Diagnostic yield and repeat biopsies in rectal and nonrectal colorectal adenocarcinoma: Are we hedging on rectal biopsies?

Kmeid, Michel; Brar, Rupinder; Sullivan, Luz; Arslan, Mustafa Erdem; Shrestha, Neharika; Lee, Edward C.; Chen, Anne; Jennings, Timothy A.; Lee, Hwajeong

doi:10.1016/j.acpath.2022.100063

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…those > 2 cm) as benign or malignant. Endoscopic biopsies are largely limited to the exposed surface area, and suffer sampling error in approximately 20% of cases, if not more [6,7,9,10] as cancerous transformation often occurs alongside and within areas of preceding benign adenoma. Tissue biopsies are also unreliable for ruling out the presence of residual malignant cells following neoadjuvant therapy [11,12].…”

Section: Current State Of the Art Re Surgery For Significant Rectal P...mentioning

confidence: 99%

“…This is particularly evident for early-stage cancers and large pre-cancerous polyps. Clinician assessment, radiological staging, and endoscopic biopsy are limited for staging such lesions, with significant risk of over staging or false negative results [4][5][6][7]. Clinicians make treatment decisions, such as whether to perform endoscopic local excision including via Transanal Minimally Invasive Surgery (TAMIS), or radical resection based on these imperfect assessments.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Boland,

Hardy,

Moynihan

et al. 2024

Eur J Nucl Med Mol Imaging

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Colorectal cancer remains a major cause of cancer death and morbidity worldwide. Surgery is a major treatment modality for primary and, increasingly, secondary curative therapy. However, with more patients being diagnosed with early stage and premalignant disease manifesting as large polyps, greater accuracy in diagnostic and therapeutic precision is needed right from the time of first endoscopic encounter. Rapid advancements in the field of artificial intelligence (AI), coupled with widespread availability of near infrared imaging (currently based around indocyanine green (ICG)) can enable colonoscopic tissue classification and prognostic stratification for significant polyps, in a similar manner to contemporary dynamic radiological perfusion imaging but with the advantage of being able to do so directly within interventional procedural time frames. It can provide an explainable method for immediate digital biopsies that could guide or even replace traditional forceps biopsies and provide guidance re margins (both areas where current practice is only approximately 80% accurate prior to definitive excision). Here, we discuss the concept and practice of AI enhanced ICG perfusion analysis for rectal cancer surgery while highlighting recent and essential near-future advancements. These include breakthrough developments in computer vision and time series analysis that allow for real-time quantification and classification of fluorescent perfusion signals of rectal cancer tissue intraoperatively that accurately distinguish between normal, benign, and malignant tissues in situ endoscopically, which are now undergoing international prospective validation (the Horizon Europe CLASSICA study). Next stage advancements may include detailed digital characterisation of small rectal malignancy based on intraoperative assessment of specific intratumoral fluorescent signal pattern. This could include T staging and intratumoral molecular process profiling (e.g. regarding angiogenesis, differentiation, inflammatory component, and tumour to stroma ratio) with the potential to accurately predict the microscopic local response to nonsurgical treatment enabling personalised therapy via decision support tools. Such advancements are also applicable to the next generation fluorophores and imaging agents currently emerging from clinical trials. In addition, by providing an understandable, applicable method for detailed tissue characterisation visually, such technology paves the way for acceptance of other AI methodology during surgery including, potentially, deep learning methods based on whole screen/video detailing.

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Section: Current State Of the Art Re Surgery For Significant Rectal P...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Boland,

Hardy,

Moynihan

et al. 2024

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

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Unravelling interobserver variability in gastrointestinal glandular neoplasia: a contemporary study of US and Korean pathologists

Pacheco,

Kim,

Choi

et al. 2023

J Clin Pathol

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AimsInterobserver variability in the assessment of gastric neoplasia biopsies between most Western and Eastern (predominantly represented by Japanese in the literature) pathologists has been documented. It is unknown if such variability exists between the US and Korean pathologists in the current era.MethodsTen gastrointestinal (GI) pathologists from the USA (n=5) and South Korea (n=5) evaluated 100 scanned images of gastric (n=50) and colorectal (n=50) neoplasia biopsies and answered multiple questionnaires. Consensus was defined as the answer chosen by the majority. Cohen’s (κc) and Fleiss’ kappa (κf) values were calculated between the consensus of the two groups and among the raters, respectively.ResultsBoth groups reached a consensus in the majority of cases (74%–100%) with slight to perfect intergroup (κc=0.049–1.000) and no to substantial intragroup (κf=−0.083 to 0.660) agreements. For gastric neoplasia, Korean pathologists relied heavily on cytoarchitectural atypia, whereas the US pathologists focused on stromal invasion when diagnosing adenocarcinoma. For colorectal neoplasia, the Korean pathologists identified concurrent intramucosal carcinoma when diagnosing invasive adenocarcinoma, while the presence of desmoplasia was a prerequisite for the diagnosis of invasive adenocarcinoma for the US pathologists.ConclusionsFor GI neoplasia biopsy interpretation, the diagnostic approach of Korean pathologists is similar to that of Eastern/Japanese pathologists. Consensus outperformed kappa statistics in capturing the magnitude of inter-rater and intergroup reliability, highlighting the potential benefit of consensus meetings to decrease the gap between Western and Eastern diagnostic approaches.

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Diagnostic yield and repeat biopsies in rectal and nonrectal colorectal adenocarcinoma: Are we hedging on rectal biopsies?

Cited by 2 publications

References 23 publications

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Unravelling interobserver variability in gastrointestinal glandular neoplasia: a contemporary study of US and Korean pathologists

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