Endoscopic localization of colorectal cancer: Study of its accuracy and possible error factors

Abstract

Introduction: accurate preoperative localization of colorectal cancer (CRC) is very important, with a wide range of published error rates.Aims: to determine accuracy of endoscopic localization of CRC in comparison with preoperative computed tomography (CT). To analyse variables that could be associated with a wrong endoscopic localization.Patients and methods: endoscopic and CT localization of a series of CRC without previous surgery were reviewed. We studied the concordance between endoscopic and radiologic localization against operative findings comparing accuracy of endoscopy and CT. We analysed the frequency of wrong endoscopic diagnoses with regard to a series of patient, endoscopy and tumor variables.Results: two hundred thirty seven CRC in 223 patients were studied. Concordance with surgical localization was: colonoscopy = 0.87 and CT = 0.69. Endoscopic localization accuracy was: 91.1%; CT: 76.2%: p = 0.00001; OR = 3.22 (1.82-5.72). Obstructive cancer presented a higher rate of wrong localization: 18 vs. 5.7% in non-obstructive tumors (p = 0.0034; OR = 3.65 (1.35-9.96). Endoscopic localization mistakes varied depending on tumor location, being more frequent in descending colon: 36.3%, p = 0.014; p = 0.007;.Conclusions: endoscopic accuracy for CRC localization was very high and significantly better than CT accuracy. Obstructive tumor and those located in the descending colon or cecum were associated with a significant increase of the error risk of CRC endoscopic localization.

The accuracy of colonoscopic localisation of colorectal tumours: a prospective, multi-centred observational study

“…4,7,12,13,15 In the current study, 6.3% (n ¼ 5) of all study participants required altered surgical management, which seems to suggest that the majority of pre-operative localisation errors do not change the planned surgical resection. For example, on one occasion, a lesion documented at colonoscopy to be in the caecum, which was actually in the ascending colon, was categorised as inaccurate, but did not alter the planned right hemicolectomy.…”

Gastrointestinal sistem lezyonlarının değerlendirilmesinde gastroenterolog ve patolog uyumluluğu ne orandadır?

“…Fernando at al. stated that endoscopic accuracy for colorectal cancer localization was very high and significantly better than that of computerized tomography (11). They claimed that obstructive tumors and those located in the descending colon or ceacum were associated with a significant increase in error risk of endoscopic colorectal cancer localization (11).…”

Discrepancy between gastroenterologists’ and general surgeons’ perspectives on repeat endoscopy in colorectal cancer

“…Localization based on anatomic landmarks is often reported in the vast majority of polypectomies; 12 however, this technique has been associated with error rates as high as 21%. [3][4][5][6][7][8][9][10] Less clear is the practice of colonoscopic image capture, with studies demonstrating varied utilization rates. 12,13 Moreover, there is a paucity of literature assessing the use of hemoclips in colonoscopy.…”

“…In the literature, estimates of the error rate in tumour localization vary from as low as 4% to as high as 21%. [3][4][5][6][7][8][9][10] These errors can have a dramatic impact on surgical management, especially in laparoscopic cases where the surgeon lacks the tactile ability to palpate the colon for the lesion. This may result in conversion from a laparoscopic to open approach, intraoperative colonoscopies and removal of incorrect segments of colon.…”