shen

Zhang

Zhao

et al. 2020

Gastroenterology Research and Practice

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Background. The coexistence of colorectal polyps with laterally spreading tumors (LSTs) is commonly observed during colonoscopy. However, there are rare studies that assess the malignant risks for LSTs with colorectal polyps, which might largely contribute to further strategies of treatment and follow-up plans in LSTs. Methods. We conducted a retrospective cohort study that enrolled 206 patients with LSTs in the Endoscopy Center and Endoscopy Research Institute, Renji Hospital, Shanghai Jiao Tong University, China. The subjects with LSTs were divided into two groups: the nonpolyp group with 89 patients and the polyp group with 117 patients. Binary logistic regression was used to identify the independent predictors of outcomes of interest. Results. The risk of the polyps’ coexistence phenomenon increased in males compared with females (OR=2.138, p=0.047), especially in those between 50 and 75 years old (OR=7.074, p=0.036). Tumor size (3–4 cm), LSTs with tubulovillous types, and history of polyps statistically increased the risk of the polyp coexistence phenomenon (OR=5.768, p=0.003; OR=36.345, p=0.024; OR=13.245, p<0.0001, respectively). LST-NG-PD (OR=20.982, p=0.017) and LSTs≥5 cm (OR=37.604, p=0.038) notably increased the malignant risk of LSTs. When the simultaneous polyps are located in the right colon, the risk of malignant LSTs (OR=58.540, p=0.013) positively increased. Conclusion. The simultaneous colorectal polyps in the right colon were the most important risk factor to predict the malignant risk of LSTs.

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Section: Discussionsupporting

confidence: 65%

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

Shen

Zhang

Zhao

et al. 2020

Gastroenterology Research and Practice

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“…40 mm. The rarity of invasive carcinoma in patients with LST-G-H lesions has been reported previously 22,25,26) . In contrast, 76% of the LST-G-M lesions were carcinomas, and an increase in tumor diameter was associated with an increased incidence of pT1 carcinoma.…”

Section: Discussionmentioning

confidence: 65%

Comparison of the histopathological characteristics of large colorectal laterally spreading tumors according to growth pattern

Saito

Kobayashi

Sada

et al. 2019

J Anus Rectum Colon

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Objectives: Colorectal laterally spreading tumors (LSTs) are widely recognized owing to their structural characteristics. This study aims to clarify the histopathological characteristics of large colorectal LSTs according to growth pattern. Methods: We studied 297 colorectal LSTs measuring ≥20 mm in diameter. The LSTs were classified into four types: granular homogenous type (LST-G-H), granular nodular mixed type (LST-G-M), non-granular flat elevated type (LST-NG-F), and non-granular pseudo-depressed type (LST-NG-PD). Retrospectively collected data were examined to compare the histopathological characteristics of LSTs according to the growth pattern. Results: LST-G-M lesions (142 lesions) were most common, followed by LST-NG-F (74 lesions), LST-G-H (61 lesions), and LST-NG-PD (20 lesions). The mean tumor diameter of LST-G lesions (38.5 ± 17.2 mm) was significantly greater than that of LST-NG lesions (26.3 ± 7.0 mm, P < 0.001). In particular, 45% of LST-G-M lesions were ≥40 mm in diameter. Adenomas accounted for 54% of LST-G-H lesions compared with only 10% of LST-NG-PD lesions. Pathological T1 carcinomas accounted for 55% of LST-NG-PD lesions and were not found among LST-G-H lesions. Conclusions: The biological malignancy of colorectal LSTs differs considerably depending on the growth pattern even among large lesions and therefore should be considered when selecting treatment regimens.

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“…The alternative morphological term “laterally spreading tumor” (LST), proposed by Kudo, is now widely accepted in both Asian and Western countries . Although this is not an official term, the two LST subtypes – granular type (LST‐G) and non‐granular type (LST‐NG) – are significantly associated with frequency of submucosal invasion (LST‐NG 14% vs LST‐G 7%; P < 0.01) . However, the macroscopic type of some lesions is difficult to recognize (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…125 Although this is not an official term, the two LST subtypesgranular type (LST-G) and non-granular type (LST-NG)are significantly associated with frequency of submucosal invasion (LST-NG 14% vs LST-G 7%; P < 0.01). [126][127][128] However, the macroscopic type of some lesions is difficult to recognize (Fig. 4).…”

Section: Level Of Evidence: Ii-2 Level Of Recommendation: Amentioning

confidence: 99%

Standards of diagnostic colonoscopy for early‐stage neoplasia: Recommendations by an Asian private group

Sano¹,

Chiu

et al. 2019

Digestive Endoscopy

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Background and AimIn recent years, the incidence of colorectal cancer has been increasing, and it is now becoming the major cause of cancer death in Asian countries. The aim of the present study was to develop Asian expert‐based consensus to standardize the preparation, detection and characterization for the diagnosis of early‐stage colorectal neoplasia.MethodsA professional group was formed by 36 experts of the Asian Novel Bio‐Imaging and Intervention Group (ANBI2G) members. Representatives from 12 Asia–Pacific countries participated in the meeting. The group organized three consensus meetings focusing on diagnostic endoscopy for gastrointestinal neoplasia. The Delphi method was used to develop the consensus statements.ResultsThrough the three consensus meetings with debating, reviewing the literature and regional data, a consensus was reached at third meeting in 2016. The consensus was reached on a total of 10 statements. Summary of statements is as follows: (i) Adequate bowel preparation for high‐quality colonoscopy; (ii) Antispasmodic agents for lesion detection; (iii) Image‐enhanced endoscopy (IEE) for polyp detection; (iv) Adenoma detection rate for quality indicators; (v) Good documentation of colonoscopy findings; (vi) Complication rates; (vii) Cecal intubation rate; (viii) Cap‐assisted colonoscopy (CAC) for polyp detection; (ix) Macroscopic classification using indigocarmine spray for characterization of colorectal lesions; and (x) IEE and/or magnifying endoscopy for prediction of histology.ConclusionThis consensus provides guidance for carrying out endoscopic diagnosis and characterization for early‐stage colorectal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early‐stage colorectal neoplasia.

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Clinical significance and validity of the subclassification for colorectal laterally spreading tumor granular type

Abstract: This subclassification of LST-G according to the diameters of granules and nodules was both useful for choosing therapeutic strategies in the clinical setting and universally applicable.

Cited by 8 publications

References 27 publications

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

Comparison of the histopathological characteristics of large colorectal laterally spreading tumors according to growth pattern

Standards of diagnostic colonoscopy for early‐stage neoplasia: Recommendations by an Asian private group

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