The Effect of Preceding Biopsy on Complete Endoscopic Resection in Rectal Carcinoid Tumor

Abstract

Biopsy of rectal carcinoid tumor is commonly taken before endoscopic resection. However the preceding biopsy can inhibit complete resection by causing blurred tumor border and fibrosis of the tissue. The objective of the study was to investigate the effect of preceding biopsy on complete endoscopic resection in rectal carcinoid tumor. It was also determined if rectal carcinoid tumors can be macroscopically distinguished by endoscopy. We reviewed retrospectively the records of patients with rectal carcinoid tumor who had undergone an endoscopic treatment at our hospital, during a 7-yr period. The resection margin was clear in 57 of 98 cases. The preceding biopsy was taken in 57 cases and the biopsy was significantly associated with the risk of incomplete tumor resection (OR, 3.696; 95% CI, 1.528-8.938, P = 0.004). In 95.9% of the cases, it was possible to suspect a carcinoid tumor by macroscopic appearance during initial endoscopy. The preceding biopsy may disturb complete resection of rectal carcinoid tumor. In most cases, the carcinoid tumor could be suspected by macroscopic appearance. Therefore the preceding biopsy is not essential, and it may be avoided for the complete resection.Graphical Abstract

S2k-Leitlinie Neuroendokrine Tumore

“…Initiale Biopsieentnahmen aus einem Rektum-NET können infolge der Narbenbildung die R0-Resektionsrate einer späteren endoskopischen Resektion verringern [266].…”

Endoscopic management of rectal neuroendocrine tumours. How to avoid a mistake and what to do when one is made?

“…Biopsy should only be considered in doubtful cases (atypical features) and in tumours that are more than 2 cm in size (according to the guidelines, these patients should be referred to surgery). The advantage of taking biopsies is the significantly high percentage of positive histopathological results compared to other subepithelial lesions, whereas the disadvantage is that it can lead to fibrosis and blur the tumour borders, making further endoscopic treatment more complicated from a technical viewpoint [1,12]. In the study by Lee et al biopsy of rNENs on initial endoscopy was the only factor that was significantly related to the risk of incomplete tumour resection [12].…”

“…The advantage of taking biopsies is the significantly high percentage of positive histopathological results compared to other subepithelial lesions, whereas the disadvantage is that it can lead to fibrosis and blur the tumour borders, making further endoscopic treatment more complicated from a technical viewpoint [1,12]. In the study by Lee et al biopsy of rNENs on initial endoscopy was the only factor that was significantly related to the risk of incomplete tumour resection [12]. The authors underlined not only the aspect of uncertain tumour borders, which can lead to the problems with snaring and targeting the lesion, but also of preceding biopsy-related fibrosis, which can disturb the ESD or EMR [12].…”

Neuroendokrine Tumoren in der täglichen gastroenterologischen und endoskopischen Praxis – ein klinisch orientierter Leitfaden

“…Aufgrund des typischen Aussehens kann in der Regel bereits vor endoskopischer Abtragung der Verdacht auf einen rektalen NET bestehen. In dieser Situation sollte zur Befundsicherung keine Biopsie erfolgen, da dadurch häufig eine vollständige Resektion behindert wird (Fibrosierung des Gewebes im Bereich der Biopsiestelle) [152]. Im Fall der Diagnosestellung eines rektalen NET als Zufallsbefund nach Polypektomie ist eine Risikostratifizierung nötig.…”