Potential factors predicting histopathologically upgrade discrepancies between endoscopic forceps biopsy of the colorectal low-grade intraepithelial neoplasia and endoscopic resection specimens

Abstract

Background: It was gradually accepted that endoscopic fragment biopsy (EFB) diagnosis cannot accurately guarantee the absence of higher-grade neoplasms within the lesion of digestive tract. There are no well-established predictors for histopathologically upgrade discrepancies between EFB diagnosing colorectal low-grade intraepithelial neoplasia (LGIN) and endoscopic resection (ER) specimens demonstrating higher-grade diseases. Methods: A total of 918 colorectal LGINs was histopathologically diagnosed by EFB, including 162 cases with histopathologically upgrade discrepancy and 756 concordant cases. We compared clinicopathological data and relevant pathologic results of EFB and ER specimen between these two groups. Multivariate analysis was performed to investigate predictors for this upgrade histopathology. Results: The predominant upgrade discrepancy of LGINs diagnosed by EFB was upgrades to high-grade dysplasia (n = 114, 70.4%), followed by upgrades to intramucosal carcinoma (n = 33, 20.3%), submucosal adenocarcinoma (n = 10, 6.2%) and advanced adenocarcinoma (n = 5, 3.1%). NSAID history (OR 4.83; 95 % CI, 2.27-10.27; P < 0.001), lack of standardization of EFB number (OR 2.99; 95 % CI, 1.91-4.68; P < 0.001), ≥ 1.0 cm maximum diameter of the target adenoma (OR 6.18; 95% CI, 1.32-28.99; P = 0.021), lobulated shape (OR 2.68; 95 % CI, 1.65-4.36; P < 0.001), erythema (OR 2.42; 95 % CI, 1.50-3.91; P < 0.001), erosion (OR 7.12; 95 % CI, 3.91-12.94; P < 0.001), surface unevenness (OR 2.31; 95 % CI, 1.33-4.01; P = 0.003) and distal location of the target adenoma (OR 3.29; 95% CI, 1.68-6.41; P < 0.001) were associated with the histologically upgrade discrepancies. Conclusion: NSAID history, lack of standardization of EFB number, adenoma size and location, abnormal macroscopic patterns are significant predictors for potentially upgrade histopathology of LGINs diagnosed by EFBs. The standardization of EFB and advanced imaging techniques could minimize the risk of neglecting potential this upgrade histopathology.

Potential Factors Predicting Histopathologically Upgrade Discrepancies between Endoscopic Forceps Biopsy of the Colorectal Low-Grade Intraepithelial Neoplasia and Endoscopic Resection Specimens

“…The manuscript has been presented as a conference abstract at the 19th Congress of Gastroenterology China on 27–29 September 2019. The preprint version of this article has been uploaded [ 46 ].…”